DeLong Care

Erik Kain

Erik writes about video games at Forbes and politics at Mother Jones. He's the contributor of The League though he hasn't written much here lately. He can be found occasionally composing 140 character cultural analysis on Twitter.

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14 Responses

  1. ChrisWWW says:

    This is pretty much the Singapore plan I brought your attention to before, except with government mobile clinics.

    It’s a good plan for sure. But it completely gets rid of insurance companies, which likely means it will never get the support of so-called American conservatives.Report

  2. Jaybird says:

    There are a number of systems that may be better than the status quo.

    I think that the one thing that they all have in common is that they assume a dismantling of the status quo and then replace the vacuum with this, that, or the other plan.

    Is a dismantling of the status quo, like, even possible? Don’t get me wrong. I’d love to see the status quo dismantled. I’d love to see a libertopia. I just dwell on such things a lot less than I used to.Report

  3. Jaybird says:

    Oh, and I’d add one more caveat – lets stop protecting Big Pharma. No way we can ever control costs while we let protectionist policies set prices on our drugs.

    This part also made me scratch my head.

    From what I understand, other countries pay “big pharma” just a little over cost for pills. R&D isn’t taken into account, the R&D for pills that never made it to market sure as hell aren’t taken into account… under threat of “if you don’t sell to us at this price, we’ll steal your IP”.

    Without getting into the whole “information wants to be free” debate with regards to IP, this strikes me as an area where a somewhat more “protectionist” policy would result in lower costs in the US without risking the death of a golden goose.Report

  4. Tim Kowal says:

    Points three through five, regarding the Health Savings Account, are interesting. The rest of the points, of course, are going to be dismissed out of hand by conservatives. It seems the HSA idea could comport quite easily with conservative thinking, so I frankly don’t understand why it’s bundled up with other ideas that are so anathema to conservatives.

    But the HSA idea might have enough of a “pay for your own self” spirit without too much paternalism in forcing folks to pay into it. But oy!—what’s this bottomless pit lurking around in there at number 6? I think I can find catastrophic insurance for less than 5% of my income. I understand that folks have this over-enlarged “social justice” center in the brain that spurs them to sliding measures like this into the conversation, but many of us do not. Over here in California, we pay through the ear for social programs. If health care is the social program du jour, then implement some pay-go spirit, and shift the cost from welfare into health care. All of it seems silly to me, this feeling worse for people than they feel for themselves. But shift around those silly program dollars to less silly programs, if you like, and you’re not likely to hear folks like me pipe up about it.

    Without the HSA idea, the rest of the points are rubbish. I’m on board with fighting costs by some federal preemption on health care regulation and lifting the shroud of mystery over the costs of procedures. (And re pharma, is anyone talking about any ways of kicking the euro-free-riders off the innovations we pick up the tab for?) But let’s do those things before shoving out with this funny sounding mobile government doctor army idea. And “taxes on public health hazards” at number one on the list is going to halt the eyeballs’ downward momentum straight off.Report

    • Tim Kowal in reply to Tim Kowal says:

      Perhaps I fail to take to heart DeLong’s admission that the plan is “unrealistic.” Then again, one can’t use such things as a shield from criticism.Report

    • Travis in reply to Tim Kowal says:

      Why is it “bundled up with other ideas that are so anathema to conservatives?”

      Because that’s the way to ensure everyone has access to affordable health care. Yes, doing that involves taxing the rich and using that money to subsidize the poor.

      This is a compromise (from a full single-payer government system) that recognizes personal responsibility for payment of health care needs while simultaneously ensuring that nobody goes bankrupt paying their hospital bills.

      If you’re going to reject offhand any proposal that involves tax-subsidizing health care based on income, then the rest of us can just safely ignore you, because you’re in right-wing fantasyland. Whether it’s public option, DeLong Care or Canada-style single payer, there’s going to be tax subsidies involved.Report

  5. Art Deco says:

    Milton Friedman suggested a decade ago comprehensive public insurance for costs over a high deductible conjoined to the use of medical savings accounts. I do not recall if he suggested these accounts be funded though mandatory sequestration of income. To distinguish sequestration from taxation, one would have to be permitted to use at ones discretion any funds in excess of a standard balance.

    One question I have had is whether an economic analysis has been done of the implications of the deductible being on a sliding scale according to income or being a specific dollar amount per family.

    You could vitiate ill effects of the latter by having a comprehensive tax and welfare reform (which is at least as unrealistic).

    As for who functions as the insurer, one might consider dividing the country into catchments and then randomly assigning the households therein to cohorts. The government might then hold an auction for each cohort, with each participating insurer submitting bids for the medical insurance contract and / or the long term care contract for one of the cohorts. The government collects the premium for the cohort by making a flat assessment on incomes, so the affluent are subsidizing the impecunious. The contracts run for (perhaps) six years and expire at staggered intervals and the deductible is automatically re-adjusted so that public commitments through the sum of all contracts remains fixed at 9% of domestic product. The government writes the contract, conducts the bidding, and collects the premiums. The insurers negotiate with provider networks over rates. Local medical societies publish the rates for consultations and lab work charged by the practices within their bailiwick. Some degree of constraint on prices is maintained by the cash-for-services transactions taking place below the level of the deductible.Report