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 his vision of health care financing, everybody gets these high-deductible insurance policies. This puts a much greater share of health care spending on the consumer, I see. But not all of it. Catastrophic expenses — that is, everything over $5,000 a year — are still covered by insurance.
Not only does this represent care for the most seriously ill, as we’ve discussed previously. It also represents some of the most ethically tricky treatment decisions possible: Do you pursue a new, experimental cancer treatment with slim but still realistic chances of success? Do you prescribe ongoing physical therapy for somebody for whom recovery from an injury is unlikely, but still possible? Do you perform radical invasive surgery on somebody who probably, but not certainly, will die within six months?
Clearly, somebody has to make those decisions. And simply leaving it to the doctor and patient won’t work, at least according to Kling, since they’ll be insulated from cost just like they are now.
So who’s making those decisions? How? And why are those decisions any more moral and efficient than the ones being made under the schemes Holt and I have advocated?