Kinsley: Don't Make Me Sick!
Kinsley critiques the superior arguments of Krugman and Wells on a couple of points.
First, regarding the superior efficiency of single payer health care, Kinsley says, that Krugman and Wells :
don't do much more than simply assert that a single, government-run insurance program would be more efficient. Even the most competitive industry can seem wasteful and inefficient when described on paper. Dozens of computer companies making hundreds of different, incompatible models, millions spent on advertising: Wouldn't a single, government-run computer agency producing a few standard models be more efficient? No, it wouldn't.
Actually, Krugman and Wells don't merely assert that a government-run insurance program would be more efficient. They show that government-run insurance programs in other countries are more efficient than our patchwork public-private system. They also explain that, unlike computer software companies, with health care "the fragmentation of a system that relies largely on private insurance leads both to administrative complexity because of differences in coverage among individuals and to what is, in effect, a zero-sum struggle between different players in the system, each trying to stick others with the bill." Krugman and Wells note that an additional reason for superior efficiency of government-run insurance is its ability to bargain for lower-price pharmaceuticals (unless, of course, as with the Medicare drug benefit, pharmaceutical-company-written law prohibits such bargaining).
Second Kinsley states that:
Krugman and Wells note repeatedly that 20 percent of the population is responsible for 80 percent of health care costs. But that doesn't explain why health insurance should be different from other kinds. The small fraction of people involved in auto accidents in any year is responsible for almost all of the cost of auto insurance. You insure against the risk of being in that group.
But healthcare insurance isn't like auto insurance. It seems just and appropriate that people who get in a lot of accidents or who have DUIs and speeding tickets should have to pay more for their auto insurance. Does it seem right that sick people should have to pay more for health care insurance? Most people would say no. And while some might agree with making smokers or heavy drinkers pay more for health care, few would agree with denying such people insurance entirely. By contrast, if someone has a terrible driving record, denying them insurance (and a driver's license) might be the best thing for society.
This Kinsley argument is just depressing, coming from a liberal:
Krugman and Wells say that private insurance is flawed by "adverse selection": Insurance companies will avoid riskier customers. Only a single payer (that is, an insurance monopoly) can insure everybody, and spread the risk. But anyone is
insurable at some price -- a price that reflects the cost he or she is likely to impose on the insurer. Adverse selection is only a problem to the extent that insurance is not really insurance but rather a subsidy.
No no no! Adverse selection is a problem to the extent that it prevents sick people from getting insurance. Adverse selection is a problem to the extent that it makes employers want to avoid employing potentially unhealthy people because of the impact that it could have on employer-provided health insurance costs.
Kinsley concludes by recommending a pathetically small health care reform, based on a bogus issue.
Should people be allowed to opt out of rationing if they can afford it? That is, if the system (private or single-payer) won't pay for the $100,000 pill, should you be able to pay for it yourself? Fear that this would not be allowed helped to kill the Clinton health care reform 13 years ago.
Bizarrely, Kinsley fails to explain that this fear was unfounded. The Clinton plan would have allowed individuals to purchase additional insurance or health care as they chose. Moreover, no one is proposing national health insurance programs that would prevent people from buying additional health care.
Kinsley concludes by stating that "if a few smaller reforms like that don't work, maybe it will be time for single-payer." This makes no sense politically. Can he really be serious that progressive forces in this country should mobilize in favor of small reforms that are unlikely to do any good, and that after "a few" such failed reforms, then we'll be in position to convince the country that single-payer is the way to go?
Ignore Kinsley. His way would ensure that progressives lose the trust of the nation on health care issues for a generation. Now is the time to build a movement that can elect a government that will support the most just and efficient system-- single-payer government-provided healthcare.