The Health Care Crisis and What to Do About It
By Paul Krugman, Robin Wells
The New York Review of Books
March 23, 2006
The good news is that we know more about the economics of health care than we did when Clinton tried and failed to remake the system. There’s now a large body of evidence on what works and what doesn’t work in health care, and it’s not hard to see how to make dramatic improvements in US practice.
The bad news is that Washington currently seems incapable of accepting what the evidence on health care says.
1. Is health care spending a problem?
2. The unraveling of employer-based insurance
3. Medicaid and Medicare
4. The “consumer-directed” diversion
5. Single-payer and beyond
6. Beyond reform: How much health care should we have?
7. Can we fix health care?
A mere shift of power from Republicans to Democrats would not, in itself, be enough to give us sensible health care reform. Even liberal economists and scholars at progressive think tanks tend to shy away from proposing a straightforward system of national health insurance. Instead, they propose fairly complex compromise plans. But the main reason for not proposing single-payer is political fear: reformers believe that private insurers are too powerful to cut out of the loop, and that a single-payer plan would be too easily demonized by business and political propagandists as “big government.”
These are the same political calculations that led Bill Clinton to reject a single-payer system in 1993, even though his advisers believed that a single-payer system would be the least expensive way to provide universal coverage. Instead, he proposed a complex plan designed to preserve a role for private health insurers. But the plan backfired. The insurers opposed it anyway, most famously with their “Harry and Louise” ads.
We believe that the compromise plans being proposed by the cautious reformers would run into the same political problems, and that it would be politically smarter as well as economically superior to go for broke: to propose a straightforward single-payer system, and try to sell voters on the huge advantages such a system would bring. But this would mean taking on the drug and insurance companies rather than trying to co-opt them, and even progressive policy wonks, let alone Democratic politicians, still seem too timid to do that.
So what will really happen to American health care? Many people in this field believe that in the end America will end up with national health insurance, and perhaps with a lot of direct government provision of health care, simply because nothing else works. But things may have to get much worse before reality can break through the combination of powerful interest groups and free-market ideology.
http://www.nybooks.com/articles/18802
Comment: By Don McCanne, M.D.
You likely do not have the time right now to read this very long article. The sections are listed above simply to demonstrate that it really does address the health care crisis and what to do about it, as promised in the title. Save this for your next break.
Do not be deterred by the fact that this is a book review, actually a review of three books. It is a stand-alone article on our health care crisis, not constrained by the subject matter of the books reviewed.
You should encourage others who are concerned about our health care system to take the time read this article. You can assure them that most authors would have required an entire book to communicate the messages that Krugman and Wells have presented here in a single article. In this day of information overload, you’ll rarely find a bargain like this: a lucid perspective of the basics of our health care crisis with a very modest commitment of time.
Tell everyone to read it.