Health Care Clubs

I congratulate Michael Cannon on his efforts to form an anti-universal club aiming to take universal health care proponents on directly rather than much around pretending that everyone agrees on the goals and we only disagree on the methods. I'm fairly certain that, politically, "we don't care if you can't afford health insurance" is a losing slogan. Even better, though, is Arnold Kling's club:

I once wrote that "The original sin of America's health care system is employer-provided health insurance." The best outcome might be for America to abolish employer-provided health insurance, try single-payer, have it fail, and then experiment with the sorts of policies that I talk about in my book.

I'll take that bet in a heartbeat. We all remember Europe, right, where national health care systems were build in the postwar period only to be abandonned in the late 1970s still in place across the board. Indeed, I'll even be fairminded and note that Kling is putting his own side at an unfair disadvantage. Anything as giant as a universal health care system would be nearly impossible to dismantle almost irrespective of its merits. The same features of US political institutions that make it almost impossible to start significant new programs make it even harder to get rid of them.

Comments

Agreed. No matter how crappy single payer turned out to be, it would take many decades or longer to get rid of the damn thing -- a strong argument against it, of course.

Posted by ostap | June 27, 2007 12:23 PM

hell, look at the current unbelievably crappy system and how hard it is to get rid of no matter how obvious its flaws.

nonetheless, let us agree with kling: employer-provided health insurance is a completely silly idea (although, of course, at a time of wage and price controls, you can see how the lightbulb went off).

Posted by howard | June 27, 2007 12:37 PM

Cannon's cheating. His first "goal" of the club is to expand healthcare access as much as possible. Well, why? If he's got the courage of his libertarian convictions, he should forthrighly say that other people's health care access is none of his concern. On the other hand, if this is the "goal," is he prepared to support any policies to achieve it? If not, then his "goal" is bullshit just designed to make him like something other than a heartless asshole. If he does think policies to increase access are acceptable, then why is that in principle any different from government provision of health care/insurance directly? He's just objecting to one specific method of achieving his "goal" -- hardly a noteworthy or courageous stand.

Whatever. Typical libertarian crap.

Posted by Glenn | June 27, 2007 12:53 PM

You'd think, given the right's inability to gut Social Security or Medicare, that they would have figured this out by now.

Posted by beckya57 | June 27, 2007 12:54 PM

Shorter Cannon/Kling position on health care: non-rich people ought to die.

Posted by rea | June 27, 2007 1:02 PM

Um, you do know that Germany and France don't have single payer, right? In France and Germany most people have private health insurance.

Posted by John | June 27, 2007 1:26 PM

Um, Matt. You offer the snarky "We all remember Europe, right, where national health care..." [is still around] and then follow 2 sentences later with "Anything as giant as a universal health care system would be nearly impossible to dismantle almost irrespective of its merits." Forgot to take the gun from the holster before firing on that one.

For what it's worth, I agree with your second point more, and I think more compelling evidence than the mere continued existence of European health care is the relative efficacy of most European health care systems.

Posted by Ben V-L | June 27, 2007 1:56 PM

Um, you do know that Germany and France don't have single payer, right?

Wrong.

I'm not crazy about the lack of precision in terminology myself, but most people conversant with the issue use the term "single payer" to refer to any system of guaranteed, universal health insurance with a single payer or guarantor -- the state -- playing a dominant role. "Single payer" does not mean a total absence of non-governmental funds. It is quite true that in many nations with universal healthcare -- even Britain, for example --- private sources of insurance and health care funding fill in gaps.

Posted by Jasper | June 27, 2007 2:07 PM

I guess it depends what he means by "fail." No industrialized democracy has a health care system funded entirely by the government. They all have a substantial amount of private funding. In that sense, there's no such thing as "single-payer" health care. But the countries whose health care systems have traditionally been described as "single-payer" and as providing "universal coverage" (Britain and Canada being two obvious examples) seem to be clearly moving in the direction of a reduced role for the government and a greater role for the private sector. In that sense, single-payer does seem to be failing. As health care services become increasingly sophisticated and expensive, and governments find it increasingly difficult to provide those services to the entire population for "free" or at low-cost, I expect that the share of health care spending that is funded publicly will continue to decline.

Posted by Seamus | June 27, 2007 2:14 PM

kling is thinking like an economist, not a sociologist.

Posted by razib | June 27, 2007 2:16 PM

"Anything as giant as a universal health care system would be nearly impossible to dismantle almost irrespective of its merits. The same features of US political institutions that make it almost impossible to start significant new programs make it even harder to get rid of them."

This is a classic argument for libertarianism.

Posted by Klug | June 27, 2007 3:11 PM

employer-provided health insurance is a completely silly idea

No it's not. You try to find a better source of "natural" purchasing pools that aren't health-selected. People almost have to buy health insurance in groups to spread risk. How many different groups does society generate?

Posted by marcus | June 27, 2007 3:14 PM

The problem with universal coverage.

We could probably create a relatively efficient and practical system to ensure universal BASIC health coverage. With preventative medicine this may even save money.

However, as a practical matter those “basics” would continue to grow and expanded coverage would be politically difficult to resist.

To get the idea across, The day after such a program was initiated…the REBUBLICANS would be promising you dental to boot.

Both parties would be scrambling to say –“we will lower your co-pay” & cover your podiatrist, psychologist, chiropractor, and dermatologist.

Posted by Fitz | June 27, 2007 4:11 PM

Here is an idea.

You could pay say a 20% of your salary and that would buy you gold level care - everything you want as long as you live.

Or you could pay 5% of your salary and buy a new kind of plan. The insurance would offer 100% coverage till the age of 45 then coverage would gradualy decline as you got older. If you have kidney failure at 35 - you get a transplant - if your 70 - only dialisis - and at 85 you get nothing - only hospice.

I have seen way too many 90 yo patients spend weeks in the ICU costing $1000's per day - we can't afford it!

Posted by John | June 27, 2007 4:48 PM

John, what do you get if you're 95? They take you out to the shed and give you the Old Yeller treatment?

Posted by Chuchundra | June 27, 2007 4:55 PM

When I'm 95 I only hope I can do it myself. There is no way they are putting me in a home - just take me out back.

Posted by John | June 27, 2007 6:10 PM

Re: How many different groups does society generate?

All kinds of groups. The group of all people who live in Iowa. The group of all people who attend a Methodist (UMC) Church. Even the group of all people whose last name starts with "W". There all kinds of random (in the sense of not being correlated with health issues) groupings you could use for large subscriber pools. (Granted geography may have a slight inluence on health statistics, espcially if you get down to the zip code levels where some zip codes are poor, some rich, some old and some young. And people can change their last names and their religion. Still, people can and do change jobs for the benefits too)

Posted by JonF | June 27, 2007 7:24 PM

It's funny that no voters are aware that it is a solid plank in the GOP platform that the elimination of employer supplied health insurance is a goal. Not one that can be reached, since they are loath to mention it, but an ideological one. Well they could reach it if they got a dictator with more guts than Bush. One who would just send congress home and order health plans null and void.

Then there is the little problem of the bankruptcy of the entire health care industry. I suppose they could file that under creative destruction. After they bury all the bodies we can start over. That's quite a dream you have there Mike.

Posted by rapier | June 28, 2007 9:20 AM