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The John Edwards health insurance plan

Kevin Drum writes:

John Edwards' new healthcare proposal is, basically, an individual mandate (everyone is required to get health insurance coverage somehow) combined with community rating (private insurers have to take all comers, regardless of medical condition) and government subsidies (the feds will pay for insurance if you're too poor to afford it).  Private insurance would be available through a mechanism Edwards calls "Health Markets."

Edwards is honest enough to tell us this will raise our taxes.  Kevin Drum is honest and he tells us that the best hope for this plan is evolution toward a single-payer system.  Here is Matt Yglesias, here is Ezra, here is more

Loyal MR readers will know that I do not favor a single payer system but I can appreciate its logic.  If we are going to regulate insurance companies very heavily, they become a superfluous middleman and a source of manipulation, while yielding few offsetting benefits. 

In the United States doctors (check out those wages) and insurance companies are far more politically powerful than elsewhere.  You might think that makes our health care system worse, if so it will make our health care reforms worse too.  If anything happens, those groups will have a veto, more or less, on the distribution of the resulting rents.

I believe that the best and most intelligent Democratic bloggers are already rooting for an evolutionary path whereby the first-step reforms -- whether at the state or federal level -- eventually succeed only by making matters intolerable and unprofitable for doctors, insurance companies, and perhaps hospitals as well.  After profits have suffered enough, perhaps everyone will see the light at the end of the tunnel and simply abolish those nasty private health insurance companies.

Given how politics actually works, I do not consider this a promising sign for the future of American health care reform.

Addendum: I did very much enjoy reading the first comment left on this post...

Posted by Tyler Cowen on February 7, 2007 at 06:58 AM in Economics | Permalink

Comments

Private insurance would be available through a mechanism Edwards calls "Health Markets."

Did anyone else crack up at reading this? Let me guess:

"Patients and insurers will reward health care providers with what Edwards calls 'Money.' Americans will monitor their health through what Edwards calls 'Doctor Visits.' They will secure access to this money through a mechanism Edwards calls 'Having a Job.' Decision to provide or purchase various medical service will be determined by what Edwards calls 'Supply and Demand.' People will arrive at health care providers in what Edwards calls 'Vehicles.'"

Posted by: Person at Feb 7, 2007 9:37:48 AM

If we are going to regulate insurance companies very heavily, they become a superfluous middleman and a source of manipulation, while yielding few offsetting benefits.

What benefits do they yield if we don't regulate them very heavily? (I don't think "they use market power to negotiate better prices with health care providers" is the answer to that question; those benefits accrue even if insurers are heavily regulated or if the government is the monopsony buyer of health care services.)

Posted by: alkali at Feb 7, 2007 10:38:30 AM

Alkali - current health care regulation mandates minimum amounts of coverage so that everyone is buying "cadillac" coverage. Additionally, there are severe barriers to entry.

The de-regulation would have to allow new entrants and allow companies to provide a wider array of services.

Posted by: Chris at Feb 7, 2007 12:31:51 PM

In the United States doctors (check out those wages) and insurance companies are far more politically powerful than elsewhere.

Not to deny the conclusion, but I wouldn't stress the wages too much. Singaporean doctors make as much money as American doctors, yet they expend much less on health care than western Europe, where doctors are paid much less.
(both salary and health spending as %GDP)

Posted by: Douglas Knight at Feb 7, 2007 12:55:41 PM

What benefits do they yield if we don't regulate them very heavily?

If left to do their job, they eliminate (or reduce) UNPREDICTABLE risks. Since most people are risk-averse, this is a considerable benefit.

(It's a benefit to me to have car insurance; I pay the expected cost of my damage, and get the actual cost--the expected cost is predictable, so it is mcuh less risky.)

Posted by: SamChevre at Feb 7, 2007 1:05:13 PM

Chris writes:

Alkali - current health care regulation mandates minimum amounts of coverage so that everyone is buying "cadillac" coverage.

I'm not sure this is true. Federal law doesn't require any insurer to offer any particular amount of coverage, although it does require employers offering coverage for certain types of illnesses/situations -- e.g., mental illness or maternity -- to meet certain requirements. State law is all over the map, but lots of states don't have many mandates at all, and a lot of the mandates are unusual but not very expensive on the whole (e.g., a number of states require health insurers to cover wigs for cancer patients). I'm not sure any state restricts things like deductibles and overall coverage limits.

Is there any evidence that there is a market for people who want to buy a particular kind of policy but can't because the insurer can't offer it?

Additionally, there are severe barriers to entry.

I don't see how this is responsive to my question, even if it were true. (My question is what benefits we should expect to realize from having private, lightly-regulated health insurers.)

SamChevre writes:

If left to do their job, they eliminate (or reduce) UNPREDICTABLE risks.

How is this a benefit of private insurers? How does regulation of private insurers supposedly prevent this benefit from being realized?

Posted by: alkali at Feb 7, 2007 1:17:59 PM

As my friend John says, "If anyone thinks there's a health insurance crisis they can sit next to me as I call 100 leads and talk to 95 people with absolutely zero interest in either saving money or getting health insurance."

Posted by: Shmuel at Feb 7, 2007 2:15:51 PM

alkali,

All I'm saying is that, absent regulation, insurers reduce the unpredictability of risk. I'm not claiming that they don't do this when regulated.

Posted by: SamChevre at Feb 7, 2007 5:09:24 PM

Health Care plans also could serve a purpose by using their expertise to come up with plans that deliver the best value for money. In a healthy market, health care plans would deliver considerable value as the patients' advocate to find a package of care that matches their needs with the best available care from all over the United States for the best price. Unfortunately, the incentives of the current health care system are not aligned in this manner, so health care plans join suppliers and providers in a game of hot-potato cost-shifting.

Posted by: Chris Prottas at Feb 7, 2007 8:01:39 PM

The arguments against the health insurance companies reminds me the turn of the century arguments that pointed out the great savings that could be realized by removing redundancy is we had only one car company, only one steel company etc.


Posted by: Floccina at Feb 8, 2007 11:14:13 AM

BTW A single payer cannot negotiate price properly. It has too much power and can almost dictate price. This creates shortages and surpluses and disincentive to innovation or too much incentive to innovation.

So competing insurance companies serve us by negotiating price.

Posted by: Floccina at Feb 8, 2007 12:03:26 PM

What Edwards calls a 'commentary'.

Posted by: jordi dlt at Feb 8, 2007 12:28:55 PM

An over powerful single payer can have serious unintended consequence on the system. Doctors are free agents and will respond to a heavy-handed monolith in ways that may not be best for patients (e.g. retire early, change what services they offer, stop taking one or another kind of insurance, change specialties or towns, etc). Medicare has had their fair share of access problems because of this.

Also, as long as Americans can sue for huge amounts for any bad outcome and so long as they expect the cadolac of care, it is going to be impossible to affort care for everyone. We need a baseline of care with liability protection to affort universal care, even if it means a two tiered system.

Posted by: Mitch at Feb 9, 2007 4:55:56 AM

Every American should have affordable health insurance.

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