Free Market Healthcare

| Tue Jan. 18, 2011 12:00 PM EST

As House Republicans embark on their sham vote to repeal healthcare reform today, Matt Yglesias points out that in the GOP's free market paradise virtually no one would have health insurance:

The only reason most people are insured today has to do with the non-market elements of the system. First, the tax code provides an enormous subsidy for employer-provided health insurance that ends up putting the majority of employed Americans into large risk pools at the expense of everyone who doesn’t work full-time for a big company. Second, Medicare mops up the largest pool of non-employed people by giving single-payer health care to everyone over 65. Third, a regulation bans discrimination against people with pre-existing conditions as long as they maintain “continuity of coverage” as they shift from one employer to another. Fourth, COBRA allows people to maintain continuity of coverage even if they experience transient spells of unemployment. Fifth, Medicaid and SCHIP give coverage to many classes of poor people who’d otherwise be unable to afford it.

Conservative apologists will object that we're setting up a straw man. Why, Republicans don't want to eliminate government involvement in healthcare! They just have a different idea about how to do it.

Sure. And like the Beatles said, we'd all love to see the plan. When it comes to things like Medicare, the GOP's plan was to oppose its creation, subsequently do their best to demolish it every chance they got, and then cynically bash Democrats when they actually did something to rein in its costs. Nice plan. And pretty much every other advance in healthcare coverage has been passed over their objection too. So what do they want instead? Ask them and they'll usually mumble something about tax credits and HSAs, an idea so patently deficient that partisans usually just toss out a few incoherent words about it so they can pretend to believe in something before abruptly changing the subject.

There is, simply, no acceptable free market solution for healthcare. There's only a free market solution if you're willing to let lots of poor people get sick and die, which most of us aren't. Given that, the obvious solution is to create pools of coverage, and the most efficient pool of coverage is everyone in the country. Eventually even Republicans will figure that out and we'll finally have a real chance to provide better coverage for everyone and seriously slow the growth of healthcare costs at the same time. Eventually.