Saturday, May 06, 2017

Health politics U.S. style

Minimally politicized health care would be best. But it is an ideal that we are drifting ever further away from.  What would minimally politicized health care include?  Here are five pillars: (1) A light-touch FDA that tests for safety and lets efficacy be judged by doctors as they consider the complexities of the cases before them; (2) Light-touch insurance regulations that focus on the solvency of health insurers; let competing insurers disrupt and innovate; (3) A mandate that everyone open a health savings account; (4) A mandate that everyone purchase catastrophic care policies; (5) Subsidize the catastrophic insurance purchases of the poorest.

Can anyone assemble a winning political coalition for this approach?  Unlikely.

Obama-care mustered a winning coalition the day it was signed into law. But Democrats have lost four straight elections since then -- probably because the coalition fizzled after the real thing was up and running.

The replacement is not yet  known -- and will have to work its way through the sausage factory. The WSJ's Holman Jenkins writes "GOP Health-care Sausage is Good for You". But what could possibly emerge?

Health care politics is big in the U.S. -- and has been for a long time. As many have pointed out, World War II price controls spawned non-wage competition among employers, including employer-provided tax-sheltered health care. Add Medicare and Medicaid and today most medical procedures are paid for by third parties. This means ever less scrutiny and ever more politics. It also means unsustainable expectations.

On top of that, there are now too many health care "insiders" with "skin on the game" who have set up shop in Washington. After all of the disappointments and all the "sausage," what can enough of them possibly agree on?  Not the 5-part approach mentioned above. Unfortunately, it might be universal single-payer.

Will that solve anything? We are not Denmark. U.S.-style single-payer is likely be VA medical care for everyone.  Note that every incoming administration coming to Washington promises to "fix" VA medical care. None has yet been able to do so.