Universal Coverage Matters More

At the moment more emphasis is being placed on extending health care coverage than on cost containment. I would argue that this is in fact the correct position from a political standpoint. Once coverage is expanded it will be extremely difficult for future lawmakers to diminish it, and it will also put additional pressure on the cost problem. This is certainly worrying, but I believe that in practice it takes a real crisis to prompt serious reform owing to our onerous system of checks and balances and special interests. Costs are out of control so action on that front must come; universal coverage, however, is much less of a sure thing.

Should Financial Reform Have Come First?

The Obama administration has attempted to use the financial crisis as leverage towards tackling health care reform, but it's possible that financial reform should've come first. With the economy improving a lot of the impetus for reform is already waning and a recovery of some kind was not entirely unexpected. Additionally, all the expenditure on bailouts has made the discussion of further public funding of any large initiative more difficult. Health care under the current system is only going to get worse, so time isn't a factor on that score. These factors seem to indicate that regulatory reform should've preceded health care and we're already seeing a considerable retreat on my areas of reform. Perhaps the Obama administration was counting on continued high unemployment (as it's a lagging indicator) to keep up voter outrage and maintain pressure on legislators. Since large deficits and an aversion to spending will persist for some time, it may have been seen that there was no benefit to waiting on health care reform and capitalizing on honeymoon period popularity was the best strategy. I find myself extremely skeptical that their decision was the correct one.

Consumer Level Competition Fixation

Economists and policy makers often seem to be unaware that competition can occur at a level other than with the end consumer. The economic idealization that market decisions are made by perfectly informed and rational actors cannot be translated to the real world in many cases. I just heard a ludicrous example today when an economist called for all patients to directly control the money spent on their health care, so they could make their own decisions and put price and quality pressure on the industry. Having a populace that's largely ignorant make the majority of their medical spending decisions is a recipe for conditions to go untreated and worsen (and frequently balloon in cost). Competition between medical institutions themselves is a much more appropriate arena for competition to occur. Just to choose one simple way this could work is that a medical company could be given a premium to keep patients healthy (adjusted perhaps by pre-existing condition). Anything they spend less than that premium, they get to keep, and over time the premiums could be reduced, using data on the actual costs as a reference. The way we handle financial products currently is another example of unrealistic ideas of end user competition being the deciding factor and is something I've blogged about previously.

Birthers and Death Panels Are Pissing Me Off

Lately I've been extremely angry about the continued claims that Obama wasn't born in Hawaii and that any of the proposed health care reform bills contain the concept of "death panels". I stopped to ask myself why these particular idiocies should be aggravating me more than ones in the past and believe I have the answer: because they are so demonstrably ridiculous. Anyone with even a modicum of intellectually ability or honesty can rule them both out definitively in the space of about ten minutes. That leaves me with the inescapable conclusion that people pushing these views are either too stupid and arrogant to realize they are hopelessly incompetent and should keep their mouths shut, or are intentionally trying to spread misinformation to stop any potential improvement in our mediocre social systems. Both of those possibilities are worth getting angry about.

Independent Non-Profit Public Health Care Option

Much of the debate about health care reform has centered on whether or not to have a public option. Simultaneously some are arguing that it would be very inefficient, but at the same time be cheap enough to put private insurance companies out of business. On the face of it that seems absurd, but one reasonable objection I've heard is that a government system would be subsidized in a way that would give it an unfair advantage. Another expressed concern is that a public option's sheer size would give it bargaining clout to negotiate lower drug prices. I don't feel that's a valid objection as not only is that a good thing, but also private companies could in theory band together in their purchasing. I believe that the public option should be a non-profit business set up by the government, but then run as a separate entity. Its charter would direct its policies, but it would not have the onerous requirements of being a government agency. It should be allowed to fail if it performed badly, although initially it would require some public investment to become established. To further reduce the temptation for it to be bailed out and to add more competition, in theory multiple non-profits could be set up although that should probably be considered only after the first one was successfully in operation. I am developing a system for blending public and private activities in general and will post about it once it's more fleshed out.

It May Not Be Perfect, But Canada's Health Care System is Better Than Ours

One fallacious argument I hear time and again with regards to the inferiority of Canada's health system is that they have long waiting periods for many services. While true, this ignores the fact that overall Canada has a better quality of health, which puts such waiting times into proper context. It's the logical equivalent of an advertisement that touts a single aspect of their product as superior, but ignores all the others. Even worse such a stilted view completely glosses over that they spend so much less per capita on health care than we do (10% vs 17% of GDP and their GDP per person is about 17% less than ours, making our per capita expenditure roughly twice as much). If we adopted their system, funded to our levels, it would blow the doors off our current health care standards. This means their methods are superior to ours, but does not mean we can't explore alternatives. Since almost all modern nations beat the tar out of us on health care there are a lot of sources for inspiration.