Here’s some healthcare reform I can support, at least more than the current monstrosity being proposed:
So what to do? Leonhardt then looks at various proposals to increase choice and competition, including one by Sen. Ron Wyden (D-Ore.).
In the simplest version, families would receive a voucher worth as much as their employer spends on their health insurance. They would then buy an insurance plan on an “exchange” where insurers would compete for their business. The government would regulate this exchange. Insurers would be required to offer basic benefits, and insurers that attracted a sicker group of patients would be subsidized by those that attracted a healthier group.
The immediate advantage would be that people could choose a plan that fit their own preferences, rather than having to accept a plan chosen by human resources. You would be able to carry your plan from one job to the next — or hold onto it if you found yourself unemployed. You would never have to switch doctors because your employer switched insurance plans.
The longer-term advantage would be that health insurance would become fully subject to the brutal and wonderful forces of the market. Insurers that offered better plans — plans that drew on places like the Mayo Clinic to offer good, lower-cost care — would win more customers.
Can this really be in the New York Times, much less on its front page? Have I somehow entered an alternate universe in which economic sanity reigns?
I take back all the bad things I said about Mr. Leonhardt. Well, no I don’t, but I will temper them with praise for this piece.
I’ll add my own personal hobbyhorse: make sure to divide the voucher up into catastrophic insurance and non-catastrophic health care (arbitrarily divided by some relatively high dollar amount), since the markets for these two products are (or should be) much different.
Via Hit&Run, David Leonhardt doesn’t like fat people:
So one of the nation’s top public health officials is now a fierce proponent of a soda tax. Meanwhile, other Obama advisers and some Senate staff members have been talking about such a tax — which wouldn’t apply to diet soda or real juice — as a way to help pay for expanded health insurance. Among 15 options for paying for health care reform, a new Senate Finance Committee analysis lists a “sugar-sweetened beverage excise tax.”
First of all, I want to thank Mr. Leonhardt for being a voice for the government punishing and controlling your actions — it takes a noble and generous soul to stand up for the concept of telling other people what to do.
Secondly, I’d like to commend him for being so prescient as to propose taxes on everyone’s behavior even before we’ve established national healthcare, thereby making it seem like he knows something we don’t:
On the other hand, activities [such as drinking soda] that really deserve to be taxed — activities that place a cost on the rest of society — often go untaxed or undertaxed.
Feel free to scan the entire article. Note how there is zero discussion of people whose healthcare costs are not placed on the rest of society — almost as if they didn’t exist. Hm! Obviously he’s been going to meetings I don’t get invited to.
I also really like this line, pre-emptively defending himself against the charge that his cool new soda tax will be horribly regressive:
Just as important for the purposes of a soda tax, economic research has found that soda drinkers are price sensitive. In the past, when the price of soda has risen by 10 percent, consumption has dropped by an average of roughly 8 percent. This means a soda tax may not be quite as regressive as it sounds, because poor people would end up buying less soda than they now do.
Did you get that? It’s not really all that regressive because they’d buy less of the now-more-expensive soda! Wow. Hear that silence? That’s David Leonhardt not actually giving a damn about what people want. The concept that people might actually like drinking Coke, and therefore suffer harm in the important yummy-things-that-I-have sector because they now have less of it is completely lost on him. I guess I might take tax-the-fat-people advocates more seriously if they gave the impression that they saw consumers (especially poor ones) as something other than moronic obese cows who greedily guzzle down anything placed in front of them.
Now, in the spirit of balance and objectivity and crap like that, let’s list the good things Mr. Leonhardt says:
Most public health scourges have a brutal way of holding down the associated medical cost: they kill people. That’s why preventive medicine doesn’t provide nearly the cost savings that some advocates claim. “One of the uncomfortable truths is that when you prevent an illness,” says Dana Goldman, the head of the health program at the Rand Corporation, “you prolong a life and can increase costs.”
Unpleasant to hear, perhaps, but true.
It would get rid of the current government subsidies for corn syrup — and that New Jersey gym tax.
Not only has the [current tax] system been failing to collect enough revenue to cover government expenses, but it is also complex in all the wrong ways.
Good for you.
Take a good long look at this article, because this is what the policy debates are going to look like for the forseeable future: what actions can we tax, outlaw or penalize in order to make the budget work?