March 17, 2006


To Your Health: Why modest reform is preferable to single-payer health care. (Michael Kinsley, March 17, 2006, Slate)

In the March 23 New York Review of Books, Paul Krugman makes the case for a health-care system that is not only "single payer," meaning that the government handles the finances, but in some respects "single provider," meaning that the government supplies the service directly.

Krugman and his co-author, Robin Wells, correctly diagnose the problem with the Bush administration's pet health-care solution of encouraging people (with tax breaks, naturally) to pay for routine care à la carte instead of through insurance. Like Willie Sutton in reverse, this notion goes where the money isn't. Annual checkups and sore throats aren't bankrupting us: It's the gargantuan cost of treating people who are seriously ill. People who can get insurance against that risk would be insane not to, and the government would be insane to encourage them not to.

Most lucky Americans with good insurance are doubly isolated from financial reality. They don't pay for their health care and they don't even pay for most of their insurance—their employers or the government pays.

So Mr. Kinsley both recognizes the value of a system where Americans are forced to face financial reality by paying for their health care and opposes such a system because George W. Bush is implementing it. Such are the wages of BDS.

Posted by Orrin Judd at March 17, 2006 4:13 PM

Krugman wants to make the hospitals run on time.

Kinsley wants help with schizophrenia.

Posted by: Luciferous at March 17, 2006 4:29 PM

. . . out of self-interest on the part of Kinsley!

Posted by: obc at March 17, 2006 4:41 PM

in a different age, kinsley would be working with chickens at a carnival.

Posted by: toe at March 17, 2006 4:51 PM

"their employers or the government pays"

Where does Kinsley think the money to pay comes from other than the working folks? Krugman's an economist? I suppose my emplyees thought I was paying half of their SS. It was merely a cost of doing business. It was part of their salary whether I paid or they did. Smoke and mirrors.

I also wonder if Krugman wants to use Canada for his health care.

Posted by: jdkelly at March 17, 2006 6:30 PM

You want smoke and mirrors? I'll give you smoke and mirrors.

Of course, the lunch isn't free, and the cost of health care is part of the cost of maintaining a givin number of human beings.

The guestion should be whether the proposal is necessarily more efficient, and I strongly suspect that it is not.

The reality is that if the routine office visit costs $125 instaad of the typical HMO co-pay of $15, many people won't go or willl put off going.

That's the idea, to get people to cut down on medical care. Does that save money?

Well, if serious condition are undiagnosed, probably not. If timely medical advice and procedures are foregone, probably not.

This issue needs to be looked at carefully and discussed carefully. I'm not going to sacrifice my assault rifles and the lives of the unborn over it, but, hey, that's me. If people come to understand it, it looks more and more klile selling apples on streetcorners.

Posted by: Lou Gots at March 17, 2006 8:42 PM

The bottom line is that most routine medical "care" is unnecessary.

If we can get out in front of that, then we can save money. That's the point of tort reform, to let doctors stop practicing "defensive medicine".

If people stop going to medical practitioners about colds and flu, due to the higher cost of office visits, rather few more people will die than do now, since medical science can do nothing about colds and flu, once they're contracted.

Posted by: Noam Chomsky at March 17, 2006 9:06 PM

For many of the elderly, going to the doctor is a social event where they enjoy a snack of juice and cookies and chat with friends and neighbors in the attractive ambience of a modern healthcare facility -- and best of all, it's free.

Posted by: erp at March 18, 2006 10:51 AM