Posted by
Mr. Right(wing) on Thursday, January 08, 2009 12:00:00 AM
I am a freedom-fry eating American. I bought all of the rhetoric about keeping government out of health care... and for the most part I still do. But when I started dating a gal who lived in France for 9 years and who was very, very happy with the health care she received, I started to look into it.
Did you know that in France they openly ridicule the English "socialized medicine." But at the same time, they have universal coverage?
Did you know that in the US, some 40% of people report satisfaction with their health care? In France it is 60%. And we know what whiners the French are.
One of the common approaches for conservative and libertarian "puritans" is to ignore successful “universal coverage” countries like France and Germany, which do have some theoretically unappealing aspects, and to focus the debate on countries like Canada and England. It's an easy argument, almost a straw-man. But this sort of thing fails to advance the conservative side of the debate.
Everyone knows that England and Canada have lousy single-payer systems. But people also know that America can do better than Canada, and they just don’t believe that Democrats are that stupid (although in truth, they may be). To win the debate, Conservatives need to champion our own comprehensive plan; one that will address the Democrats’ talking points by “triangulating;” using Conservative means to solve the Democrats’ issues, thus depriving them of the urgency they require to enact their ill advised reforms.
Any conservative reform would include the staples of this past campaign; decouple insurance from employment by voiding the employer deduction and making it a personal deduction. And also, get rid of mandates by allowing interstate competition.
Why is coverage cheaper in Idaho than in Massachusetts? Because of mandates like the ones Sowell outlined in his article. Obama argued that such a reform would just cause the insurance companies to locate in one state, like the credit card companies. McCain failed to say: who cares? More people are able to get credit that way, which benefits consumers. And more people will be able to buy health insurance if they can buy plans from companies with cheaper policies that are unburdened by mandates.
These issues are well trodden ground for conservatives, and they form a basis for any reform.
But a related issue that conservatives often fail to address is that of the uninsured. Democrats have been pummeling conservatives over the 45 million uninsured, and in spite of the problems with this number (transience due to frictional unemployment, not to mention the presence of illegal aliens amongst that number), conservatives have been unable to convince Americans that the vast number of uninsured is not a “problem” that we need single-payer health care to “fix.” We are losing the debate over just this issue. We need to deprive the Democrats of it by enacting policies that will lead to fewer uninsured, without resorting to single-payer coverage, and the rationed, one-size-fits-all care that goes with it, on Americans.
To lower the amount of uninsured, we first need to lower costs, which the above should take care of. And decoupling insurance from employment will also help, by reducing the amount of people who have no health insurance because they have no job.
But we also need some government involvement here to fix some market failures as well. Here, we can emulate the French, who have a system where people have absolute freedom of choice as far as doctors, hospitals, and treatments, but also a system of tightly regulated private insurers.
The first government intervention conservatives should support is “guaranteed issue;” if you want to sell insurance to anyone, you have to offer it to everyone. Failure to have guaranteed issue will lead insurers to "cherry-pick” and offer coverage only to low-risk insurance buyers (as they do now). And here is where conservatives might need to deviate from orthodoxy a bit. We also need a cap on rates.
Auto insurance in Massachusetts, where I live, is a requirement for motorists. So we have guaranteed issue. But a lot of bad drivers cannot afford market rates, so there are caps on rates, set by regulators. This results in good drivers subsidizing bad drivers. Now, this is unfair because people usually choose to drive recklessly (bad drivers are usually young men with, shall we say, a surfeit of testosterone).
But in health care markets, people normally cannot help it if they are sick. No, there is no logical reason why you should have to pay for my health care, nor I, yours. But politics often involves some sacrifice. Ronald Reagan once said (and I paraphrase) that he would rather “get 80% of what I want than go charging off a cliff with banner held high holding out for 100%.”
Conservatives need to support caps on rates, and let the healthy subsidize the sick. Otherwise insurers will price people with pre-existing conditions out of the market. We need more people to elect to buy health insurance in order to drive down that frighteningly large number of uninsured, and we cannot do that if the people who are sickest cannot afford to buy insurance.
For the poor, we need to offer direct subsidies to allow them to purchase health insurance. The other reforms discussed should keep these subsidies to a minimum, as insurance will cost less without all the mandates. And remember, we already subsidize the poor by allowing those without insurance to seek treatment at emergency rooms, which drives up costs for the insured already. Certainly a direct and transparent subsidy is superior to the implicit subsidy we already pay, one which is hard to quantify because we don't see it on our bills. In fact, we could use Medicaid funds already budgeted to pay for this subsidy, thus more efficiently using dollars we are already spending.
As to achieving universal coverage, this need not be the goal. Conservatives rightly reject an individual mandate. We want to put health insurance within reach, but in America, to use a trite expression, we can lead the horse to water, but we are not going to force him to drink.
But at the same time, we also believe in accountability. If insurance costs are driven down, and an individual elects not to purchase it, they do so at their own risk. If you don’t have insurance and you rack up medical bills, no longer will the insured bail you out. This, along with subsidies for those truly too poor to pay for coverage on their own, will provide a powerful incentive for everyone to buy health care, without a mandate.
The sum total of these changes would give America a system much like the successful ones in Europe... and totally unlike the failed single-payer systems Democrats seem to want to emulate.
Consumers would be free to choose doctors, hospitals and treatments (unlike Medicare and Medicaid patients now).
Insurers would be free to offer a wide range of plans to suit the needs of our diverse nation.
People would have an incentive to purchase insurance, because of the risks associated with expensive illnesses potentially wiping out a lifetime of savings, but they would not have any incentive to insure against routine expenses, as the current employer-linked system encourages.
Individual involvement in purchasing of insurance, and also in the selection of doctors and treatments would help to control costs.
Eliminating mandates by making plans that include them have to compete for dollars with plans that don’t will also control costs.
All of this will have the net effect of making health insurance more affordable, which will lead to more people purchasing it.
And in the end, if we can control costs, and reduce the number of uninsured, the public clamor for “universal” coverage provided by the government, will subside, and with it will go the Democrats hopes of nationalizing health care, and turning all Americans into wards of the all-powerful state.