Person Career

There is a discussion in a NY Times blog with proposals for controlling health care costs.

Most of the ideas make things worse, not better.

Quick summaries:

Jacob S. Hacker, political science academic: Use government price controls.

This quickly turns into shortages. Some political scientists still ignore basic economics.

Len M. Nichols, think tank health guy: Give more power to the Medicare commission to run everything.

Really? Because the Medicare folks already do such a bang-up job of making sure Medicare isn't going to lose trillions over time?

Gail Wilensky, medicare bureacrat who moved to an NGO: Tax more expensive health insurance more and give the secretary of Health and Human Services lots more power over everything.

Yep, Congress is too busy to make the important, hard decisions that the policy elite want to happen, so it's best to outsource it all to the "experts" in the executive. Better deniability for lousy decisions all around.

Joseph Antos, think tank academic: Fix the employer tax break, competition in state markets, give pricing information to patients, make Medicare compete with Medicare Advantage.

And here's our first set of proposals that would actually lower costs while improving things. The solutions are of the "tweak the existing system" mentality, but at least they are steps in the right direction.

Daniel Callahan, think tank guy: Medicare rationing and price controls on health insurance.

At least he comes right out in favor of legally limiting how much health care people get! I'm not sure that's going to be too popular. It's definitely not necessary for bureacrats to tell people how much they need. And of course, price controls always result in shortages anyway.

Leslie Greenwald, think tank academic: Setup rationing by the elite based on "evidence".

Some how I don't think she gets who should be making the decisions about how much health care people should consume...

Arnold Kling, economist: Use vouchers to move from third-party payers to patients as consumers.

Our second idea that would actually accomplish something positive. Not sure it's totally workable, but it's for sure a big improvement on the current system!

My answer to the same question is totally unrealistic in the current political environment, but just for the record:

• Increase supply of medical care by removing legal obstacles. That means removing licensing restrictions (especially for Health care professionals trained in other countries) and removing AMA (Doctor's union) restrictions on the number of new health care workers trained every year. It also means severely limiting the FDA's ability to stop drugs from being produced. At most, they should evaluate and report on, rather then control the legality of drugs. That way Doctors and their patients could choose what risks to take based on their best information available.
• Add more competition to the system by overriding state insurance regulators with a federal mandate that allows interstate commerce in insurance policies. Either end tax breaks for employer-provided plans or make sure that they are matched exactly by breaks for non-employer-provided plans. Prevent any regulators anywhere from regulating what is offered at what price in health insurance plans. Innovation in insurance service doesn't start in state health insurance regulation committees!
• Allow prices to reflect demand as much as possible by providing methods for price transparency in service as well as allowing insurance as insurance instead of pay-for-service plans. Most of that would be taken care of by removing regulatory obstacles as above.

Health care is a solvable problem, but it's unlikely to be solved when most of the proposals to do so just provide more of the same ideas that created the problems in the first place.

When people in this country consume more books than people in another country, we don't lament that U.S. "book costs" are much higher than average and that "something must be done!" Some of this issue results from government distortions of the market for health care at State and Federal levels, but a lot of this issue is also a misunderstang of what's going on.