January, 2007

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

by Matthew Holt

January 26th, 2007

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 [...]

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

Last Word

by Arnold Kling

January 26th, 2007

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 [...]

Read: Last Word

Of Rationing, Trade-offs, and Morality

by Jonathan Cohn

January 26th, 2007

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 [...]

Read: Of Rationing, Trade-offs, and Morality

Managed Competition, if You Can Keep It

by Clark C. Havighurst

January 24th, 2007

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, [...]

Read: Managed Competition, if You Can Keep It

The President’s Plan

by Arnold Kling

January 23rd, 2007

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 [...]

Read: The President’s Plan

Not Politically Realistic

by Arnold Kling

January 19th, 2007

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 [...]

Read: Not Politically Realistic

Postscript . . .

by Jonathan Cohn

January 19th, 2007

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 [...]

Read: Postscript . . .

In Search of the “Politically Realistic”

by Jonathan Cohn

January 19th, 2007

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 [...]

Read: In Search of the “Politically Realistic”

Who Pays?

by Clark C. Havighurst

January 19th, 2007

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 [...]

Read: Who Pays?

Holt’s Elitism

by Arnold Kling

January 19th, 2007

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 [...]

Read: Holt’s Elitism

The Future: Medicare for All?

by Matthew Holt

January 18th, 2007

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 [...]

Read: The Future: Medicare for All?

Response to Holt, Havighurst, and Cohn

by Arnold Kling

January 17th, 2007

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 [...]

Read: Response to Holt, Havighurst, and Cohn

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

by Jonathan Cohn

January 16th, 2007

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.”

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

Unhealthy Subsidies

by Clark C. Havighurst

January 12th, 2007

Clark C. Havighurst agrees with Kling’s “diagnosis of what’s wrong with health care” in the U.S. “as far as it goes.” Havighurst goes further and digs into the reasons the U.S. health system “has evolved into an entitlement program under which everyone expects nothing less than the very best that ‘modern medicine’ has to offer.” Havighurst lays the blame at the feet of the government’s choice to subsidize the purchase of health care by “excluding the cost of employer-sponsored coverage from employees’ taxable wages and income” and lucidly details three different mechanisms by which the tax subsidy insulates workers, consumers, and voters from the costs of health care. Havighurst proposes that “something approaching [liberals'] goal of universal health coverage could be achieved by ending the current tax subsidy and offering refundable tax credits of, say, $6000 to families that spend at least that amount in health plan premiums or contributions to a health savings account.”

Read: Unhealthy Subsidies

Abundance Is Insulated from a Crisis—For Now

by Matthew Holt

January 10th, 2007

According to health care strategist Matthew Holt, Arnold Kling is correct that consumer insulation from the costs of “premium medicine” is partly responsible for the rising cost of health care, but Holt dissents from Kling’s solution. Holt examines what he takes to be the three main strategies for dealing with “the insulation and overuse of medical care in the U.S.”: a nationalized “single payer system; a system of “managed competition”; and “individual consumer control of spending at the point of service.” Holt argues that the latter two options face deep problems, and that a nationalized single-payer system “is the likeliest outcome in perhaps a decade or so,” even it is not politically feasible at present. “Kling has provided a decent analysis,” Holt argues, “but has proposed a solution that both ignores the political and cultural realities of the health care system, and probably wouldn’t even work in theory.”

Read: Abundance Is Insulated from a Crisis—For Now

Insulation vs. Insurance

by Arnold Kling

January 8th, 2007

In this month’s lead essay, Cato Institute adjunct scholar Arnold Kling draws from his book, Crisis of Abundance, to argue that the health coverage most Americans enjoy is not insurance at all, but what he calls “insulation.” “The problem with insulation,” Kling argues, “is that it is not a sustainable form of health care finance… Insulation leads people to over-consume health care services. Americans make extravagant use of services that have high costs and low benefits.” Kling explains how real health insurance would work, and how it would help solve the crisis in health care, and explores how we could transistion to a system over time institutionally and culturally in order to resolve the inconsistent demand for insulation and affordable, effective care.

Read: Insulation vs. Insurance