Tuesday, May 2, 2017

Healing Healthcare – A Two-Part Mini-Series

The United States healthcare system is badly broken.  Almost everyone can see this, but hardly anyone can agree on how to fix it.

This is not for want of trying.  The past 50 years have seen a litany of attempted reforms, from Medicare and Medicaid in the 60’s, to HillaryCare and HIPPA and COBRA in the 90’s, to Medicare Part D and the Affordable Care Act in the 2000’s.  The recent failure of the Trump administration’s feeble attempt to repeal and replace Obamacare was but the latest chapter in this tired fight between well-entrenched ideological camps.  Each chapter has the same ending: our healthcare gets much more confusing, but not much better; Americans more bitterly divided, but no healthier than before.  And when the dust settles, what remains is the worst of both worlds: none of the universal coverage enabled by single-payer systems so popular with our wealthy allies, yet none of the cost-consciousness of a low cost, high deductible private system like Singapore’s or Switzerland’s.

As frustration mounts, more and more people are recognizing that we cannot remain in this ambivalent middle ground.  Incremental compromise will not cure what ails us: we need a complete reorganization of our healthcare system.  I see only two directions that could go.

The first is the most famous: a European-style single-payer system (sometimes called “
Medicare for All” on this side of the Atlantic) in which all citizens are offered expansive health insurance at taxpayer expense.  Progressives passionate about the egalitarian moral imperative (or “right,” as the kids say these days) of universal healthcare access have championed this policy for decades.  And even some conservatives, fed up with the current labyrinth of rules and regulations, are now drawn to such a system for its comparative simplicity.  The traditional objection – cost – is a tough sell when the cost of our current system so far dwarfs those of single-payer nations.  And while the other alleged downsides are largely unseen to the casual observer, the humanitarian appeal of “nobody denied care for inability to pay” is highly visible.

For these reasons, universal “socialized” healthcare is increasingly popular in the US, especially among young Americans.  Perhaps it’s even inevitable; people are tired of fighting it.  At this point, many don’t know what other options we have.
My goal today is to illustrate the other option.  

Amazingly, many of in my generation are under the impression that our country already has a free-market healthcare system.  If they are make meaningful choices about our healthcare future, it is imperative that they understand the truth of the present.  America has never been a country to blindly follow in the footsteps of others, and before we go the way of Europe and Canada on healthcare, our alternatives deserve a vigorous investigation.

What would a market-based healthcare system really look like?  How does it differ from what we have today?  How could we get back to one, and why should we want to get back to one?  What is the goal of market-based healthcare reform, and why would it be effective at achieving that goal? And, importantly, why is that goal more important than the goals of competing reform strategies?

Today’s posts will tackle those questions.

Healing Healthcare, Part I: The Philosophical Case for Market-Oriented Reform

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