Wednesday, April 8, 2009

A partial defense for Arnold Kling's views on heathcare

A comment to Patriot's Quill unfairly titled "Arnold Kling does not understand the concept of insurance":
I will not defend the totality of Arnold Kling's views on health care.  It is indefensible.  A single payer has more leverage to attempt to reduce prices, and no market-magic-mumbo-jumbo can deny that fact.  That is why a company of several hundred employees does not have every employee buy their own desk at Ikea or Staples, and then reimburse them by adding to next month's paycheck.  Kling cannot address this simple issue because then he would lose valuable "Going-Galt" points with his friends at the Libertarian Cato.  (To be fair, it is also true that single payer is not a magic solution either.  If there is no accountability for incompetence or graft with the legislated single payer, a market solution can look pretty good.)
Back to the post.  I read Kling's point here as more nuanced.  It is transparently true that Americans, as a nation, consume health care with some personal irresponsibility.  Consider health care costs as percentage of GDP.  How much could be saved by personal lifestyle changes with regards to health, like diet or eschewing a sedentary lifestyle?  How much could be saved by people, as individuals, choosing less expensive treatments, treatments that are less expensive but still effective.  Without a component in a nationwide health-care plan that rewards for using less expensive treatments over the course of a lifetime, we could have functional single payer system, but still with the tragedy of America, as a whole, paying much more for health-care and getting much less for it.  Co-payments can be an effective incentive.  Co-payment rates based on evidence of healthy lifestyle choices can be effective.

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