Uwe Reinhardt: Unifying themes for healthcare policies
Uwe Reinhardt at Economix sums up health care policy proposals over the last decades(hat tip save the rustbelt)
To describe the unifying theme running through these past variants, it is helpful to enumerate the major economic functions any health system must perform:
- Producing health-care goods and services.
- Financing health care, which involves extracting money from households (which ultimately pay for all of health care) and funneling it to the producers of health care, usually through the books of private or public health insurers.
- Risk pooling by private or public insurers to protect individuals from the financial inroads of high medical bills through insurance policies.
- In most modern societies, assuring that every member of society has timely access to a defined set of health-care benefits.
- Purchasing medical treatments from the producers of health care, which includes determining the prices to be paid, claims processing for insured patients and controlling overall spending and the quality of that care with various forms of controls lumped together under the generic label “managed care.”
- Regulating the behavior of the various participants in the system to preserve the integrity of health care markets and the safety of health-care products and services.
Most of the debate over health policy in this country has been over two questions.
First, to what extent should healthier or wealthier members of society be asked to subsidize the health care received by their poorer or sicker fellow Americans? Second, influenced by the answer to the first question, who should perform the functions listed above: government, private nonprofit entities or for-profit entities?
a little surprised that your post elicits no comments. maybe you said it all already.
but as for your questions.
the wealthy should not “subsidize” the health care received by the poorer and sicker. the wealthy and healthy ought to pay insurance against the day when they are less healthy and not wealthy enough.
America has tried “private” financing of health care, and it is largely failing. The rest of the civilized world relies on one form or another of “government” financing. Maybe this should be telling us something.
i think there needs to be some way to keep the government “honest,” so i propose two suggestions:
the first is for the government to simply replace “the employer” in the present paradigm. that is, call for bids from the insurance companies to provide coverage for a well defined package of services “without regard to prior condition.” and then to monitor the contracts let in much the same way that highway contracts are monitored. i don’t know if the defense department provides a horrible example against this proposal.
the second is to just let the government compete with the private market… that is, offer an insurance policy, and provide services in government clinics with government paid doctors and simply beat the private providers and insurers on cost and quality.
there would be some problem doing this without using the government power to tax.. we might have to watch a lot of people die who were too healthy when young to buy insurance and not wealthy enough when old to afford it.
The high in taxable income finance healthcare and not the wealthy.
– Single Payer through Medicare
– Private amrket is the problem today which the ACA will reconcile.
– Much could be financed by cost-save as we swith cost models.
no doubt you are right. not sure why, or if, you think you are disagreeing with me.
troubles: the government no longer understands Medicare as insurance. they treat it as welfare, and instead of raising the premium to cover the costs, they cut the coverage so that people are forced to find money when they don’t have it… money they could easily have paid over a lifetime of a relatively modest tax.
ACA… obamacare?… doesn’t seem to me to have a reasonable way to control costs. it forces people into a “market” in which they have no way to make informed choices. and i don’t see the government doing any reasonable actions to control costs from its position of better knowledge.
besides, i really don’t like being forced to “do business” with people i consider organized crime.