David Piepgrass
Jul 10, 2017 · 3 min read

Are you being hyperbolic or have you not actually looked?

(Sheepishly) Well, no, I haven’t. I expected that after several years of health care debate after Obamacare passed in the U.S., I would have at some point come across conservative proposals without specifically looking for them, yet I don’t remember seeing any except the Individual Mandate, to which most conservatives are now opposed because Obamacare.

I could lay down the excuse that although I’m an American interested in U.S. politics, I haven’t actually lived in the U.S. since I was 9.

Let’s see. Avik Roy seems to say “let’s try to copy Switzerland — only we’ll want to avoid their individual mandate so let’s, um, prohibit people from buying insurance for a few years if they opt out of the individual mandate.” Er… what? So what, you’ll think twice about opting out, if it could lead to your bankruptcy or death when you can’t get insurance? Okay, it makes a little more sense when you see that poor people would not be allowed to opt out — but it kind of leaves me scratching my head about why it’s a good rule. Still, I can imagine conservatives liking it simply because it’s less “liberal”.

Ross Douhat says of copying Singapore “there has never been a major Republican policy proposal that just imitates what Singapore actually does” because of “a degree of statism and paternalism that present-day American conservatism instinctively rejects.” So perhaps a truly conservative adaptation of the Singapore system would be watered down so much as to be no improvement.

Megan McArdle’s graphs are a bit annoying in that she keeps using derivatives (in the calculus sense) — noisy graphs of year-to-year differences make it impossible to see cumulative totals.

Which reminds me, the U.S. system has so many components, moving parts and complications that any biased commentator in this debate, liberal or conservative, can probably easily find a nice pretty graph that agrees with their position, and almost no one will notice what was left out.

I guess I’d be happy with anything — single-payer, two-tier, Singapore, Swiss — as long as it gets costs under control.

But what has made costs rise faster than inflation for decades? Somebody mentioned that hospital rooms with single beds in them cost more than communal rooms, but many of those hospitals were probably built in the 60s and 70s when costs were dramatically lower. Not only that, but people are paying far more now despite spending fewer nights in hospital beds and less time with doctors.

I was thinking about prices along similar lines. Hospitals play despicable price games — one hospital charges $60,000 for something while another charges $15,000, and the same hospital will charge completely different prices to different customers. It’s nuts. What if we simply require that hospitals charge the same price regardless of customer, and require them to post a “no hidden fee” price list online? Maybe it’s naïve, but I have a strong suspicion that it could make a big dent in costs. But if I’m right about that, then it seems like single-payer should work even better.

Then there’s bureaucracy/paperwork. I have read about doctors starting their own practices and charging cash for everything — somehow this dramatically lowers costs! Why does it work? Can they avoid buying malpractice insurance? Surely doctors are not simply slashing their own pay? The Time article mentions an “army of administrators”…

Then there’s the monopolies (“many regions of the U.S. are now dominated by one hospital chain” — linked article). That’s never good for prices, and with two main components to the health system — hospitals and insurers — Americans are twice as likely to suffer from monopoly pricing.

Now why haven’t I seen a proposal that bans per-customer pricing, does something to make administrators redundant, and does something about monopolies?

Overall I think what blocks change the most is money in politics. Corruption. I knew Obamacare wasn’t a good law from the beginning. I mean, don’t get me wrong, it’s better than nothing. But I could tell it was flawed for one simple reason: the insurance companies weren’t funding big ad campaigns against it. Any truly good proposal is going to hit plenty of private-sector opposition, and politicians in both parties are too spineless to risk that.

    David Piepgrass

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    Fighting for a better world and against dark epistemology.