Saturday, November 11, 2006

No Bandaids Please

If the coverage is <i>universal</i>, the people who are covered today will see little difference.  If they want additional coverage, they are certainly in a position to buy it.
The big picture is that we spend 15% of our GDP while similar countries spend 10%, but they get better results providing health care for their money.
The savings come from the <i>universal</i> aspects of their coverage, not least the ability to constrain prices by aggressive bargaining with suppliers.
The question is, how do we get the savings, that is to say, what practical steps need be taken?  It remains necessary to collect the 10% of GDP to pay for the care, but also important to distribute the 5% that is saved to the right people.  That might involve mandating increases in pay by employers relieved of the necessity of providing coverage to employees, or it might involve investment in the building of clinics or the provision of services.
Introducing a patchwork of bandaid repairs is the worst approach.  Every such 'fix' becomes a perpetual hostage of legislative fortune, administered by empire-building bureaucrats who can be trusted, in any case, to ignore the legislative intent and mandate of the legislation that funds them.  The intended recipients are harrassed by means tests and the providers by authorization demands.  The worst approach.


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