June 30, 2005

Still afraid of single-payer

Via economist James Hamilton's new blog comes word of yet another new health care plan, this one from Massachusetts Governor Mitt Romney.

Romney's plan would require everyone to purchase health insurance, and would provide financial assistance to those who can't afford to. As Hamilton points out, whether this is a good idea or not comes down to exactly how much government help would be provided, and to whom.

It would be callous and unfair if the plan pegged the level of state assistance to a straightforward assessment of a person's income or assets. Private insurance costs are much higher for people who are sick or who have preexisting conditions, so someone with an expensive disease and a high income might still not be able to afford adequate insurance. On the other hand, though, it would be intrusive and unwieldy for the state to adjust its level of support to all aspects of a person's medical history. The simplest way would simply be to require that everyone submit quotes for private insurance in their applications for state insurance; but even then, the bureaucratic apparatus required to evaluate all the data might be more cumbersome than it's worth -- especially if the state isn't generous with its help. At best, it would be costly and inefficient At worst, it would be unnecessarily intrusive.

My initial reaction to this plan is that it's just another misguided attempt to insure everyone without embracing single-payer. It runs the risk of becoming just another subsidy to the same private insurers that will continue to compete in the marketplace by shifting costs to someone else instead of keeping their insureds healthy by emphasizing preventive care. I'm tempted to think that this plan mistakenly treats the existence of uninsured people as if it were our fundamental health care disease, when in fact it's just one of the worst symptoms of our real problem, which is the lack of single-payer health insurance.

At least Romney is trying something. He should get some credit for that.

Posted by Carey at June 30, 2005 06:57 PM