HEALTH REFORM À LA COWEN & KLING (& ME)

Cowen offers a more detailed blueprint than does Kling, but it is WAY too dependent on the kind of government meddling that has created much of the current health care mess:

Construct a path for federalizing Medicaid … produce a greater net increase in Medicaid than the current bill will do … Boost subsidies to medical R&D by more than the Obama plan will do … blah, blah, blah …

Kling believes Cowen’s approach is too complicated and thus condenses his own prescription into a single sly paragraph suggesting a state-level competition between single-payer and free-market “experiments.”

The bill I would propose would be one that encourages experimentation at the state level. Offer to support an experiment that allows an individual state to adopt single-payer, while allowing another state to offer deregulated insurance and medical practice.

Kling knows, of course, that the unregulated market approach would drive down costs and improve quality, while the single-payer model would produce the same unsatisfactory results it produces in Canada.

Unlike Cowen and Kling, I don’t traffic in the obscure incantations of the dismal science. But I have toiled for two decades inside the Rube Goldberg contraption called “U.S. health care.” Thus, I have also produced a cure:

Decouple employment from health care by eliminating the tax advantage that exists for employer-provided health insurance.

Create a national health insurance market by knocking down the state-imposed barriers that prevent people from buying insurance across state lines.

Encourage the spread of HSAs that incentivize consumers to economize on unnecessary medical expenditures.

Reform Medicare/Medicaid/SCHIP by moving the whole system to a market-based model similar to the Medicare Advantage program.

Pass nationwide tort reform to reduce the huge number of unnecessary tests and procedures that now result from defensive medicine.

Remove the stealth price controls (e.g. MS-DRG, APC, RBRVS) that have been gradually imposed on the system by the federal government.

Repeal EMTALA, HIPAA, and all other federal statutes that add huge costs but no real value to the health care system.

Eliminate all state and federal barriers (e.g. certificate of need statutes) to provider entry into the market.

Eliminate all state and federal barriers (e.g. the Stark law) to provider combination and competition.

Allow all hospitals, doctors, and other health care providers to charge what the market will bear.

I will now grab a beer, take a seat by the phone,  and await the inevitable call from Washington.

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