Sundry Thoughts on Health Care

by Conor Friedersdorf

As I ponder an Obama Administration health care reform bill, whatever that turns out to look like, I am struck by how different the debate is on the left, where Ezra Klein and other wonks are deep in the weeds on health care policy, and the right, where objections to a greater federal role are predicated largely on a general principled aversion to interference in markets and a rapidly expanding state. I'd like to pose a few questions meant to stoke conversation between these groups, and to highlight a couple of my own (possibly mistaken) ideas about health care in America. As I've yet to study this issue deeply, I am persuadable on most points, and I expect some who share my opinions are too.

  • I am convinced of the need for major reform in the health care sector, especially due to three arguments. a) The current system is an economic drag insofar as it ties people to jobs they'd otherwise leave, discourages entrepreneurship, and otherwise lessens healthy risk-taking because people fear losing their insurance. b) There is a moral obligation to ensure that every citizen has some minimum level of health care, in the same way that society has decided everyone should have some baseline level of food. I find it difficult to pinpoint what level exactly, but I suspect we're currently falling short of it. c) I suspect the government can play a useful role pushing measures like electronic medical records that I doubt would happen absent a state coordinating role (including privacy protection measures). I'd be curious to hear the best arguments against those propositions.

  • I am skeptical that I'll be able to support the plan progressives intend to put forth. This is due to three concerns. a) Its cost. I'd bet a hefty sum that expanding coverage and the role the federal government plays in health care is going to significantly increase rather than decrease costs. Since we're already paying for costly foreign wars, generations of accumulated debt, a massive bailout, and other entitlements with rapidly rising costs, it doesn't seem like we're in a fiscal position to pile on more government spending. b) Fear of excessive state power. It shouldn't be too difficult to imagine another Dick Cheney or Richard Nixon in the White House. Are we really comfortable assuming that the state will never use its role in health care to pressure political opponents, or collect frightening kinds of data, or politicize medical decisions more than is now the case? Isn't there any size and scope of government that progressives deem to be too big on prudential grounds? Why doesn't this put us there? Isn't it better for one among many health insurance companies to deny coverage, compared to one government run entity deeming something uncovered, as could happen if a public option drove some or most insurers out of the market? Health care is really important. Isn't it unwise to concentrate too much power over it in any one place, the federal government included?  c) Fear of lost innovation. I keep seeing the argument that America is the leading health care innovator, and that if our system looks more like what Europe has, there won't be anyone left making strides in research and development. I haven't seen a convincing rebuttal, though there may well be one. Links?

  • Lastly, a few scattered thoughts. a) It seems like we should train people other than doctors to perform certain discrete medical tasks that don't require all those years of medical school -- a mix of pharmacists, professional bone setters, nurse practitioners and others should be able to dole out a lot of routine examinations, procedures and cures at a lower cost. b) I hate the attitude among doctors that patients should keep quiet, refrain from asking questions, and basically remain totally ignorant about the process of diagnosis. People ought to know how their bodies work. Yes, I'd get sick of patients convinced by Web MD that they've got lupus too. But there is a pretty astonishing ignorance about the basics of how the human body works for which the medical establishment is partly to blame (so is the biology curriculum in high schools). c) What is the objection to a fair formula that largely determines damage awards in medical malpractice cases, rather than relying on the vagaries of the jury system? Wouldn't this make the risk insurers are taking on more predictable, and significantly lessen the cost of malpractice insurance for doctors? And wouldn't a set of payouts -- perhaps based on a formula that factored in relevant differences between cases -- result in a fairer distribution of award money?

In sketching out these questions and arguments I'm sure I've made some faulty assumptions, fallen prey to some clever talking points that don't hold up to scrutiny, etc., but I think it's worthwhile to raise certain matters in good faith, if only to narrow the gap in the conversation by airing arguments, weighing rebuttals, and reasserting a more refined position.