Monday, July 26, 2004
"Limited Paternalism"
[Arnold Kling, "Our Coming Ideological Battles," Tech Central Station, 20 July 2004.]
This recent column from Tech Central Station provides a decent roadmap toward a future not dominated by single-payer health care. That such a plan will reduce calls for socialized medicine may be unlikely, but it certainly should undermine efforts to cast those calls as reasonable:
America's health care system has many flaws. However, the solution is not to enlarge government's role. What I would like to see is a role for government in health care that is streamlined, rationalized, and bounded. I call this approach "limited paternalism."
Limited paternalism has the following components:
- Direct provision of health care services to the poor. For example, government-subsidized clinics in poor neighborhoods with nominal charges (say, $10 per visit).
- Aim to switch from a system of employer-provided health insurance to consumer-purchased health insurance, by ending the tax deductibility of insurance for corporations and eliminating requirements that companies provide health insurance.
- Mandatory catastrophic health insurance for all families not eligible for Medicaid. Rather than expand Medicaid and other government programs upward to the middle class, as some Democrats propose, tighten eligibility for these programs and require co-payments for all but the poorest participants. Eventually, phase out Medicaid and replace it with health care vouchers.
- Phase Out Medicare, and instead mandate health care savings accounts. This would change the medical portion of retirement security from a defined-benefit plan, which Congress will tend to pack with benefits that it cannot pay for, to a defined-contribution plan, which is much sounder financially and much fairer generationally.
- Institute government-provided "catastrophic reinsurance" for very high medical expenses. The Kerry campaign has proposed this for expenses of over $50,000 per year. The purpose of catastrophic re-insurance is to enable private insurance companies to compete for business without having to screen out high-cost individuals. Of all the mechanisms for spreading the cost of break-the-bank illnesses among the general public, catastrophic reinsurance would involve the government in the least number of individuals and the least number of medical decisions. While the rest of the Kerry health care plan tends to be the opposite of what I would like to see, this proposal strikes me as a good plank in any health care reform platform.
"Limited paternalism" may not be everyone's ideal. However, the most likely alternative will be creeping socialism -- or perhaps galloping socialism. As more and more medical care comes under the auspices of government, the American system will start to acquire the flaws of Canadian health care. Without a safety valve.
[Arnold Kling, "Our Coming Ideological Battles," Tech Central Station, 20 July 2004.]
This recent column from Tech Central Station provides a decent roadmap toward a future not dominated by single-payer health care. That such a plan will reduce calls for socialized medicine may be unlikely, but it certainly should undermine efforts to cast those calls as reasonable:
America's health care system has many flaws. However, the solution is not to enlarge government's role. What I would like to see is a role for government in health care that is streamlined, rationalized, and bounded. I call this approach "limited paternalism."
Limited paternalism has the following components:
- Direct provision of health care services to the poor. For example, government-subsidized clinics in poor neighborhoods with nominal charges (say, $10 per visit).
- Aim to switch from a system of employer-provided health insurance to consumer-purchased health insurance, by ending the tax deductibility of insurance for corporations and eliminating requirements that companies provide health insurance.
- Mandatory catastrophic health insurance for all families not eligible for Medicaid. Rather than expand Medicaid and other government programs upward to the middle class, as some Democrats propose, tighten eligibility for these programs and require co-payments for all but the poorest participants. Eventually, phase out Medicaid and replace it with health care vouchers.
- Phase Out Medicare, and instead mandate health care savings accounts. This would change the medical portion of retirement security from a defined-benefit plan, which Congress will tend to pack with benefits that it cannot pay for, to a defined-contribution plan, which is much sounder financially and much fairer generationally.
- Institute government-provided "catastrophic reinsurance" for very high medical expenses. The Kerry campaign has proposed this for expenses of over $50,000 per year. The purpose of catastrophic re-insurance is to enable private insurance companies to compete for business without having to screen out high-cost individuals. Of all the mechanisms for spreading the cost of break-the-bank illnesses among the general public, catastrophic reinsurance would involve the government in the least number of individuals and the least number of medical decisions. While the rest of the Kerry health care plan tends to be the opposite of what I would like to see, this proposal strikes me as a good plank in any health care reform platform.
"Limited paternalism" may not be everyone's ideal. However, the most likely alternative will be creeping socialism -- or perhaps galloping socialism. As more and more medical care comes under the auspices of government, the American system will start to acquire the flaws of Canadian health care. Without a safety valve.
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