Obamacare

Ezra Klein's Confusion Over "Rationing"

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rationing poster

Washington Post blogger Ezra Klein is taking exception to Post columnist Charles Krauthammer's depressing op/ed on how health care "reform" will likely play out. Krauthammer's op/ed argues that the public option is dead, as is end of life counseling, and imposing treatment choices through comparative effectiveness studies will be downplayed. The notion that health care reform will cut costs will also be dropped. So what will happen? Krauthammer predicts:

Tear up the existing bills and write a clean one -- Obamacare 2.0 -- promulgating draconian health-insurance regulation that prohibits (a) denying coverage for preexisting conditions, (b) dropping coverage if the client gets sick and (c) capping insurance company reimbursement.

What's not to like? If you have insurance, you'll never lose it. Nor will your children ever be denied coverage for preexisting conditions.

The regulated insurance companies will get two things in return. Government will impose an individual mandate that will force the purchase of health insurance on the millions of healthy young people who today forgo it. And government will subsidize all the others who are too poor to buy health insurance. The result? Two enormous new revenue streams created by government for the insurance companies.

And here's what makes it so politically seductive: The end result is the liberal dream of universal and guaranteed coverage -- but without overt nationalization. It is all done through private insurance companies. Ostensibly private. They will, in reality, have been turned into government utilities. No longer able to control whom they can enroll, whom they can drop and how much they can limit their own liability, they will live off government largess -- subsidized premiums from the poor; forced premiums from the young and healthy.

It's the perfect finesse -- government health care by proxy. And because it's proxy, and because it will guarantee access to (supposedly) private health insurance -- something that enjoys considerable Republican support -- it will pass with wide bipartisan backing and give Obama a resounding political victory.

Krauthammer paints a very plausible scenario. The ultimate result is that government expenditures on health care will explode. Klein's specific beef is Krauthammer's observation that this will inevitably lead to "rationing." Klein writes:

"Look at Canada," says Charles Krauthammer. "Look at Britain. They got hooked; now they ration. So will we."

So do we. This is not an arguable proposition. It is not a difference of opinion, or a conversation about semantics. We ration. We ration without discussion, remorse or concern. We ration health care the way we ration other goods: We make it too expensive for everyone to afford.

Like most left-leaning folks, Klein clearly doesn't know the definition of rationing. Take this one from Britannica: 

Government allocation of scarce resources and consumer goods, usually adopted during wars, famines, or other national emergencies.

Klein evidently thinks that market outcomes that he dislikes mean that government should step in and impose outcomes that he does like. All right, let's admit it; the health insurance market and the rest of health care are royally screwed up as a result of decades of government interventions and mandates. Consequently we don't actually find the usual benefits of falling prices and improving products and services that we experience in normally operating markets where robust competition and choice reign. 

As I explained in an earlier column where I tried to clear up New York Times economic columnist David Leonhardt's similar confusion over rationing: 

…what is rationing? Leonhardt is correct when he writes, "In truth, rationing is an inescapable part of economic life. It is the process of allocating scarce resources." The crucial question that Leonhardt misses is that "rationing" depends on who is allocating the scarce resources. It's not rationing if an individual decides to spend his money on a 16-ounce steak—but it is rationing if he can only purchase a USDA prime rib eye when he has a coupon issued from a government agency. In other words, true rationing occurs when individuals are forbidden from spending their money on products or services they want to buy.

Imperfect as private health insurance markets are, if a customer [or his employer] doesn't like the decisions made by Blue Cross Blue Shield, Kaiser Permanente, or Golden Rule insurance bureaucrats, he can look elsewhere for his health insurance coverage. But if the government health care scheme becomes a monopoly, when the bureaucrats at the new Health Benefits Advisory Committee decide that a treatment should be withheld, that treatment will be withheld. That's rationing.

I concluded: 

"Americans should get the first chance to limit their own health spending," Rep. Jim Cooper (D-Tenn.) observed recently. "Once they learn the true cost of what they are buying, share a larger portion of the cost, and can judge the benefits—if any—of treatment options, then they will choose more wisely than the government." He's right. Congress should think about "rationing" health insurance and health care the old-fashioned way—through the market.

But through the usual lack leftwing lack of imagination and a truly touching and naive faith in the efficacy of top/down government "solutions," Klein ends up advocating for government rationing and for imposing a government monopoly on health care, instead of for more competition and choice.