health care reform

…is something I lately haven’t been able to keep up with. It seems every couple of days there’s news that components of the reforms being discussed in Washington have been added or removed, or that someone (Obama, Congress, ‘the people,’ Wal-Mart) has changed his/her/their support of the reforms, etc. etc. etc.

I’m hoping to get back on track, to keep up with the latest developments and such, because I think that our country’s health care, reformed or not, will be a pretty important factor in the well-being of our children, grandchildren, great-grandchildren, great-great… you get the idea.

One person I’ve read a lot of in the last year, and quite honestly can’t keep up with (he’s prolific! a new post every twenty minutes, it seems), is Ezra Klein. He writes from a pretty liberal standpoint but is, in my opinion, pretty fair in his criticism of politicians and legislation ‘from both sides of the aisle’ and provides reasonable, thoughtful and well-articulated analyses of policy, current affairs and such. Klein happens to specialize in health care policy, so I’d recommend reading his blog at the Washington Post if you’re looking for information about, and discussion of, health care policies and reform.

One particular post of his that I enjoyed a while back caught my attention with its title: Why the Public Plan Is a Fundamentally Conservative Idea. I’ve not heard many people call the public plan a ‘fundamentally conservative idea,’ but he makes a good case:

In general, there are two ways for firms to adopt an idea. The government solution — the socialist solution — is to impose it on them by legislative fiat. An example would be Congress passing a law that makes selling New Coke illegal. The other path is through market competition. Plummeting revenue and rising market share for Pepsi convince the Coca Cola company that selling New Coke is a bad plan and they should cut it out…

The public plan is an effort to institute reforms through a market mechanism. But if it fails, and the health industry doesn’t manage to bend the cost curve on its own, it’s fairly likely that it will end up on the business end of some serious new regulations. And at the point that costs become a crisis, those regulations will need to work fast. That means they’ll be implemented in the government’s way, not the market’s way.

There’s also a humanitarian aspect to all this that I think supersedes the party-line-toeing conversation that seems to guide the health reform debate… and while this particular argument doesn’t really address the politically tricky ‘how’ of health care reform, I think it makes a good case for more extensive reform than less. It’s a pretty simple argument, really: we’re going to have to pay for the welfare of others at some point, either up front or down the line, but doing it up front carries with it the advantage of increasing the future welfare of all.

Provision of health care is expensive, no doubt. And we run into a couple of problems trying to provide it. On the insurance side of things there’s the risk of ‘moral hazard’ – that people who are generally healthy are less likely to purchase insurance, but those in poor health are more likely (as they need help covering the high cost of their health care), and this in turn raises premiums for all insured. And socialized health care systems run into the problem of freeloaders (a problem inherent in any sort of social welfare program, and one not unfamiliar to us: our welfare reforms in 1996 were in part an attempt to decrease welfare recipients’ ability to take advantage of the system).

But here’s the deal: if health care is socialized, we certainly incur a great expense up front, but we also end up with a healthier population. A healthier population means people need less care down the line (which eventually lowers the cost of insurance); they can be more productive in the meantime, contributing to economic growth; inequality would decrease, and for all the right reasons (not because wealth was simply redistributed in a ‘steal from the rich’ scenario, but because the poor were better able to keep work and earn a living).

Would it be a massive expense? Of course. And it has to be paid for, somehow (likely by increased taxation). But the alternative, non-reform of health care, simply delays the cost, leaves us in poorer health and with more costly insurance in the meantime, increases the freeloader problem and its resultant expense, and works against further economic growth and development…

It remains to be seen whether the reforms currently being sussed out will actually end up being a step towards a healthier, more productive population… but that is certainly my hope,



  1. Mike Upshaw

    Nice artice Jer-bear.

    I notice the word “rationing” never entered your analysis–good deal. It seems like the problem with the discussion in the public forum is that there is an emphasis on what “-ism” should dictate our policies. For some reason, every time there is a government solution to a problem there is a nasty slippery slope to socialism contingent that is just trying to rile up the raff that don’t know any better. The fact of the matter is that our healthcare is currently rationed by insurance companies who’s duty is to the shareholders’ profits and not to the well-being of the insureds.

    I do believe that the free market is the most efficient model for running anything so long as there is not abuse of the system. But, where market participants act irresponsibly and without concern for the customers it is time for an alternative solution. That solution may be as minimal as some simple rules regulating the market, or something as drastic as a government takeover of the entire market. At least with a government takeover there is a primary responsibility to the citizens of the country.

    Whatever the solution is, there is no question that what exists currently is not going to cut it.

  2. kleverenz

    A common concern also seems to be that if medicine is socialized we will not “end up with a healthier population” as you stated-it’s not just that people are afraid of the cost. This is rooted in the idea that government run agencies produce lesser quality help or assistance than open market economies. Whether or not this is the case, I do not know. I think it’s a fair thought. I don’t really know what I think about all of this, in fact I try not to say anything when it comes to touchy subjects like this, but I just think it’s something else to consider.

    Having said that, I do think that some form of Universal health care needs to be implemented.

    • takeaparthead

      That’s an important point!… I’ll be quick to say that I don’t always trust that the government would necessarily provide better quality care than a private market could possibly provide. You’re absolutely right to point out that the success of some system providing universal access to health care depends largely on the quality of care; it would certainly be a less-than-ideal situation for every person to have access to what amounts to crummy health care. I think I ought to have phrased some parts of my post differently, as it definitely deals more with the ‘what’ than the ‘how’. I suppose I’m operating on the assumption that socialized health care (however it’s implemented) would come with some improvements, especially of the cost-cutting and quality-improving sort, upon the current system: more efficient record-keeping, some sort of non-profit system of insuring health care, doctors’ compensation based not on volume but on quality of care provided, etc. – none of which, admittedly, are without their obstacles in trying to achieve them.

      I read an interesting article yesterday on another important aspect of the debate, and one I hadn’t really thought of – that we would quite simply need more physicians than are currently available to handle the influx of newly-insured (I wish I could find the article now – will send you the link when I do). There’s another obstacle in the way of providing universal, quality health care.

      By the way, I hadn’t seen the photography website yet… looks fantastic… good work!

  3. kleverenz

    Interesting. I’d like to read that article if you find it. I know Dan would be interested.

    Thanks for writing about this. Though the subject is commonly talked about on NPR and other news stations that I am bombarded with daily, I rarely hear or read something that opens the topic up for discussion. It’s usually more of a statement of the effects that are certain to come from “this” plan or “that” one. I appreciate your willingness to spark discussion.

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