The Great Healthcare Stalemate


I feel fine today. Thanks for asking! But what if I weren’t? Then I’d have to go to the doctor. And that would cost a lot of money. It wouldn’t cost me a lot of money, mind you, but it would certainly cost someone a lot of money. Probably MoJo, which is too bad since they have lots of better uses for their money than paying huge sums to insurance companies for their employees’ aches and pains.

It would be nice if we could pay less. Unfortunately, as Ezra Klein points out, Democrats and Republicans have come to opposite conclusions about how to do that. Democrats, quite sensibly, point out that private insurance is the most expensive kind of healthcare there is, so perhaps we need more government involvement. Republicans, who are ideologically opposed to more government involvement, insist that Medicare is the big driver of high medical costs, even though there’s no actual evidence for this. Ed Kilgore is despondent:

Beyond that, the arguments can get confusing. Sometimes Republicans seem to identify health care inflation strictly with rising public costs; shifting those costs to beneficiaries, from that perspective, “solves” the problem. Other times Republicans appear to believe that over-utilization of health care is the only real problems in the system; thus, exposing patients to more of the costs generated by their demands for care will “bend the curve” of health care costs. More direct reductions of costs via the use of the government’s leverage “distorts markets” and can’t, according to conservative dogma, possibly work.

How do you find a “compromise” between people with such diametrically opposed ideas of how the health care system works? Beats me.

Well, it’s a good question, all right. Roughly speaking, if you place the rich countries of the world on a scale from most government involvement to most private involvement, you find countries like Britain and Canada at one end, and they spend the least. You find countries like Switzerland and the United States on the other end, and they spend the most.

Now, it’s almost certainly true that if we switched to a purely private system and eliminated standard healthcare insurance as we know it, we’d end up spending less. This is the “skin in the game” theory, and it means that if we all had to pony up full cost whenever we visited the doctor or got an MRI, we’d pay a lot fewer visits to the doctor and demand lower cost MRIs. The problem, of course, is that this idea is universally hated and will never happen. This leaves Republicans in a quandary. It’s really the only idea they have, but they can’t seriously propose it because they’d probably get kicked out of office for the next 50 years or so. Their solution, in practice, is to (a) propose watered down versions of this idea hidden under enough layers that maybe no one will notice, and (b) relentlessly oppose every other idea without really offering any alternatives of their own. Remember “Repeal and Replace”? We never did hear much about the “Replace” part of that, did we?

Will this stalemate ever end? Probably someday. But not soon.

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