Tuesday, November 13, 2007

Jonathan Cohn's Flawed Argument for Universal Coverage

TNR's Jonathan Cohn argues today that the only serious opposition to universal health coverage is that it would inhibit medical innovation. He goes on to argue that while this is a possibility, an appropriately structured system would solve this problem. Such a system would maintain a relatively high level of health care spending, and would create a more centralized system in Cohn's view.

While Cohn's argument is more respectful than most, it contains several major flaws:
1. It acknowledges problems with Canada and Great Britain's systems, but then argues that those problems don't exist in places like France, Germany, and Switzerland. Thing is- each of the positively cited examples rely heavily on the free market, private sector and are quite decentralized. In France, for instance, 85% of the population owns supplemental private insurance; similarly, Germany's system is "highly decentralized," and leans heavily on the free market and individual choice amongst state-offered insurance plans (there are about 400 options)(also worth noting is that state control of the health care industry has resulted in a wage freeze on health care workers, not a good thing); Switzerland, on the other hand, has a system that is in some ways more market-based than the current US system.
2. It argues for maintaining high spending on healthcare. But high costs are the primary problem with the US system, as I have argued here. So Cohn's solution is to make the biggest problem the solution!
3. It ignores the fact that the current US system has in many ways little to do with market forces since it relies so heavily on employers to provide health insurance rather than private individuals. Indeed, one could argue that the biggest problem with the current US system is that it has become increasingly over-regulated.

As for his underlying argument that you can have both innovation and universal access to health care- he is, of course, right. The problem is that he fails to understand that market-based solutions are the only way to accomplish that, something that the nations he uses as examples actually do understand.