An Insidious Mindset
So, the Providence Journal editorial board likes ObamaCare. What are you gonna do? A recent unsigned editorial, though, points toward a disturbing underlying premise:
Let us start with one of the provisions most beefed about on the campaign trail but also most necessary — the requirement that everyone buy coverage. Forcing people to obtain insurance is essential for two reasons: One is that it ensures a larger insurance pool to cover the expenses of sick people. Does this mean that the healthy must subsidize the ill? Yes, but that’s how insurance works.
This, in a phrase, is socialized medicine, and there’s no difference between this sort of involuntary insurance and compulsory redistribution of resources. Indeed, what redistributive scheme would not be possible to present in terms of “insurance”?
Relatedly, note this double misconception:
Perhaps the most important place to trim waste is in the unhealthy economic incentives that nudge doctors to prescribe more treatments and office visits than are necessary. This is also the hardest to fix, because it means narrowing or shutting down some income streams in a health-care industry that has virtually bought many members of Congress.
The Medicare program and private insurers are the ultimate payers and therefore perfectly placed to move health care away from the wasteful fee-for-service model and toward a results-oriented one.
First of all, Medicare bureaucrats and insurance providers are not the “ultimate payers.” They are middle-men between the people you pay for healthcare and people who deliver it. The ultimate payers are policy holders and taxpayers. They are perfectly positioned to trim waste from the system by deciding whether they’re willing to pay for it.
That suggestion leads to the second of all: It is hardly obvious that the players in the healthcare industry who neither receive the care nor deliver it have any incentive to lower costs in a way that maintains services. Their incentive is to extract more money from the payers and procure lower prices from the providers. Take more money from the payers, and they’re going to seek more services to make the higher price worthwhile; give less money to the providers, and they’re going to seek ways to tack more services on to their bills.