In any system that lacks unlimited resources, the available assets will be allotted either by price or a regulatory regime. “Universal coverage” is really an ambiguous term. Does it mean everybody gets seen by a medical practitioner or does it mean everybody gets “cured” or cured to a certain extent?
As I understand it, the current US health care system has people who cannot be seen or cannot be treated over a long term, a percentage which varies, depending on how you calculate it, between 8% to 16% of the population, depending on whether or not you count illegal immigrants and those who could get insurance but haven’t. But the real underlying problem is that many of the resources are used inefficiently, which is a consequence of institutional players — insurance companies, lawyers, medical professionals — deriving monopoly rents from the system.
The main criticism of Obama’s health care “reforms” is that it will increase coverage while aggravating the institutional inefficiencies. This means that while more will be “covered”, the system will act in an even more broken way. But the institutional players won’t care because they make out like bandits now and will make out even better under health care reform. There may be a redistribution of receipts among the bandits, but the bandits will win in either case.
The killer talking point of the “reform” is that it will provide this elusive holy grail called universal coverage which in actuality may or may not provide more people with better care. In reality it might provide more people with worse care or even fewer people with worse care if you look at the actual therapeutic output of the system. But clearly the way to unambiguously better outcomes, however you want to describe it, is straightforward. You have to rid the system of gross inefficiencies.
If you provide more coverage with the current inefficiencies you will get more expensive premiums. This can be creatively packaged as higher taxes, mandatory insurance, or fees between one party and another. That is smoke and mirrors. The inescapable fact is that to cover more at a higher marginal cost means more money. The body politic has the right to do that. It may impose higher taxes on itself to produce greater transfer payments to provide more coverage for low income groups or even if it so desires to illegal immigrants. People can spend their money on whatever they want. They are entitled to buy social peace. If they’re feeling generous they can give gratuities to people for no reason at all because it makes them feel good or more civilized. That’s a valid use of money.
But the taxpayers are currently in a foul mood. Politicians aren’t leveling with them by saying “we can give this 8% or 16% coverage but we have to raise your taxes (premiums, co-payments, excess) to do it”. That would be too honest. Instead, they are saying “we’re going to give you something for nothing” and to prove it they trot out the old shell game.
The logical course, given price resistance, is to find ways to cut health care costs by tort reform, producing more doctors and promoting competition among providers. If, as someone asserted above, the current system pays 25% to lawyers, then simply getting rid of the lawyers would enable the system to reduce premiums and in return enable a corresponding rise in taxes but at no net out of pocket. However that would require real health care reform, which in this setting means institutional reform, not more coverage with the same broken institutions.
But institutional reform is hard because it means taking on the very institutions who are crafting the health care “reform” bill. It’s easier to increase coverage than to fight City Hall.
I suppose this is why I find the debate over universal coverage somewhat unhelpful, not because “universal coverage” is a bad concept, but because it is a misleading concept. The debate isn’t about universal coverage, it is about who gets what. It is ultimately about money. But nobody ever says that. They always says its about the children, the planet, or medical care for all. Yet somehow it is depressingly almost always about the money.
