Battlepanda: Competition time!


Always trying to figure things out with the minimum of bullshit and the maximum of belligerence.

Monday, January 23, 2006

Competition time!

A few of you monkeys nominated me for the "Best New Blog" catagory Koufax. Seeing the crazy competition, I don't think I would bet on me. But I am glad that I made Norbizness and Roxanne's short(er) lists.

Speaking of competitions, I don't know if my 11th hour submission to Matt Holt's "solve the healthcare crisis in 250 words or less" competition made it before the cutoff or not. Either way, it's amazing how a ridiculously short word-limit sharpens the mind on a byzantine subject. Here's my submission, which actually clocks in substantially under 250 words:

Our first order of business is to separate the public from the private. Our inability to face up to the inevitability of a single-payer health care system has resulted in a weak and and inefficient crazy quilt of care. We bribe employers with tax breaks to provide healthcare for their employee, because doing so directly would be considered "socialized medicine". Even when we are openly subsidizing the purchase of prescription drugs, we manage rope in private companies to "provide" the plan, adding an unnecessary layer of overhead, rent-seeking, and confusion simply to provide a little free-market lipstick on the pig.

What's public should be public. If we pull together all the taxpayer's dollars subsidizing healthcare in different ways, we have enough to eke out a bare-bones single-payer plan the covers everyone. Only non-elective procedures will be covered. Copays should be applied strategically to discourage overuse. End of life care should focus on comfort and dignity rather than life-prolongment. What's private should be private. Not a red cent of subsidy for medical care outside of the public system. Let providers freely compete to lower their costs and improve their standard of care.

To expand on this last point a little bit: I am a big believer in the power of the free market AND the necessity of government interventions to produce the optimal social outcome somtimes. There are pros and cons to both privatization and state-run institutions, but what exists in the awkward interstice between the two is almost always a non-optimal program. Enough have been written (and very eloquently too) about how the insertion of private interests have made programs like the medicare prescription drug coverage the nightmare that it is, so I won't go into it. What is less often recognized is how universal healthcare insurance can unleash the free-market potential of the private market in healthcare. If my plan as outlined above is enacted, the market for private health insurance will effectively evaporate under the triple pressure of (a) competing with free universal healthcare, (b) withdraw of government subsidy and (c) well-understood adverse selection problems. Every procedure would now be an out of pocket expense, thus transforming consumer choice. The doctors should be happy -- they will never have to fill out another insurance claim form again.

And believe me, the consumers will be happy. Picking an HMO or health care plan is a little like picking a suitor -- you look through a lot of publicity material that might or might not relate to the actual experience after you commit, you weigh up a lot of pros and cons dealing with future events beyond your control, and by the time you realize you've picked a bum steer it's usually too late. In the case where your employer picks the service for you, it's more like an arranged marriage. But when you're not tied to a plan, the experience of buying medical care becomes more like the market for home electronics or beanie babies or lawn furniture or anything else -- the power is in the hand of the consumer and producers make money by coming up with the best product, not by playing games. Heck, they even have to work twice as hard because in many cases (all non-elective procedures), they will have to provide care good enough to lure patients away from the public system, which is providing it for free, or with very low copays.

Just my two cents. Let me know what y'all think.