Friday, June 8, 2007

If you want a picture of the future, imagine a barefoot doctor examining your prostate--for ever.

The first two prongs of Brad DeLong's health care plan (a 20% tax on income to fund the thing, a tax rebate if expenses are less than 15%; the rest covered and is funded by the extra money from the program, or the general budget, or unicorns) don't make any less sense than most other funding methods for single player plans. On the other hand, I'm having a hard time describing the third prong without getting Godwin's law thrown at me...

Sin Taxes: on Tobacco, Gorgonzola, Three-Liter Bottles of Liquid High-Fructose Corn Syrup, Tanning Clinics (Melanoma), et cetera: Sin taxes (and, perhaps, someday general revenues) pay for an army of barefoot doctors and nurses and mobile treatment vans roaming the country and knocking on doors: Let me examine your prostate. Mind if I check your refrigerator and tell you how to eat healthier? Have you exercised today? I'm a Pilates instructor, and we could do a session now? Are you up on your immunizations? Anybody here have a fever and need antibiotics? Come on out to the van and I'll clean your teeth." The idea is to make the preventive care cheaper-than-free, to insure that nothing with a high long-run benefit/cost ratio gets left undone because people would rather get a bigger check the next April to use to buy an HDTV.

I know!

'Smith!' screamed the shrewish voice from the telescreen. '6079 Smith W.! Yes, you! Bend lower, please! You can do better than that. You're not trying. Lower, please! That's better, comrade. Now stand at ease, the whole squad, and watch me.'

The fourth prong is a relatively inoffensive increase in public health research funding.

h/t MR.


Flinger said...

Funny funny stuff.

But I disagree. I support single payer, but recognize that there are some plausible critiques, having mostly to do with doctor driven overutilization or, alternatively, reduced incentives for research.

The budgetary angle, however, is the single payer's long suit, at least if you are an honest advocate for it. Single payer should be funded by raising individual and corporate income taxes -- it would unquestionably expand the fiscal scope of government. The tax-payer (individual or corporate), however, would enjoy a significantly better financial position because the increased taxes would almost certainly be less than the price of the premium. This is because a single payer can restrain cost growth, and the 8% or so greater overhead attributable to private insurance over medicare could be either turned into health care or refunded. Moreover, the individual would be freed from the specter of bankruptcy, and the job market would be more efficient because people would not be tied to jobs.

The only people/corporations that would experience a tax increase would be those who are voluntarily foregoing insurance in the status quo.

MattXIV said...

I'm going to post some more substantial critiques of DeLong's plan this afternoon.

I think that a lot of the benefits of single payer cited wouldn't materialize in practice. A lot of the cost suppression is simply from rationing care - less generous benefits cost less. Also, the overhead tends to be from administering rationing and anti-fraud policies, and to the extent that those policies are more or less precise the costs will vary.

The job-insurance linkage is an artifact of tax policy. Delinking jobs and insurance is simply a matter of either making insurance deductible from income taxes or not deductible from corporate taxes or (probably best) not deductible for anybody.

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