Prelude: A few weeks back, I went to a walk-in clinic at MGH, saw a doctor for about ten minutes, had some basic tests run, and was astonished to later learn that the "official" bill for this service was $700 [although my copay was only $10, thanks to my gold-plated insurance plan]. I somewhat naively suggested that under a more free-market system where consumers were exposed to real prices, cost would drop and quality would increase. A firestorm of comments ensued, including some lengthy discussions. At a friend's urging, I obtained and read T. R. Reid's The Healing of America: A Global Quest for Better, Cheaper, and Fairer Healthcare. I took extensive notes, and researched various topics further on my own. I believe I am somewhat better informed than I was a few weeks ago, and I would like to share my thoughts.
In this post, I'll give a brief overview of my current position, which I'll be attempting to support from various angles throughout this series. My posts will touch on philosophy, economics, data analysis, statistics, and who knows what else. If you think my arguments are weak, call me on them. If you think my data's bad, point it out. Hopefully we can all learn something.
My current thoughts on health care policy:
- I am a strong supporter of free market reforms. I believe a free market approach would be morally just, and would also lead to high quality, low costs, and wide availability of care.
- The current US system is not a free market system. It is heavily regulated in some very ugly ways. In many ways, our regulations are worse than those in many European countries.
- There are some European countries, notably France, Germany, and Switzerland, about which I feel a reasonable case can be made that their systems are better than the current US system. I don't actually think they are better, but I do think a case could be made. There are a number of other countries with nationalized universal health care, notably Britain, Canada, Italy, Spain and Portugal, whose systems seem obviously worse to me. In particular, I strongly disagree with statements by Reid and others that "Every other rich industrialized country obviously does health care better and cheaper than us."
- My ideal system would be one in which all health care was paid for privately and in which costs were set by the providers. Individuals would tend to pay for routine care out of pocket, and for large unexpected expenses via high-deductible [and therefore low-cost] insurance. If we as a society wanted to ensure healthcare for the poor, we would do it via tax credits. I feel strongly that this system would be better than any currently existing system on the planet.
My thoughts on Reid's book are that are there a few bright spots, but in general it is a very bad book. It is filled with arguments that are specious or incoherent or innumerate, and frequently selectively interprets or omits data in a way that supports its overall thesis that nationalizing healthcare is a good idea. However, it is an interesting book, in that it states in one place most of the traditional liberal arguments I've heard for nationalizing healthcare, as well as the data backing up these arguments. I will therefore address many of its arguments specifically, not because I care about attacking Reid in particular, but because I want to point what I view as the flaws in these lines of reasoning.
Subscribe:
