Thursday, February 9, 2012

Free Health Care!


In America the Exceptional you ask how I would fix our unsustainable health care spending trajectory, "Just get rid of the whole thing and let everybody fend for themselves! Let the miracle of the market unfold! That’s the answer?"

That's one answer, sure. Another would be to provide a safety net to those truly in need instead of a middle class entitlement that has put us on this vector. We can start with means testing. The next step could be reducing, with the goal of ultimately eliminating, the tax deductibility of health care. Instead of making everything "free" and a "right" we can move in the opposite direction so consumers choose what they want to purchase or not, instilling some discipline into the market. Sure, the ripping off the bandaid approach can be taken, but that's certainly not the only choice.

Whenever this conversation takes place I find there's a conflicting tendency in your (and I'm using you as a representative for the entire supporting infrastructure of Medicare/Medicaid/ACA) argument. On the one hand you clearly recognize government funding of health care is on an unsustainable path. The shorthand way this is characterized is health care is on an unsustainable path. But I don't think that's true. I think government funding of health care is on an unsustainable path, and I think we both agree on that.  

But your (as the proxy for the health-care/industrial complex) solution is to do MORE of the same. For instance, let's make condoms "free" and let's make priests distribute them after mass (I know, a cheap shot. Couldn't resist). Two bad ideas wrapped into one. I identify a problem, and you seem to agree, that the removal of consumers from the purchasing decision is one of the reasons for the cost growth and the ACA solution is to do MORE of that. I shake my head in disbelief.

The driving motivation for this argument is government sponsored health care is on an unsustainable trajectory. So it will stop. The question is will it stop by imposing market discipline that has worked in every other industry we interact with? Or will it stop by the heavy hand of the IPAB deciding condoms are good and should be free but certain forms of cancer treatment should not be paid for and the sufferer should go gently into the night for the good of the whole. I think consumer choice is a much more desirable model.


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