Jon Cohn is one of the more intellectually honest supporters of universal healthcare and so I'm not surprised that he has grasped one nettle that some left-liberals refuse to even acknowledge: any shift to a centralized system where government has far more leverage and control will mean a decline in pharmaceutical and medical innovation. I think you can make an honest case that it's morally better to provide more healthcare to more people now rather than maintain recent levels of pharmaceutical research. But Jonathan insists that everything depends on how the new system would work. If you have the right experts, he claims, you won't have a slowdown in medical research:
The ideal would be to come up with some way of achieving the best of both worlds--paying for innovation when it yields actual benefits, but without neglecting less glitzy, potentially more beneficial forms of health care. And that is precisely what the leading proposals for universal health care seek to do. All of them would establish independent advisory boards, staffed by leading medical experts, to help decide whether proposed new treatments actually provide clinical value. The fact that Barack Obama's plan includes such a provision is particularly telling, since one of the plan's architects is David Cutler-- the economist constantly promoting the value of innovation.
Convinced? Me neither.
There's the usual liberal complaint that the private sector rewards short-term profits and that the government would be so much wiser in in its healthcare investments than the private sector. Yeah, right. Jon at least concedes the nightmare that is the British NHS, but doesn't address the fact that so many of the new drugs that France doles out to its patients come from the US free market system, a system that Cohn would essentially stymie. But the real money quote is this:
The goal is to reduce our spending moderately and carefully; the savings, most likely, would materialize over time.
And why should we reduce spending at all if we don't want to and the market reflects it? At some point, there really is an unbridgeable issue here. I don't see why the government should have any real say on how much a free people wants to spend on health. I don't think there is some "optimal" balance here, solely devisable by smart people who "promote the value of innovation" on government boards. We have a classic trade-off: between the innovation and choice of the private sector - and a "rational", government-based system that ensures that politics and not markets decide what our healthcare should be. I don't doubt this trade-off is coming. In a democratic society, the impulse to redistribute wealth and goods according to the wants of the majority - and a majority that's getting older - is politically irresistible. But the quality will suffer - as will the innovation. If we haven't learned that by now, we're ineducable. No special board of experts has ever saved us from this; and none ever will.