Predictions about Healthcare
I’m going to make a few predictions about the future of U.S. healthcare, provided that the bill under consideration passes.
First, the bill will prove substantially more expensive than projected. Ezra Klein is naive to take the CBO numbers at face value, and Peter Suderman is right to dig deeper, but I strongly suspect that that’s not the half of it.
Significant upward revisions are on the way, but only after passage. Everyone will profess to be surprised. Everyone will be lying, because large new federal programs usually cost more than expected. There will be fights about whether a very large sum of money — the difference between today’s estimate and the future’s — is really all that large. These fights will be of little consequence.
Second, I predict that Obamacare will trundle along despite all of the above. I hope I’m wrong on this, but I don’t see a serious repeal effort in the near term. Once something’s done in Washington, it’s very hard to undo, even if everyone agrees that it’s a bad policy.
Third, even if the bill is implemented more or less as we see it now, I predict that U.S. health outcomes will not substantially improve relative to other countries. I predict this because U.S. health outcomes are already fairly good. There’s not a lot of room for relative improvement, even if we do spend more money. We’re in the middle of the pack of industrialized nations today, and I expect that we’ll still be in the middle of the pack ten years from now, barring any major localized catastrophes (civil war, plague, nuclear attack, a major dollar crisis, or the like).
A substantial part of the difference in health outcomes between the United States and the world’s very healthiest countries stems not from lack of health insurance, but from the American lifestyle. Americans eat more, drive more, and exercise less than most other wealthy nations. We have more accidents, more heart disease, more diabetes, and more cancer owing to things that aren’t addressed here at all. These are things we will presumably keep right on doing to ourselves.
Giving many more people free or subsidized insurance will certainly improve some people’s particular health outcomes, but it won’t have a large effect on health outcomes across the board. Many of the newly covered people will be poor but young and healthy. They won’t especially need the insurance, and it won’t help their health in the least. Policies like these buy a small amount of health with a large amount of cash. The rest becomes a corporate subsidy.
Now, the corporations may need this subsidy to pay for the new requirement that they cover people with preexisting conditions and the other various restrictions they will face. But this just brings me back to my biggest problem with the bill as it’s finally being voted on: What is “state-subsidized mandatory insurance for anyone with a preexisting condition,” if it’s not a farmed-out corporatist version of socialized medicine? I’ve wondered about this for a long time but never found a satisfying answer.
If I’m right in this hunch, then even single-payer could prove to be a better system than the one we’re on the verge of implementing, which seems to further marry the worst aspects of both the market and socialism, albeit in a spectacularly inefficient way. It seems also to foster more entanglements between big corporations and the government, of exactly the sort that genuine libertarians hate, and that liberals ought to hate as well.
So: Bigger deficits, no significant attempt to repeal, no big improvement in health outcomes, and more corruption in the form of state-corporate collusion. Those are my predictions. Oh, and at some point a new crop of Democrats will get fed up with it all and try to implement single-payer. By then we won’t even be able to pretend to pay for it.