Supposed voice of liberal moderation Michael Kinsely is out with a Washington Post op-ed called Before We Go ‘Single Payer’ which is just staggering. I thought Arnold Kling was bad in his misunderstandings, but I apologize to the libertarians on this one. Kinsley’s piece just doesn’t make sense, which indicates to me that he doesn’t understand what he’s talking about.
He accuses Krugman and Wells of ducking the rationing issue — they don’t. Instead they say it can be delayed by cutting out some administrative costs, but it will come in the end. You may not buy that argument, but it is a proven fact that admin costs are lower in single payer nations than they are here. Check the CMS cost data if you don’t believe me.
But then he wonders off into absurdity.
But anyone is insurable at some price — a price that reflects the cost he or she is likely to impose on the insurer. Adverse selection is only a problem to the extent that insurance is not really insurance but rather a subsidy.
Frankly I have no idea what he’s talking about with this “subsidy” stuff. If he means that some people pay more in premiums than they receive in benefits and some pay less, then that’s what insurance is. But I have a simple way of correcting his notion that everyone is insurable at a price. Let’s give Kinsely a pre-existing condition, and send him out into the individual market. He’ll change his tune faster than Mark Pauly wold under the same circumstances.
And then he seems to have missed the whole concept of the debate on the political left between the Enthovenistas/voucher crowd and the single payers. And most importantly that no one seriously thinks Americans won’t be allowed to trade up to a better class of waiting room with their own money.
The problem is putting in a floor for everyone, not getting rid of the ceiling — that’ll come naturally once everyone’s in the same system.
Nowhere does he mention the one thing that is necessary for fixing health care — the imposition of some type of mandatory universal insurance system. Something that everyone in the voucher v single payer argument realizes is essential. And however it happens that is not “incremental change”.
(Trap, you can use this as a thread to beat up on Kinsely, Krugman me et al)
UPDATE: Meanwhile a (gasp) Republican, although not one in the good graces of the loonies running the country any more, has some ideas that are at least getting at (some of) the problem and mention the "mandatory" word. Here’s what Paul O’Neill said:
Mr. O’Neill has long argued that addressing health care with tax
incentives is an inadequate approach. "When they’re talking about tax credits,
they’re talking about our money, not their money," he said in a phone interview
last night. "When you use tax credits and deductions, unless they are
refundable, … they’re very inequitable, because the value of the credit or
deduction depends on the level of income or wealth accumulation an individual
has."Mr. O’Neill said Congress should pass a law requiring all Americans
who make more than $30,000 a year to purchase catastrophic health care coverage
for themselves and their families, with fewer deductibles and co-insurance
payments. The government would then use general revenue funds to purchase health
insurance coverage for lower-income people, he said.