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 road, after the public is fed up with health care gimmick policies that don’t work, the policy establishment will discover the ideas in Crisis of Abundance.
As that essay emphasizes, no serious health care policy approach (including the status quo) works well politically, because no approach is painless. The economic analysis says that we have to absorb pain in terms of limiting access to health care, limiting consumer insulation from health care costs, committing extravagant resources to health care, or some combination of all three. However, those trade-offs are evaded in political debates. Instead, there is strong demand in the political marketplace for gimmicks that purport to provide painless solutions.
Cohn and Kevin Drum (whom he cites) argue that individuals will pay a premium in order to avoid the stress of having to factor in cost when making health care decisions. That’s fine! There are all sorts of things that individuals pay for that I think are not worth the value. Cable television, for example. No one forces me to get cable TV, and I don’t force other people not to buy cable TV. I think it should be the same with health care insulation. If people want insulation, they are welcome to pay for it. And if they cannot afford it, meaning that they choose to spend their money on other things, so be it. Doing without insulation is not the same as doing without catastrophic insurance or doing without health care.