Sometimes there's a trade-off between equity and efficiency. Health insurance is interesting in that the equitable thing -- universal coverage -- is actually more consistent with efficiency. The industrial countries that provide universal coverage also spend a lot less per capita on health care than we do.
Single-payer has always made the most sense to me, and to most of my fellow travelers. Some of us are irritated that Obama's health insurance plan didn't just go that route. Instead, it's sort of universal coverage by bank-shot: give everybody, the already-insured, the underinsured, the uninsured, the "public option," or the opportunity to sign up for something like a Medicare plan or the health insurance plan available to government employees.
I don't have a problem with this approach. After all, if you wanted to go the single-payer route in this country, what would you do about all the private health insurance infrastructure out there? When Dennis Kucinich was running for president, his answer was to put them out of business but compensate them, which seems like a frightful prospect to me (the compensation part, I mean). Single-payer's not the only way to go to provide universal coverage; both
France and Germany cover everyone with a hybrid of government insurance and private plans, which seems similar to the public option legislation now under consideration.
The reason why these countries can control costs at the same time that they're covering everybody is that people who aren't necessarily using health care resources are all paying into health insurance (through taxes and/or premiums), thus subsidizing the people who are using health care resources, as opposed to this country, where the uninsured get care in the most expensive point-of-service there is (the emergency room or treatment more expensive than preventive care), shifting the costs to everyone else.
The right-wing critique of the public option plan, articulated
here, makes the point that we don't make that application to car insurance of life insurance, so why health insurance? An important difference is the emergency room. Hospitals, by law, have to take care of people needing emergency care (you wouldn't want to live in the Third World public health conditions of a country that didn't have such a requirement), and when people who can't afford it go there and incur thousands of dollars of care they can't pay, a dynamic exists that isn't applicable to other forms of insurance. Not to mention that people will lose insurance or find claims denied in the midst of treatment for diseases, thus also incurring costs that get passed on to others in the same way. That kind of stuff doesn't happen with car or life insurance.
So pass the damn public option already!
Labels: health