Selling National Healthcare

SELLING NATIONAL HEALTHCARE….Matt Yglesias on one of the upsides of a national healthcare plan:

There seems to me to be decent evidence that labor market flexibility leads to employment growth. It also seems clear that America’s health care system generates substantial labor market rigidities as people with medical histories need to maintain a seamless web of insured-ness in order to remain insurable. [The] economic costs here seem potentially quite large, but obviously you’d need some really smart people to take a look at it.

I don’t know the size of this effect either, but I certainly know of people who are basically stuck in their jobs forever because they have an expensive, chronic condition that wouldn’t be covered during their first year at a new job. Policies vary, but it’s not uncommon for pre-existing conditions to get limited (or no) coverage during an initial period under a new group health plan. As for taking a year off to go to school, or leaving to start a new business, you can just forget it if you have a chronic condition that’s too expensive to risk losing coverage for.

It’s this, by the way, not cost, that I think is the strongest argument for national healthcare. My own belief, based on looking at the numbers, is that national healthcare might reduce overall healthcare costs in America by a bit, but probably not by much (and maybe not at all). A French-style system that paid doctors and nurses at American levels, for example, would be only moderately less expensive than our current system. In the end, given the political realities of constructing a universal plan, we’d probably save some money on administration, spend some extra money to insure all the uninsured, and end up with total costs only a bit less than we have now.

Which is fine with me. A system that works better and doesn’t cost any more strikes me as a huge win for everyone. Rather than overall cost, then, which doesn’t matter to most people anyway (as far as most employed people are concerned, healthcare is essentially free right now) the selling point of national healthcare is freedom from the endlessly gnawing problems of our current jury rigged system. For example: HMOs that make it hard to see a specialist. High and rising copayments. Fear of losing coverage if you lose your job. Long waits for non-urgent care. New (and usually worse) healthcare coverage every time your HR department is told to find a cheaper plan.

And more: Small businesses that have a hard time attracting good employees because they can’t afford to offer health coverage. Big business that are on the verge of bankruptcy because of skyrocketing health costs. Lack of choice in physicians because you’re limited to whichever medical groups have signed contracts with your company’s insurance carrier. Losing your longtime family doctor because your company switches insurance carriers and you can only see doctors on your new carrier’s approved list.

And yet more: Fear that preexisting conditions won’t be covered if you take a new job. The risk of financial ruin if someone in your family has a truly catastrophic illness. Crowded emergency rooms that have essentially become clinics of last resort for the poor. Being forced to go on strike year after year because your employer relentlessly tries to gut your healthcare benefits every time your union contract gets renegotiated. 43 million people who lack health coverage of any kind.

Reducing healthcare costs ought to be a goal of any national healthcare plan, and a truly national plan is probably the only way we’ll ever accomplish that. But that’s not the way to sell it. Freedom from fear, freedom from pain, and freedom of choice are the ways to sell it.

So: maybe I should take the afternoon off and finally see SiCKO? I think I might just do that.