Tuesday, September 18, 2007

More on Health Care

I think there is really an absence of realistic discussion of first principles for healthcare reform. Everybody and their brother speaks of universality but more importantly are issues of affordability (both for an individual and in the aggregate), access, and innovation. These three elements do not all move in the same direction but are ultimately in competition. Most commentators and politicians agree that health care expenditures consume too great a portion of GDP and the rate of growth in this sector is too high. What do the Democratic proposals do to corral this growth? In my view it doesn't look like cost containment is even considered in these proposals. There seems to be some sort of premise that if we have universality that health care will be cheap of a sudden, as if universality of coverage were some sort of pixie dust. If you achieve universality of health coverage merely by extending SCHIP and subsidizing insurance you are not addressing the cost issue, rather you are exacerbating it.

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