Ross Douthat had an interesting piece in the NYT a few days ago on the health care reform issue. Here’s the key passage:
We know what one such approach would look like. It’s the eventual endgame that liberals pushing a “public option” are aiming for: a federal takeover of the health-insurance sector, paid for by rising tax rates, in which the government guarantees universal access while using its monopoly power to hold down costs.
But there’s another path, equally radical, that’s more in keeping with the traditional American approach to government, taxation and free enterprise. This approach would give up on the costly goal of insuring everyone for everything, forever. Instead, it would seek to insure Americans only against costs that exceed a certain percentage of their income, while expecting them to pay for everyday medical expenditures out of their own pockets.
People who could not afford to pay for anything at all would have to be helped, of course, but with this approach they would be assisted in buying the same care that everyone else is getting, not be shunted off into a separate and inferior system.
As a number of people have pointed out over the past few months, what we call “health insurance” is not really that. Insurance is something you purchase to protect yourself in the event of some catastrophe that leaves you facing an expense you can’t possibly cover. You have insurance on your house so that if it burns down you can replace it; you don’t expect insurance to pay for fixing a broken window or a clogged drain. You don’t expect your car insurance to pay for a flat tire or an oil change.
But that’s the way we treat health care. Even more irrationally, we expect the lion’s share of this expense to be borne by our employers, and so we have a situation in which people who are out of work or self-employed or employed by small businesses are either at a severe financial disadvantage where health care is concerned, or are shut out of the system altogether, having to fall back on a patchwork of government programs.
I really don’t have much hope of our elected representatives taking this path, but it seems by far the most sensible. I don’t think anyone who’s thought about it for more than a minute or two would argue that the system doesn’t need major reform. I have been saying for at least twenty years that we will eventually get a government-run system because the present system is crazy and unjust. But I’m afraid we’re going to get something that’s worse—almost certainly in the long run, and perhaps in the short run. The Democrats want a federally-controlled system, and the Republicans will most likely play their usual role in limiting the expansion of federal power: that of a piece of chewing gum on the bottom of the Democrats’ shoe, annoying them but slowing them down only a little.
The ideas presented by Douthat are radical in the sense of getting at the root, or rather roots, of the problem, but, as he says, they seem far more suited to the American context. I’ve also been thinking that for some time, and discussed it here a couple of months ago. My view is frequently reinforced by stories like these:
Organized crime’s new targets: Medicare and Medicaid
As I said in that earlier post, we have a large number of people in this country “who would approach the system as vultures would approach a big dead pig.” I wasn’t joking.
Nearly 65? Time for the Medicare Maze
For someone new to the system, the hundreds of options Medicare provides can be daunting. “We’ve seen C.P.A.’s get stymied,” said Paul Gada, personal financial planning director at Allsup, a provider of Social Security and Medicare consultation services…
There’s something wrong with a system which ordinary people can’t navigate without a consultant. If we extend that to everybody, it will be neither cheap, nor efficient, nor fair.