Patient Power

Brian,

I have been aware of your positions since the days of the 208 Commission when your proposal stood out among all the others. My concern centers on the deeply entrenched infrastructure, not only of the "entitlement mindset", but the mindset of so many in the system (hospital administrators, policy wonks, politicians, etc) that do not even have a concept of a "free market" economy. These are the people who came of professional age in the Medicare era (post 1966) and have been so inculcated with the government framework that they say things like "the public option will increase competition". They fill many of the key positions in medical societies and government and they have been framing the debate in their terms. Those of us who espouse less government involvement are shoveling uphill. I will keep slogging away because I do not see an alternative. Changing one mind at a time?

Seamus, I agree with your outlook. Once government creates an entitlement program those who are "entitled" form a powerful constituency to sustain the program, as do the government employees who manage it.

Replacing Medicare and Medicaid w/ a voucher for (what we call) "private" insurance would be an improvement, but is by no means the free market ideal. Still, it would be better. The "entitled" would still be getting a handout at taxpayer expense, but they'd get better choices of health plans and the gov't programs would not bust budgets and crowd out non-government insurers. It's not impossible to sell.

I prefer a form of tax credit such that if you donate, say, $100 to a charity comparable to Medicaid, Medicaid loses that tax revenue and you pay $100 less in taxes. Then Medicaid would have to compete for funds, just like other charities. (I have a few blog posts on this.)

The big picture, though, is to change public opinion. Then the politicians will follow. My cynical take is that successful politicians want to be a politician first, and what they actually stand for comes second. You know, like the rock band that just wants to be popular, and will play any tune they think people will like. Yes, an over-generalization.

Check out an essay by Robin Hanson called "Showing that you care." In a nut shell, people are loyal to those who help them, or appear to help them, when they are in a bad spot. Hence, the political value of "providing health care" (which means forcing other people to pay for your health care) is very valuable. Otto Van Bismark knew this. (I have a post on that, too, I think.)

Brian,

I agree with you in principle, but the great difficulty lies in deconstructing the existing infrastructure (Medicare/Medicaid) and the prevailing mindset (entitlements) that have dominated the healthcare landscape for the last 3-4 decades. I just don't see Congress, (even if there is a repeat of 1994 in House & Senate) having the willpower to roll back or shrink either of those programs. The premise that government is suited to "run" healthcare is a hard one to break. We need to encourage regular everyday people to help redefine the premise, or free market reforms will go nowhere. What do you think?
Seamus