Because of the New York Times new pricing policy, requiring a $50/year subscription to view columnist online, I'm going to stop linking to them. But as a parting gesture, I'll give you one last link, this one to Paul Krugman's One Nation, Uninsured. (If the link dies, blame the Times.)
In the column, he endorses a single-payer health plan.
Let's ignore those who believe that private medical accounts - basically tax shelters for the healthy and wealthy - can solve our health care problems through the magic of the marketplace. The intellectually serious debate is between those who believe that the government should simply provide basic health insurance for everyone and those proposing a more complex, indirect approach that preserves a central role for private health insurance companies.
He's right on that point. But we diverge on his next point:
The great advantage of universal, government-provided health insurance is lower costs.
To be more precise, what's lower is administrative costs. But that ignores where we (through insurers, Medicare, and Medicaid) spend the bulk of the money, on medical care. And it assumes that all of that care is just fine or not very expensive, or that even if it isn't the case, governmental action would take care of the problem. That's where I see things differently. We've talked here extensively about unnecessary care and I just don't have a lot of confidence in a single centralized system's ability to find the Mama Bear solution, not too much, not too little, but just right.
Krugman goes on:
Some people, not all of them right-wingers, fear that a single-payer system would hurt innovation. But the main reason these proposals give private insurers a big role is the belief that the insurers must be appeased...
But I think that's the wrong lesson. The Clinton plan actually preserved a big role for private insurers; the industry attacked it all the same. And the plan's complexity, which was largely a result of attempts to placate interest groups, made it hard to sell to the public. So I would argue that good economics is also good politics: reformers will do best with a straightforward single-payer plan, which offers maximum savings and, unlike the Clinton plan, can easily be explained.
Actually much of the Clinton plan's complexity was based on the the need to guarantee that the cost of the program would be within certain budget constraints (boy, those were the good old days, weren't they?).
No question about it, we need to demand more of health insurers. Alternative plans would afford us the means to box them in and we should do just that.
I agree with Krugman with much and particularly that " We need to do this one right. If reform fails again, we'll be on the way to a radically unequal society, in which all but the most affluent Americans face the constant risk of financial ruin and even premature death because they can't pay their medical bills." But I think we can do a better job both programmatically and politically and do so without rolling the dice on a one-size fits all, single-payer solution.