Tuesday, October 09, 2007

Left-Wingers on the Individual Mandate

The leftosphere seems evenly split between those who oppose the individual mandate because it's not single-payer, and those who favor it as another brick on the road to single-payer.


Given the special-interest pressures that are the Achilles' heel of the individual mandate (and for that matter, the status quo), I do wonder what a single-payer system would look like in the U.S. I suspect it would have a rather different set of problems here than in countries that already have it. Special interests are a problem in any representative democracy, but the American system seems especially prone to cultivating them (though I don't say this with great confidence; unions seem especially powerful in other industrialized nations). In any case, in the inevitable trade-off between bloated expenditures and rationing-by-waiting, existing single-payer systems have generally chosen the latter. But I wouldn't be surprised if the U.S. went the other way, making even more healthcare available to everyone, paying munificent salaries to politically influential special interest groups in the medical field, and spending an even more outrageous amount of money on healthcare than we do now.


Kevin B. O'Reilly said...

This is an excellent point, Glen. The folks pushing single payer in the U.S. often refer to it as "Medicare for all" (e.g., www.pnhp.org). Well, we all know the fiscal shape that Medicare's in. It's hard to fathom why things would be any different once Medicare was in charge of virtually all health care spending, and not just that spent on old folks.

Single payer would either result in bureaucrats rationing care or spending levels so high that taxes would crush or stall economic growth -- probably both.

Jeffrey said...

Dead link: the "archives" link at the top of the page doesn't seem to be working.

(The month that I look away y'all write a whole lot and now I can't find out what I missed!)


I'm just dumb, I guess said...

If people are required to buy medical insurance then are insurance companies going to be required to provide it to them even if the person is a bad risk? That sound coercive on both ends if you ask me.

I also find it strange that rich people who can self-insure often have health insurance that covers their teeth cleaning & eyeglasses. They pay for their BMWs and yachts, don't they? I put it in the same category as the fact that rich people can easily borrow money at low interest rates because they are low risk to the lenders. The poor are stuck paying 18% compound interest if they borrow on their credit card. And who does all that interest money go to? Yeah, I know , rich people in big houses. The rich are the ones who don't need to borrow money, and can easily afford to pay more for the loans they get. These are paradoxes that make me suspicious of the whole economic system. Also, the fact that Cheney can make millions of dollars a year on his investment portfolio also bothers me. How can someone sit on their fat ass and reap such a windfall? How did he get so filthy rich in the first place? I guess I just don't understand the workings of the system. It strikes me as inherently dumb & unfair. Why can't great minds design a better one? Am I asking for the impossible?

Jacob Wintersmith said...

Hmm... I'm not sure how the number and fatness of rent-seeking special interests in America compares to other states. However, it's to be expected that the particular groups who get to skim off the taxpayer's wallet will be different in different places, since the situation is highly path-dependent. (As Krugman notes, America now has more World of Warcraft players than farmers; but even if the WoWers organized themselves to, say, lobby for free broadband, they'd have a very hard time muscling in on farmers and other existing rent-seekers.)