The National Review‘s Ramesh Ponnuru joins the ranks of Time opinion columnists in the current issue. Curious Capitalist commenter Chuck really hated his first effort, so I just went and read it (sorry, been on the road). First, here’s Chuck’s take:
His thesis is that our healthcare is expensive because it is free, and to fix it we have to make people have more skin in the game.
How am I supposed to take your magazine seriously when silliness like that gets printed? Every other industrialized nation provides cheaper care than we do, and their systems are all essentially free like ours. It seems pretty clear that free-ness isn’t the main problem with our system.
Ponnuru only had 734 words to make his point, so I wouldn’t be too hard on him (or my colleagues at Time) for not going into all the counterarguments. But I’ve still got to say that I mostly agree with Chuck. Here’s Ponnuru:
[I]n recent years, most Republicans have come to believe that our health-care system is dysfunctional because it is employer-based and that this dysfunction has to be attacked at the root.
In this view, everything people dislike about our system results from the tax break for employer coverage. It makes costs rise, since people are less careful when they’re not paying out of pocket. It means people often lose their insurance when they switch jobs. And it keeps a lot of people–those who don’t have employers who provide coverage–from having much access to health insurance.
The conviction that employer-based health care is a problem is actually not at all unique to Republicans. In fact, the most serious proposal to do something about it has come from Oregon Democrat Ron Wyden. And there are two big problems with the alternative solution that Ponnuru advocates, which is basically letting the market take care of things.
The first is that health care markets don’t work like the markets of economics textbooks. That’s not just because employers and Medicare and Medicaid are involved. It’s because health care purchasers are at a huge informational disadvantage relative to health care providers. Yeah, lots could be done to get more information to health care consumers. And you could argue on libertarian principle that it’s better for individuals to make their own choices about health care than some government bureaucrat or HR person or HMO gatekeeper. But it’s hard to argue on the basis of outcomes. The U.S. gets less bang for its health care buck than any other wealthy nation. And I think that’s partly because government bureaucrats with some training in public health actually can make better decisions about how to allocate health care resources than lots of individuals choosing for themselves. Which bothers me, center-right commentator that I am. And makes me wonder whether we just haven’t figured out the right way to structure a true market for health care. But it can’t really be denied.
The other, possibly bigger, issue is that hardly anybody in the U.S. wants the kind of health care system that Ponnuru advocates. There is simply not much voter appetite for it, and no real Republican interest in pursuing it. The current administration’s main legacy on health care is going to be the expansion of Medicare, not the end of employer-based health care. And does anybody really think that Rudy Giuliani or Mitt Romney, once the Republican primaries are over, is going to keep pushing this line?
Update: In a post Tuesday, Ezra Klein notes that the Wyden health care bill’s 11 Senate co-sponsors include six Republicans. “And these are powerful, conservative, Republicans — Grassley, Judd, Gregg, Alexander, Coleman, Crapo, and Bennett (not to mention Lieberman).” So the “turn in Republican thinking on health care” that Ponnuru embraces clearly isn’t the only possible turn.