Jonathan Cohn is more thoughtful than most journalists who write about health care (admittedly, not a high bar to get over), but his mistrust of the market usually leads him astray on the question of reform. Thus, when he pans John McCain’s proposals, it suggests that the Senator is on the right track:
The main thrust of [McCain’s] plan is to change the tax treatment of health benefits … so that people have more options for insurance … and grow more sensitive to how much their health care costs.
This would be an excellent policy. Perverse tax incentives have created many of the problems that bedevil U.S. health care. Predictably, Cohn dislikes the idea and attempts to make it sound scary by conjuring up the dread spectre of adverse selection:
It’s quite possible that only relatively healthy people would opt into the individual market … Once these more robust specimens fled employer groups, however, the cost of insurance for those remaining behind would go up …
The problem with this argument, as I have pointed out before, is that it assumes a cross-subsidization of insurance premiums that simply doesn’t happen in the real world. And, as if to prove that he doesn’t understand economic incentives, Cohn goes on to praise one of the worst flaws in McCain’s plan:
[McCain] understands that we waste all sorts of money on care that is either unnecessary or counterproductive. To thwart this, he has embraced an idea known in wonkier precincts as ‘pay-for-performance.’
The most ironic aspect of Cohn’s enthusiasm for P4P is that it would produce something closely akin to … well … adverse selection. As soon as providers start getting dinged for the poor outcomes that inevitably accompany the chronically ill, they will begin “firing” those patients.
Exacerbating the various logical flaws in his argument, political bias keeps popping up in Cohn’s analysis of McCain’s health care positions. He solemnly advises his readers of the Senator’s most irredeemable flaw:
He’d act less like [Teddy Roosevelt] than William Howard Taft–and even a little like George W. Bush … President Bush has embraced these ideas …
Cohn is wrong about health in general and McCain’s plan in particular. McCain’s health care policy positions are not without flaws, but they are vastly superior to anything proposed by Hillary Clinton or Barack Obama.
Post a Comment