OK. The bickering about Jon Cohn’s new book Sick has started over at TPMCafe Book Club. Lots of interesting stuff including one from moi.

Jonathan Cohn’s book Sick is out today. The early version of some of the chapters I read was fabulous, and I’m really looking forward to reading the whole thing. If you want to buy it follow this link and click on it here there & I get the odd shilling, I think

I like Michael Cannon a lot, but I fear his (and Michael Tanners’s) book (unlike fellow Cato-ite Arnold Kling’s) was very, very weak on dealing with the problems of actually sick people. It devoted a whole three lines to the problem of what happens to controlling costs beyond the deductible–even though everyone knows that that’s the most expensive part of health care. Kling at least knows that covering them is a problem, although he never really comes up with answer either (he does dance around the edge of high risk pools for the chronically ill).

But  I just assume the liberal LA Times is carrying this op-ed from the two Michaels as part of its affirmative action program. Cannon and Tanner have amazingly discovered that universal insurance does not mean immediate access to any care anybody might want for free. And so they have decided that lots of people not having insurance is therefore OK.

There are two basic problems with this logic.

First, and this is barely worth saying, but care is rationed in the US just as much as it is elsewhere. if you don’t believe me, believe the capitalists at the Wall Street Journal—who ran a long series on it in 2003, and believe fellow free-marketeer John Goodman. So saying that people have to wait for care in Europe or Canada is true but not an immediate indictment of their health care systems. Of course rationing of health care may not impact Cato scholars or even hopefully liberal health care consultants in San Francisco, but it sure as hell impacts poor uninsured people waiting for care in (say) Galveston, Texas.

Second and this much more important—a universal health insurance system means that the insurance is universal. What does insurance do? Insurance ensures that if you are not financially wiped out from a disaster, such as having your house burn down or in this case, being sick.

There’s no point rehashing the bankruptcy statistics here—the point is that the key reason the Europeans, Canadians and Japanese support their universal insurance systems is because they know that a spell of illness does not  mean financial destitution. Here it is quite possible that it will, and in many cases it does–but don’t worry it’s only one quarter of bankruptcy cases. Barely worth bothering about, eh?

That the Cato boys couldn’t even address this—which is by far the most important problem with the US lack of universal health insurance—is presumably because the LA Times was too cheap to give them more words. At least I assume so. It can’t be that they think it doesn’t matter, can it?

CODA: Meanwhile I just found out that John Goodman has a blog.It’s called The John Goodman Health Blog. I’ve been there poking a little fun in some of the comments, including this one about the bankruptcy issue. I suggest you all go there to check it out too and join the intellectual giants like Pauly, Herzlinger, Pipes et al in the comments.

Meanwhile, since we’re going on about LA Times op-ed pieces on health care, on Sunday Erza Klein has one somewhat misleadingly titled This time, we want healthcare reform. It’s really a study of what went wrong in 1993–4 and how to not have that happen again. As I was reading it I noticed that Ezra had done his homework over here at THCB, but waas nice enough to say so and drop my name in his piece.

Holy schamoly. The NY Times farms out John Cohn’s book Sick to get reviewed to the AEI and .it still gets a great review. I assume the AEI scholar (Sally Satel) will last about as long as an AstraZeneca drug sales manager who also tells the truth.

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.