Avik Roy’s article is very well-writtten, and it is good to see it posted.
May I add (for not the first time on this blog) that both Switzerland and Singapore have two key features that conservatives usually fail to mention:
a. rigid national fee schedules for most procedures and surgeries……there is no wild west where hospitals send bills of $3000 for six stitches and then, if the patient has a strong insurer, the hospital gets paid $400…………
b. General revenue support for some of the fixed expenses of hospitals.
This reduces the amount that insurance companies have to pay….and this in turn reduces insurance premiums, and this in turn reduces any subsidies to working class or middle class insureds.
Again not for the first time ( and I am glad to say it again), the American presumption that hospitals should be self sustaining through user fees is unmatched in the rest of the world. And deeply destructive here.
Other nations treat hospitals more like fire stations, which is where we should be going also.
Thank you for your comment. However, the “wild west” of hospital prices must be a consequence of government regulation in the U.S.
How do we know this? If a Canadian patient wants to avoid a long wait for an operation in Canada, he can easily find a fixed-price charge for the operation in a high-quality U.S. hospital. The insured American patient will still struggle to get a bundled charge quoted.
“Nobody hurt!” Since most people haven’t had their policies canceled or have yet to pay the higher premiums required for exchange policies, perhaps they haven’t been hurt yet.
It will be interesting to see if some of the newly insured drop their coverage after they get their tax refund.
Just in case anyone is interested, William Haseltine documented the large role for government funding in a book called “Affordable Excellence – the Singapore Health System.”
About 80% of acute care costs are picked up by a public tax-payer funded hospital system.
The ‘skin in the game’ in Singapore applies mainly to discretionary care.
Now Singapore is physically tiny and I believe it has very few poor people. There are no counterparts to Mississippi in this nation of 5 million.
However, there is a way to emulate their system in the USA. It would something along the lines of what Martin Feldstein proposed a few years ago.
A federal social insurance program such as Medicare Part A would cover catastrophic costs for everyone. Private insurance companies would not have to worry about maximum lifetime benefits at all.
Under the catastrophic care, the government would not care if one bought insurance or just paid cash.
This type of system would require two kinds of “attitude adjustments’ —
the left would have to abandon its goal of free preventive care;
the right would have to accept higher Medicare taxes.
There are many political scientists who think that the government of a city-state can do things effectively that the federal government of a continent-wide state cannot do effectively.
The Constitution did not create a federal government that would run a health-care system. (In Canada, the federal government plays a very minor role in financing health care, and would never dream of negotiating fee schedules with physicians or hospitals.)
One reason that NCPA proposes an individual, refundable, tax credit for health insurance is that it limits the role of the federal government to the tax code. Unclaimed tax credits would be transferred to state and local authorities to fund safety-net providers.
It is impressive the level of arrogance that the liberal media carries when stating that there are no losers from ObamaCare, when there are literally numerous examples of such.
“Although PolitiFact’s stamp of approval helped deliver two presidential victories to Obama, it later declared the same Obama promise to be 2013’s “Lie of the Year.”
PolitiFact should have given themselves a big lie of the year as well, for previously endorsing Obama’s health care plan
Avik Roy’s article is very well-writtten, and it is good to see it posted.
May I add (for not the first time on this blog) that both Switzerland and Singapore have two key features that conservatives usually fail to mention:
a. rigid national fee schedules for most procedures and surgeries……there is no wild west where hospitals send bills of $3000 for six stitches and then, if the patient has a strong insurer, the hospital gets paid $400…………
b. General revenue support for some of the fixed expenses of hospitals.
This reduces the amount that insurance companies have to pay….and this in turn reduces insurance premiums, and this in turn reduces any subsidies to working class or middle class insureds.
Again not for the first time ( and I am glad to say it again), the American presumption that hospitals should be self sustaining through user fees is unmatched in the rest of the world. And deeply destructive here.
Other nations treat hospitals more like fire stations, which is where we should be going also.
Bob Hertz, The Health Care Crusade
Thank you for your comment. However, the “wild west” of hospital prices must be a consequence of government regulation in the U.S.
How do we know this? If a Canadian patient wants to avoid a long wait for an operation in Canada, he can easily find a fixed-price charge for the operation in a high-quality U.S. hospital. The insured American patient will still struggle to get a bundled charge quoted.
“Nobody hurt!” Since most people haven’t had their policies canceled or have yet to pay the higher premiums required for exchange policies, perhaps they haven’t been hurt yet.
It will be interesting to see if some of the newly insured drop their coverage after they get their tax refund.
Just in case anyone is interested, William Haseltine documented the large role for government funding in a book called “Affordable Excellence – the Singapore Health System.”
About 80% of acute care costs are picked up by a public tax-payer funded hospital system.
The ‘skin in the game’ in Singapore applies mainly to discretionary care.
Now Singapore is physically tiny and I believe it has very few poor people. There are no counterparts to Mississippi in this nation of 5 million.
However, there is a way to emulate their system in the USA. It would something along the lines of what Martin Feldstein proposed a few years ago.
A federal social insurance program such as Medicare Part A would cover catastrophic costs for everyone. Private insurance companies would not have to worry about maximum lifetime benefits at all.
Under the catastrophic care, the government would not care if one bought insurance or just paid cash.
This type of system would require two kinds of “attitude adjustments’ —
the left would have to abandon its goal of free preventive care;
the right would have to accept higher Medicare taxes.
Bob Hertz, The Health Care Crusade
There are many political scientists who think that the government of a city-state can do things effectively that the federal government of a continent-wide state cannot do effectively.
The Constitution did not create a federal government that would run a health-care system. (In Canada, the federal government plays a very minor role in financing health care, and would never dream of negotiating fee schedules with physicians or hospitals.)
One reason that NCPA proposes an individual, refundable, tax credit for health insurance is that it limits the role of the federal government to the tax code. Unclaimed tax credits would be transferred to state and local authorities to fund safety-net providers.
It is impressive the level of arrogance that the liberal media carries when stating that there are no losers from ObamaCare, when there are literally numerous examples of such.
“…if Paul Krugman read the paper he writes for”
You can’t expect him to do that…
They have to cling on to ObamaCare, as it is there only glimmer of hope. If that fails, they are completely discredited.
“Although PolitiFact’s stamp of approval helped deliver two presidential victories to Obama, it later declared the same Obama promise to be 2013’s “Lie of the Year.”
PolitiFact should have given themselves a big lie of the year as well, for previously endorsing Obama’s health care plan
Roy’s article provides a fantastic plan for taking systems that work in other countries, and tweaking them to be effective in the U.S.