John Goodman, the president of the right-wing pressure group NCPA from which he and his wife draw down nearly $600,000 a year, has a piece in the Wall St Journal called, Perverse Incentives in Health Care. The shocking thing is that I mostly agree with him about the perversity of incentives in health care. He is though wrong to blame third-party payments for everything and more importantly wrong to assume that private third-party payment imitates government third-party payment. In fact the reverse is true. Medicare is modeled after the typical Blue Cross major medical plan of the 1960s, which is why it is so damn hard to reform today. And it’s not third party payment, it’s the way we organize third party payment that’s the problem.

But after reading Goodman’s piece I have no idea what his overall solution is. He even spends some of the article slagging off HSAs, which is pretty rich given that he and his organization pushed them on an unsuspecting nation, mostly in the pay of Dan Rooney and the other scumbags at Golden Rule. His problem with HSAs is that they are connected to third party insurance policies, which then mandate their own rules on what is covered and what isn’t. I’ve been telling anybody who will listen that that’s the problem with high deductible plans for a long time. Well done Goodman on catching up.

Goodman does have one solution. People should only have conditions and diseases that can be cured by one-time procedures that are relatively cheap and can be paid off using a credit card in a finite amount of time. It’s probably a shocking revelation to Goodman and his cohorts in the free marketeer camp, but most health care is required by a small minority of people who are very sick, and they can’t afford to pay for their care with the loose change they find in their couch cushions. That’s why we have third party payment in the first place. So perhaps it makes some sense to figure out how to reform that. Of course Goodman has no answers, which is not something that can be said for either Alain Enthoven or the single-payer crowd.

Actually I guess Goodman does have an answer–just make sure your country’s only illness is relatively mild myopia, because he thinks Lasik is the cure for everything (even if the actual research shows that there’s lots of lies told about that too!).

And then there’s a guy I’ve never heard of at Yahoo Finance called Charles Wheelan writing a very sensible piece about how we fail to rationally ration health care in the US. Why isn’t he writing in the pustilent sore licking section of the NY Times, or perhaps more appropriately, shouldn’t he get his shot in the WSJ opinion page?

CODA: This post is a reminder of why you should never use a web form for anything. I had written the whole thing, got distracted by something else, thought I’d saved it, and when I left the form I discovered that I had set a time for it to publish but not actually told it to publish. So of course it had all vanised. I usually write my post in a third-party client editor called Blogjet.  I’m now trying to quickly redo what I did before using voice dictation, but of course Dragon NaturallySpeaking is giving me a really hard time– it’s really not quite ready for prime time either.