Various links here. What's missing in all of these analyses is any particularly insightful analysis of the political economy of health care, unless you count the egregious, tendentious political hackery of Herr Doktor Professor Krugman. By being tendentious and disingenuous, he may at least be acting on a political stage he understands. Maybe he's just treating us like the idiots he thinks we are. I'm not able to provide an insightful analysis, but I might know it if I saw it.
As the spouse of a physician on the front lines, I have been listening to complaints for 20 years or so, and I think I am at least qualified to say that both private insurance companies and state insurers suck a lot, but as bad as private insurers are, Medicare and MediCal (in California) are even worse. The idea that the public plan supporters seem to have that the "public option" would provide competition to keep private insurers "honest" is utter rubbish. It can only be a strictly rhetorical point intended to convince no one who knows anything about the actual delivery of medical care. There are big and complex problems in the private insurance of medical costs, but how setting up a giant Medicare like program for people would address them is beyond me. It's like saying, FedEx has some serious problems and so does UPS. They could each be doing a better job. So let's give a trillion dollars to the US Postal Service.
I think a big part of the problem is that health care economics is like global warming. I can't imagine anyone who was very free market oriented making a career in public health or the economics thereof, any more than a global warming skeptic has any business studying global warming. You would never get a job. Public health economists from what I've seen are the original social planners. They see something puzzling in a market and think "market failure! We can fix that!" If they were surgeons, they'd be saying, "what's that red thing? Hell, we don't need that." Take this latest kerfuffle about the article in the New Yorker which exposed that some little town in Texas has a much higher cost per patient who uses Medicare than many other places, and yet no better medical outcomes. Obama took this article to his staff and said, see! This is what we need to fix! We need to equalize how much is spent on health care in different places! He ordered everybody to read the article and plan accordingly. Now that's leadership. This is just so discouraging. Some guy reads something in the effing New Yorker and suddenly the policy of a fifth of the economy is going to get planned off in some other direction? Maybe this is a clue some guy elected for his rhetorical skills should not be planning the economy? There are a million reasons Medicare costs could vary widely including plain old stochastic variation, and including, we don't know why and we aren't likely to figure it out. Costs of everything vary widely. But you should at least know what is causing it before you make it a goal to level everything. Here's an idea. Just leave it the f*&% alone. Or here's another one. Set up one public plan that works, in some state, or for some group, and make it work, before you expand it to the whole country. Why is it the statist approach that if something is a failure, you just have to make it bigger? Nothing else works that way. So here's an idea, figure out what's wrong in McAllen, Texas and fix that before you start on the entire country. If you can't fix McAllen, Texas, why should anyone think you are able to fix the entire country?
And if there is health care "reform" it will be about a bunch of laudible policy goals the same way the Internal Revenue Code is about a bunch of laudable policy goals, that is, not much. It will quickly turn into a byzantine collection of rules crafted to benefit tangled webs of interest you would need to devote your life to to understand. Oh well. More reasons to try to stay healthy.
And this. If I may ask a naive question -- about these health care costs: they vary. In some places high, in some places low. Are they normally distributed? My guess is, yes. Health care costs (paid for by Medicare) must be the result of many variables, many of them independent of each other. So suppose you have a big, fat normal distribution of health care costs. Now you look at the high end of the bell curve and say, wow, that sure is a lot more than this one over here at the low end of the curve. What exactly does that prove? That's what normal distributions are like. If your thinking is, this distribution is too wide, you should have a reason for thinking so. How wide should it be?
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