October 10, 2006

Question for the Projo Editorial Board: Is the Goal to Fix Healthcare, or is Fixing Healthcare the Excuse to Strengthen Government?

Carroll Andrew Morse

For the last several weeks (at least), the Providence Journal editorial board has been strongly advocating for implementation of a "universal health care" system. Here is an example from the October 3 Projo...

Until the United States puts everyone in the same risk pool (say, by extending Medicare to all), the situation will only worsen as the cost of increasingly high-tech medicine soars. That's especially so because those who have health insurance often ignore the cost of treatment; since they're not paying for most of it, they often overuse the medical system, injecting even more waste and expense.

The big question now is what percentage of middle-class voters who are losing health insurance will prove the critical mass that brings in a variant of the universal coverage and wide risk pool of other developed nations.

Here's another from September 30...
A national universal health plan is, of course, the logical solution to America's chaos of private insurance, state health plans, and federal programs. Every other large industrialized democracy has a national health system, as opposed to the rather barbaric U.S. "system."
I am not a big fan of universal health care proposals. The health care crisis we face now is the result of excessive government regulation that separates people from having any influence on the form that their health insurance takes. Individuals are presented a very limited package of options through their employer once a year and are told to take-it-or-leave it. There are no serious alternatives allowing people to pay for better quality or seek lower costs, if they don't like the narrow range of choices they are given.

Imagine if we sold automobiles like we sold health care. Once a year, you would be given the choice to buy a car, but the only car you could buy would be a fully loaded BMW. If you couldn't afford it, too bad; buying a Ford Escort or a Chevy Cavalier would be illegal as per regulations set by the legislature. And if you didn't decide to buy your car at the beginning of the year, you couldn't buy one until next year. Under these circumstances, we would almost certainly face an "automobile ownership crisis", but it wouldn't be a market failure, it would be a regulatory failure.

However, there is one circumstance where I might be persuaded to support a statewide universal health care experiment, a proposal by economist Arnold Kling published in TCS Daily in response to Markos Moulitsas' argument that libertarians should vote Democrat...

What I propose is that Democrats promise to support one major libertarian experiment. In exchange for Democrats agreeing to support this experiment, libertarians would agree to vote for Democrats.

The experiment that I have in mind is school choice. If Democrats would instead prefer an experiment with voluntary investment accounts substituting for Social Security, that is an acceptable alternative. But for now, let us work with school choice...

Traditional Democrats may say, "If we are willing to give libertarians an experiment, what do we get in return? Do we get a chance to experiment with our policies?"

I would welcome experiments with socialist policies, provided that they are only experiments. That is, the policies must be evaluated, and if they are found to have failed, they must be abandoned.

For example, I would welcome an experiment in which four or five diverse states adopt single-payer health care. My guess is that if people were to experience single-payer health care for ten or fifteen years, that would provide powerful evidence that it is a bad idea for the United States.

I think most people can agree upon the basis of Professor Kling's challenge; our society is facing a number of crises rooted in the fact that certain of our systems, like the systems for delivering health insurance, or social security, or public education, were designed under assumptions that no longer hold true. They need to be changed and changing them will require a choice to move in either a more socialist or more libertarian direction.

Given all of this, here is my question to the Projo editorial board: will you consider the idea that it makes sense to try a number of different paths towards public policy reform and call for something like a voucher system in education or individual Social Security accounts to accompany your call for universal health care, or rather than fixing broken systems, is the top-priority of the reforms you seek pressing individuals into state-controlled collectives wherever possible?