Thursday, June 18, 2009

Trust the Producer?

Even in well-functioning, reasonably competitive markets, I cannot think of an economist who would simply say "trust the producer to tell you how much should be consumed and at what price." I don't walk into Walmart and say "tell me what I need this week and we'll pay for it," and neither do most people. But that is exactly the argument some people make about health care. With this propaganda coming out, no wonder prices are so high!
Point 1: The market for health care is one that is inherently prone to imperfect information. In some ways, patients know more about their health and their habits, but doctors know more about their diagnosis and treatment. In fact, doctors specialize in knowing more about things that are wrong with you, so we really don't wand to correct the problem by making patients 100% informed (that would be prohibitively costly). There needs to be some sort of external regulator here.
Point 2: Health care is already rationed by bureaucrats, and we wouldn't have it any other way. Private insurance has armies of bureaucrats that determine what types of procedures and what costs will be approved for your care, not your doctor. If they didn't do this, you wouldn't be able to afford health care.
Point 3: Lots of people have public insurance already, and actually prefer it to being thrown out on the market for private insurance. Most people who are eligible for Medicare, VA benefits, or TriCare (and do not have any employer-provided benefits) happily take these benefits. Even the bureaucracy doesn't seem to bother them that much. In fact a lot of the most expensive patients in the system are already paid for using tax dollars.
Point 4: Private insurance is much more costly per person than being part of a group plan because insurees in the private individual market are adversely selected. Mostly sick people choose to be insured in this corner of the market. Healthy people in this part of the market who don't have insurance sometimes get very unlucky all of a sudden, and their urgent-care costs drive up costs for others.
Point 5: Private insurance premiums are not "actuarially fair" in economic terms. In other words, the premium i pay them exceeds the total expected cost of providing care over the entire pool of insurees. In other words, insurance companies make "economic profit," which should be distinguished from "accounting profit," or "proprietors' income."
I'm not sure if single-payer is the way to go, but the total net cost probably won't go up too much. If you think of the labor cost your employer pays in health insurance as wages you're not getting, it's outrageous! Between my employer and myself, I already pay about $10,000 per year! If that money simply shifted from my BC/BS to the government, and I got a comparable level of care, what does it matter? Bottom line: it's not patients and doctors who decide things now. Bureaucrats already decide and will continue to do so regardless.

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