Matt Miller is the host of my favorite treadmill companion, KCRW’s weekly podcast “Left, Right and Center.” The four (sic) participants might more accurately be described as “Left, Left, Left and Right,” since Miller, who represents the nominal Center, is a former Clinton White House aide — although I’ll concede he’s more of a centrist than Arianna Huffington and Bob Scheer. But I digress.
Miller is out today with a sensible op-ed titled “Why Liberals Should Drop the Public Option” in the Washington Post. He argues that universal coverage can best be achieved by market-based means — pointing to Switzerland and the Netherlands as models, rather than “fully socialized systems, such as those in Britain and Canada.”
I respect those in my party who seek the single-payer system into which the public option might eventually evolve. But I don’t agree that it’s the best answer for the United States. Though single payer has merits, especially in administrative efficiency, it is also likely to freeze in place our fragmented, uncoordinated system of fee-for-service care. It would encourage providers to goose volume (to boost their incomes) rather than improve quality and would offer greater rewards for providers of acute care when we need a fresh focus on chronic disease management. Single payer also asks government to do things I don’t think it is competent to do, such as setting prices across a large swath of the health sector in ways that seem certain to create damaging rigidities or resource misallocations (as happens in Medicare).
Finally, if government is the sole payer, provider payments will become even more politicized than they are today. On the eve of beneficial innovations in drug therapies, devices and cost-effective ways to deliver better care, it is ill-advised to make the government’s hand too rigid. Private health plans have many flaws, to be sure, but if sensibly regulated they’re likely to respond more nimbly to disperse medical innovations.
Liberals should make peace with the notion that a regulated market of competing private health plans can be the vehicle for getting everyone covered.
This argument resonates for me — even though in a single paragraph (see boldfacing), Miller opines that single-payer would be more efficient, then notes that Medicare (a limited single-payer system) causes resource misallocations.
No system will be perfect, but to me it’s axiomatic that competing, regulated insurers will be more responsive to change and innovation than a government bureaucracy.
BTW, I found Miller’s column via “The Slatest,” Slate‘s new thrice-daily compilation of the hottest stories in the current news cycle. My politics have moved to the right since 1998, when I (and perhaps a few dozen other people) shelled out $19.95 for a year’s subscription to Slate, but I still give them props for online innovation. I also like their weekly political podcast, “The Gabfest” — even though it could be described as Left, Left and Left.