Again: A Primer on Effective Health Insurance Reform

Under the heading "Things SWNID Will Never Get Used To," the first item will be, "People don't learn something the first time SWNID enlightens them."

So yet again, we offer a link to something that aptly describes what really ails health insurance in our Republic. Today it is Joseph Rago's review of Health Care Turning Point by Cornell Professor Emeritus of Economics Roger Battistella. Like everyone SWNID has linked with approval (e.g., Whole Foods CEO John Mackey, Harvard Med School chief Jeffrey Flier, Atlantic contributor David Goldhill, Atlantic economics editor Meg McArdle, Senators Wyden [D-Oregon] and Bennett [R-Utah]), author Battistella and reviewer Rago know that the best monitors of health care quality are patients and the best way to empower patients is by having them, not a third party, make the choice of insurance plans and pay the first-dollar costs.

So with the standard imperative (seldom obeyed?) to read the entire review, we offer some choice quotations:

"Because most consumers of health care are largely insulated from directly paying for the services they use, health care is generally perceived as an unlimited free good. . . . Wants and needs become insatiable when care is believed to be free." . . .

Mr. Battistella begins with the original sin of modern American health care: the government's World War II-era decision that gave businesses tax incentives to sponsor insurance for their workers but that did not extend the same dispensation to individuals. Since third parties were paying most of the bills--employers at first and eventually, with the creation of Medicare in 1965, the government as well-- no one had any reason to be assiduous about controlling the cost of care. Patients always seemed to be spending someone else's money. . . .

The solution, Mr. Battistella argues, is the "hidden pragmatism of market competition." In a competitive environment, he says, the "prosperity and survival" of caregivers would depend on "outperforming one's rivals." Meanwhile buyers--that is, patients--would be motivated to inform themselves and to "obtain the best service at the lowest price." It sounds elementary, except that in American health care it has never been tried. What would it look like? Mr. Battistella imagines individuals free to buy a wide variety of insurance coverage and choosing providers on the basis of transparent data about price, quality and value. There would be a transition, but it could be as smooth as the shift from defined-benefit pensions to 401(k)s. . . .

Mr. Battistella discounts the many ways in which our mix of private- and government-paid health insurance suits members of the political class: They always have a handy villain to blame (e.g., private insurance companies) when something goes wrong—even if the government is already calling most of the shots (e.g., archaic regulations) and even if the actual source of the trouble is the same central planning that distorts single-payer systems (e.g., Medicare's price controls).

Meanwhile, the Democratic leadership now believes that it can pass the Senate bill in the House without the Stupak twelve, even though with Stupak's anti-abortion votes they could only pass a previous bill by five votes, and some from their margin are now dead or resigned. Of course, doing the math on this issue has never been the strong suit of Obama/Pelosi/Reid.

Also the deadline for this vital legislative process has been moved back for the gazillionth time, delaying BHO's trip to Indonesia. Like after fifteen months an extra three days will do the trick. We've supervised thesis students with the same concept of time as an unlimited resource. Today, they don't have master's degrees.

Enough ink has been spilled on the chess metaphor of "endgame" to provide a different metaphor: stalemate. As gentle readers who play the Game of Kings know, "endgame" refers to that portion of the game (following the mysteriously named "opening" and "middle game") when, with few pieces on the board, one player presses the other toward checkmate. However, in a game played more or less evenly, the endgame can yield stalemate, in which neither player has enough of an advantage to bring the other to defeat or, more embarrassingly, the player with the superior and sufficient power misplays his pieces so as to allow no legal moves by his opponent or simply dithers away with pointless moves until the limits of identical board positions or game timing are reached.

Stalemate is a tie, but a moral victory for the weaker player and a defeat for the stronger. In the highest levels of chess, if one plays with the black pieces, which have the disadvantage of moving second, and plays to stalemate (or a draw, both players agreeing that the game will likely end in stalemate), one has scored the equivalent of a victory.

Democrats started with a massive political advantage, like playing white and black not having a queen on the board. Since then, they've blown all their advantages with incautious, over-aggressive tactics and now sit at a board where they have only a king and a knight while the Republicans have only a king. By definition, that's stalemate: the Dems have more material but not enough to deliver checkmate. But the Dems, blind to reality, insist on moving their pieces forever, hoping to find a miraculous way to check the black king even though they have insufficient material to do so.

In an actual chess tournament, the game would be called and the board reset, with the Rs taking the white pieces. In a democratic republic, we have elections that often do the same thing.