David, I enjoyed your exercise in fisking Paul Krugman. He deserves it every chance someone takes a notion. It's a terrible thing to trade in hard-earned academic expertise in exchange for obviously partisan punditry wielded without subtlety. I remember reading Nicholas Kristof remarking that he was surprised by how little influence his NYT op-ed slot gave him over the national debate. I can only surmise that realization has maddened Krugman into ever greater extremity.
On the other hand . . . I am no lover of the idea of nationalized health care, (I always thought if we should nationalize something it should be the practice of law because lawyers depend entirely on the existence of government to make their living.) but, I know what it's like both to go without insurance because of limited resources (as a young person without children) and then to have very poor quality insurance (as a person with wife and children). The first situation is not so bad and I imagine there are millions who do the same. The second gets a little ugly. When you have poor insurance that you pay a lot for because you don't have employer-provided coverage, you worry a lot about whether they'll reimburse things you really need, like tubes for the ears of a child with frequent, raging ear infections. You wonder whether they will pay for something utterly necessary, like the anesthesiologist. You feel outraged that you pay so much and still feel like you got your insurance card out of a box of cracker jacks. I also know how wonderful it was to get into a situation where we had a really good insurance company that everybody accepted and that reimbursed quickly. Big difference.
Times like that interfere with your intellectual process. When we had bad insurance I thought about how much I might welcome national health care and how much I would love not to pay the big premium coming up. There are people in that position and unfortunately, they don't listen to our arguments about how bad socialized systems are. They feel lowly and they would like their fortunes to rise a little. They're also powerfully attracted to everybody having the SAME level of coverage.
I know you're ultimately right about socialized medicine. My answer, based on my time as an analyst at a large insurance company, is that we should abolish health insurance altogether or make it work more like auto insurance. Basically, it would just cover the big stuff. I say that because the pricing mechanisms between providers and patients are utterly screwed up because of contract negotiations between big insurance companies and hospitals, doctors, etc. Hospitals set a price and insurers negotiate to pay a percentage of that price. Then a cycle sets in. The price keeps increasing and the percentage keeps falling as the two big forces fight it out. The result is that you get an unreal price that no one pays EXCEPT for the people without insurance or those with bad insurance. Without insurance or with a very different notion of health insurance, the price relationship between consumers and providers could become rational again and even those without policies could probably find a way to pay their bills over time.
Love to get a reaction from you on this one, David or others. I know you've been looking at it.
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