Health Care Debate

Paul Krugman points us to this link outlining the origins of health care reform.  What it tells us is that Obama's big, bad, socialist, job-killing health care reform with a freedom-killing individual mandate... was suggested by the Heritage Foundation in 1989.  But somehow, the Republican alternative to single-payer 20 years ago (which was adopted by Congressional Republicans as an alternative to Hillary Clinton's plan during her husband's first term) has morphed into a Marxist fantasy.  Interesting.

I tend to disagree with Krugman on health care- he thinks single-payer is the best option.  I think the numbers back him, but he ignores the frictions that come with transitioning to one kind of system when we've built an entire health care edifice on private insurance.  I think our best bet is to take what we've got, create incentives to provide cheaper, more effective care by aligning the incentives of providers with the incentives of patients.  It's hard to do in a market like health care, where market fundamentalists can't get it through their head that markets for health care aren't like markets for couches and markets for lattes-- if your latte tastes bad or makes you fat, or your couch is uncomfortable, you know it right away.  If you get sick, you don't know what procedures you need, and you don't really know if your doctor is doing a good job or a bad job unless they really screw up.  So just stepping back and letting the market work won't do to the health care market what it does to the couch market.  So the best we can hope for, I think, is to reward doctors whose patients get better results at cheaper rates after the fact.  It's imperfect, but I think realistically it's easier and less chaotic than blowing up the system we have right now and starting over from the ground up.