More on Health Care

One MOJ reader had this to say on my posts (here and here) about the goal of affordable access to healthcare and the question of republican commitment to that goal:

"With respect, I believe Republicans are making that argument but from a different perspective about what government's role is and should be.  Except for the most radical libertarians, right-wingers in general know that government has a role in health care policy.  However, that role is not active role in that it does not seek to displace the free-market but to protect it and help it grow and stay competitive.   Indeed, Republicans argue that current government policy is at least partially to blame for the rising costs of health care.  The tax code almost mandates coverage through one's employer which reduces the incentive for individuals to minimize costs because "someone else" is paying for it.  Moreover, this depresses wages because employers "pay" through health benefits instead of through higher salaries.  This is inefficient because if the employee had to purchase his or her own insurance through their weekly paycheck they'd have that incentive to keep costs low and avoid unnecessary procedures.  Another area in which governmental policies hurts is that individuals are restricted to buying health insurance in their own state, thus reducing the competitive forces of the free market which help keep costs down and quality up.

"John McCain made this point in a short paragraph in his speech yesterday after locking up the Republican Nomination: 'I will leave it to my opponent to propose returning to the failed, big government mandates of the sixties and seventies to address problems such as the lack of health care insurance   for some Americans. I will campaign to make health care more accessible to more Americans with reforms that will bring down costs in the health care industry down without ruining the quality of the world's best medical care.'

"I don't think its fair to fault Republicans for not addressing government's role in health care simply because most believe that role is as an enabler of the free-market and not as a single-payer system through a vast government bureaucracy.

"As a quick aside, I think your last emailer hit the nail on the head.  We could have "affordable" health care for all tomorrow by simply reducing the quality of care to such levels that everyone, even the most indigent, could afford it.  That is undesirable for obvious reasons.  The trick is how do we maintain high-quality care while keeping costs down.  Democratic proposals ignore this important distinction and focus on "coverage" for all as if "coverage" is the ultimate goal; it is not.  The goal is quality care for as many people as is possible.  Experiences in similarly-situated nations like Canada and England demonstrate that government-run health care is a nightmare and reduces the quality of coverage for everyone involved.  In those cases, only the ultra-rich get good coverage because they can afford to go out of country or patronize the few private healthcare providers that still exist. 

"Of course, there will always be a gap between the poorest in society and what the free-market can provide for.  But addressing that small gap should not come through a "universal" plan; a 1% problem does not require a 100% solution.  Instead, we should keep encouraging private charity (which does a lot of good in the health care realm already) and, if we must, use targeted government programs aimed at the truly needy who have fallen through the cracks of the good, but flawed system."

A couple of quick observations.  First, I don't think comparisons to England and Canada are helpful because neither Clinton or Obama are proposing that kind of government health insurance.  Second, I do think Obama, at least, is quite focused on the need to cut costs in order to improve access.  Third, I don't think it can fairly be said that we have a 1% problem here.  As I have explored at length in my writing, I think the system of voluntary employer-sponsored health care - very much a product of the tax code - is fundamentally a flawed system.  Finally, if McCain's quoted statement is sincere, that is wonderful.  My comment was based on the fact that I have not seen demontration of such a commitment by republicans.  Nothing would delight me more than to discover that I am simply wrong in that conclusion.