Tuesday, May 12, 2009

Focusing on single-payer health insurance confuses strategies with goals

We need to start thinking more critically, and less ideologically about health-care reform. Focusing exclusively on a single-payer system confuses strategies with goals. Ignoring the mixed public-private systems that work all over Europe plays into the strategy of those who have no such confusion. THEIR goal is clear: protect the unregulated freedom of health insurance companies to ration coverage and care in order to maximize profits and executive compensation.

In February, the Organization for Economic Cooperation and Development issued a report on the deficiencies of our current system, with detailed recommendations for reform. The OECD report focuses on issues that get too little attention from political interest groups or the media. This is a serious report and demands a serious read.

Also, in July 2001, the Heritage Foundation issued a report on European health care systems that really surprised me. Although the report is eight years old, it contains some still valuable findings and still useful recommendations. Of course, this was in 2001, before September 11, and before the Bush Administration had fully demonstrated its total allegiance to free-market absolutism.

Predictably, the report was overly critical of the flaws of the European systems, especially, and also predictably, the French. But they also included reasonable “lessons learned”, and virtual endorsements of guaranteed, affordable coverage for all.

Most surprising: all the European models Heritage discussed, except the Swiss, combine publicly guaranteed insurance with private supplemental insurance. And all the flaws are both marginal and correctable. I have always distrusted Heritage because of its ideological bias toward unregluated free markets. But, in this report, the knee-jerk, evidence-free rejection of government regulation of the health care industry, which Cato and others still embrace, is missing.

On this occasion, and perhaps unintentionally, they went off the script. They got a few things right that we can actually leverage for real health care reform.