The New York Times
March 19, 2002
By Paul Krugman
Sunday’s front-page story in The Times on doctors who shun patients with Medicare may have been alarming enough; it seems that recent cuts in Medicare payments are inducing many doctors to avoid treating Medicare recipients at all. But this is just the beginning of a struggle that will soon dominate American politics.
Think of it as the collision between an irresistible force (the growing cost of health care) and an immovable object (the determination of America’s conservative movement to downsize government).
Why don’t we just leave medical care up to individuals? Basically, even in the United States there are limits to how much inequality the public is prepared to tolerate. It’s one thing if the rich can afford bigger houses or fancier vacations than ordinary families; Americans accept such differences cheerfully. But a society in which rich people get their medical problems solved, while ordinary people die from them, is too harsh even for us.
But meeting the public’s expectations for medical care – that is, ensuring that every American, and in particular every retired American, gets essential care – will require a lot of government spending. And the conservative movement in general, and the Bush administration in particular, are not prepared to make the money available; after all, government spending must ultimately be paid for with taxes.
Yet they dare not say openly that they are prepared to deny essential health care to those who cannot afford it.
Paul Krugman, Ph.D., is Professor of Economics and International Affairs at Princeton University.
Comment: “A lot of government spending” does not have to mean more spending. The administrative efficiencies enabled by establishing a publicly administered program of universal insurance would provide enough savings to fund the deficiencies in our current system. The only hurdle has been our reluctance to accept the fact that “public administration” means that the government would collect the “premiums” and distribute those funds equitably and efficiently. That is not a bad thing. We have to get over thinking that it is.