Belmont Club

"How American Health Care Killed My Father"

An article from the Atlantic argues that the current system is broken, but broken in a way the “fix” doesn’t contemplate.

I’m a Democrat, and have long been concerned about America’s lack of a health safety net. But based on my own work experience, I also believe that unless we fix the problems at the foundation of our health system—largely problems of incentives—our reforms won’t do much good, and may do harm. To achieve maximum coverage at acceptable cost with acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value throughout the economy. We will need to reduce, rather than expand, the role of insurance; focus the government’s role exclusively on things that only government can do (protect the poor, cover us against true catastrophe, enforce safety standards, and ensure provider competition); overcome our addiction to Ponzi-scheme financing, hidden subsidies, manipulated prices, and undisclosed results; and rely more on ourselves, the consumers, as the ultimate guarantors of good service, reasonable prices, and sensible trade-offs between health-care spending and spending on all the other good things money can buy.

As I’ve argued in the past, the health care system isn’t exclusively about health. It’s about who gets what under the current arrangements. The patients get something, but so do the lawyers and other actors which are at first blush, not obviously part of the system. The corollary of this is that “health care reform” gets to be shaped by the very same actors who not only want to preserve their slices of the pie, but expand their role. Maybe the best way to approach the health care debate is to start with the dramatis personae and design a system — not to deliver “health” — but to minimize the worst instincts of those whose fingers are gouging at the pie. Minimize the maximum damage and you maximize the minimum benefit.


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