Arnold Kling of the Cato Institute, who has given President Bush’s alleged health care plan an “A+,” criticizes my criticisms.
I argued that the method of capping the deductibility of employer-based health coverage seemed like a lousy method of paying for tax credits for the uninsured (which are themselves a poor way to get people insured). In addition to setting up a system pushing group coverage to individual coverage, which is a recipe for disaster, it makes less sense than trying to pay for the tax credits through efficiencies.
Kling dissents, arguing that “paying for something with efficiencies is nothing but a scoundrel’s refuge for policymakers. It’s like saying you’re going to balance the budget by getting rid of waste, fraud, and abuse. Of all the criticisms one could make of the Bush health plan, this is the least persuasive.”
Kling is right: such an argument usually is a scoundrel’s refuge for policymakers, which is why the Republican Party, which has made this argument for more than a quarter of a century, is itself a refuge for scoundrels.
But if there is any place where the efficiency argument can be made, it is in the US health care system. Consider this table. What does it show? The United States pays far more per capita and gets far less in health outcomes than comparable western nations. And it’s not close: France has more doctors, more nurses, more hospital beds, higher life expectancy, and lower infant mortality–and all for less than half the cost per capita of the American system. The same is true with Canada and the UK, with the exception of per capita physicians. It’s easier to find inefficiencies in US health care than efficiencies. Paul Krugman has explained all of this, and it would be interesting to see why conservatives think that he’s wrong, instead of taking stupidity to high art form and making ad hominem attacks against him.
Of course, one important way to increase efficiency in the system, and perhaps save money would be to get serious about health care fraud. But somehow I don’t think Bush wants to go there. Among Bush Pioneers, the health care industry is well-represented.