AS picks up Reihan channeling Greg Mankiw. (You have to pinch yourself if you agree with Greg, most of the time, right?).
There is an obvious difference between Universal Care and Universal Insurance.
Trying to get to Universal Care via a screwy financial product is not going to be easy. That so many in the GOP are ready to argue against mandates is probably a signal ... humm... of what, I wonder?
The flaws in Reihan's logic (and AS's endorsement of it) is that the current rates of uncompensated care would remain the same. Failing to put in mandates would raise the rate, over the long term, as people figured out they don't have to pay along the way, i.e. as they learn to game the system.
There has to be a mandate, as a matter of insurance design. The affluent will not like it. Those who could afford coverage, but choose not to (cheat), will have to pay back premiums at some point (that's the enforcement, and yes, it could get very complicated administratively, but that's the cost of "Small Change We Can Believe In"). Those who intentionally under insure are problematic, as well.
Of course, there is no way to enforce payment by the poor since the beginning of time, without getting draconian.
INSURANCE COSTS MIGHT EVEN RISE BEFORE THEY FALL, IF AT ALL
The cost of insurance could go down, with a great increase in subsidized enrollees. However, all the offsetting factors, like removing the ability of insurance companies to make exclusions, could raise costs, as well. It could be years before pricing 'equilibrium' is reached - costs might even rise before they fall.
CORE COSTS PROBLEMS
The core problem of squeezing costs out of U.S. healthcare will not be solved by 'universal insurance' in a public-private partnership.
Hillary's plan puts healthcare on the trajectory in which that problem might ultimately be attacked. The rest are less ambitious.
WHAT WE COULD END UP WITH INSTEAD OF REFORM
By the time it is all hashed out, what we may end up with is a bunch of subsidies for people to buy private financial products called health insurance.
We ought to be targeting a decisive end to the Nanny Corporation. Obama is not that farsighted, apparently, nor his acolytes.
Tuesday, February 5, 2008
The Coming Healthcare Debacle, Part II
