Polimania

Posted By TomInReston on June 30, 2009

I don’t consider myself part of the far left. My views tend to be a little conservative on some issues and a little liberal on others.

I also am definitely NOT a single issue kind of Democrat. I don’t agree with Creigh Deeds on guns, but then I’ve fired one only once, when I was about eight. I’ll still campaign for Deeds, because he will be a great governor. I think thriving businesses are essential. I think their influence over the political process is so pervasive as to be pernicious.

Health Care Reform, however, is one of those issues that will help me decide which Democrats to support with my limited time and money and energy. I’m addressing this to Sen. Warner, specifically because he sent a reply to a note from my wife, saying he opposed a public option as part of the health care reform legislation in the Senate. So here’s my message:

Forget about the polls showing a vast majority of Americans want a public option in any health care reform legislation. I don’t want a Senator who abrogates his own best judgment because of a poll.

Here is the real issue: All the incentives in the current system are stacked up to guarantee that health care will get ever more expensive, more and more people will be shut out of the system, and the quality of care for most of us will get worse. The most rational way to fix that, is for there to be a competitive entry in the market that has the right incentives in place. A public insurance plan would be incentivized (I hate that word) to provide quality care, non-exclusionary coverage, and at a reasonable cost. Private insurers could (and would) compete only by changing their behavior.

That, my friends, is a market-based solution. And without it, nothing Congress passes will be reform.

First, even the most die-hard free market conservative would concede that in any market, participants respond predictably to incentives (and disincentives), and that while consumers are not perfectly rational, they’re rational enough in most instances. I suspect most would concede that a free market depends to some extent on buyers and sellers having at least some reasonable choices.

The problem with the current health care system is that:

1. The incentives are largely the opposite of what’s needed to ensure high quality affordable health care and the perverse incentives have become worse as more of the system has moved into private hands.

2. Buyers tend to be less rational about health care than other “products,” while sellers remain very rational.

3. In many senses, choice as economists use the term, doesn’t exist in the health care market.

First incentives. In an ideal world, the incentives would stack up like these examples:

1. Consumers would be rewarded for choosing the treatment options that offer the most successful outcomes at the lowest cost.

2. Insurers would be rewarded for paying legitimate claims fully and promptly.

3. Health care providers would benefit more from recommending the least expensive, effective treatment to patients and from rou

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