January, 2007

“Go It Alone” Is a Path to “Medicare for All”

I’ll end my comments with two quick thoughts. The first is that as Michael Cannon, I, and some others bickered over health care “transparency” at a conference yesterday and today, somehow (OK, it was my fault) the idea emerged that doing a kitchen renovation is damn complicated and expensive. And even if you think you […]

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Last Word

Reading over this conversation, and looking over some of the other interesting things being said about health care policy around the Web, I find myself wanting to approach health care policy by starting with a blank piece of paper and seeing what I come up with.
Clark, I can pretty much guarantee that I won’t […]

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Of Rationing, Trade-offs, and Morality

A lot has been said about health care since my last post, and not just in this space. Indeed, I hope my fellow contributors, along with my readers, will forgive this delayed response. I would have answered sooner, but I was busy tracking down the details of President Bush’s new health care plan.
I won’t […]

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Managed Competition, if You Can Keep It

This discussion has gone in so many directions that it is hard to find a way to wrap it up. Unfortunately, President Bush’s latest proposal is such a pitiful response to a huge problem that I don’t even want to talk about it.
Instead, let me embrace, with Matthew Holt, the basic Enthoven managed-competition model, […]

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The President’s Plan

With the President having proposed a new health care plan in his State of the Union Address, this might be an occasion to comment. The plan is to recognize employer-provided health insurance premiums as taxable income, while creating a standard deduction that everyone with health insurance can use. Because the deduction is limited […]

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Not Politically Realistic

Cohn writes, “But if [Kling]’s going to dismiss single-payer as politically unrealistic, then I have to ask him: Does he think his vision politically realistic?”
No. I wrote here:
I should start by saying that the book does not contain a single major policy recommendation that is politically palatable today… Maybe some years down the […]

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Postscript . . .

Something just occurred to me. Kling attacks Holt and advocates of universal health insurance because under the schemes they recommend “the practice of medicine will be governed by elite technocrats, far removed from doctors and patients” — something Kling deems immoral and inefficient, as well as politically unacceptable.
Let’s suppose Kling is right. Fine. Now, under […]

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In Search of the “Politically Realistic”

I was going to answer Kling’s original response — and still plan on doing so, shortly. But I just have to jump in and comment quickly on his reply to Holt. I’ll let Holt explain why the vision Kling paints of technocrats secretly cooking up medical guidelines is grossly misleading. Instead, I […]

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Who Pays?

Something that particularly caught my eye in this exchange is the title of Jonathan Cohn’s as-yet-unpublished book, Sick: The Untold Story of America’s Health Care Crisis — and the People Who Pay the Price. Not having seen the book, I am curious whether he has really focused, as the title promises, on “the people […]

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Holt’s Elitism

Matthew Holt writes, “reform of the way Medicare pays for care, and the way variation in care is to be removed, are subjects that will be tackled by a group of elites who actually understand this stuff, out of the view of the public eye.”
So under Holt’s ideal medical system, the practice of medicine will […]

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The Future: Medicare for All?

1) Kling and I both believe that providers are too strong in the current American system. I believe that if you make the price of health care visible at a level where consumers have to make either a monthly choice, or the government has to make a choice between spending money on health care […]

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Response to Holt, Havighurst, and Cohn

Holt
Matthew Holt raises a number of issues. His premises tend to be true. However, his conclusions do not follow.
1. Our system favors providers, not consumers
I agree that our system favors providers, but the question is what government can do to help. Almost every government intervention that I can think of, from […]

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Yes, We Need Real Insurance . . . Real Social Insurance

Jonathan Cohn, a senior editor at the New Republic, agrees with Kling that our current health care system doesn’t function according to the widely understood principles of individual insurance, but he doubts we’d do better at fighting rising costs and maintaining quality if citizens with “real” insurance were free to take price into account in their choice of care. “We have precious little evidence to believe that people can distinguish good care from bad care,” Cohn writes. And the notion that consumer choices will improve over time is, according to Cohn, “a lovely idea, but one that seems highly dubious.” Cohn argues that we need a broader notion of insurance — social insurance — to shield people not only against unexpected illness and harm, but against “genetic and economic bad luck.” Cohn argues that many nations do just fine in managing the cost/quality tradeoffs inherent in a state-controlled system of universal coverage, and that Americans would be happy with such a system “if only they knew how those systems really worked.”

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