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On the Third Hand: Stable Middle Ground

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I think that most Americans are like me: We want to have a health finance system that’s free from excessive government interference but also makes sure that people who really need health care somehow get care.

We want the system to make sure that other people pay for the consequences of their bad habits (drinking; smoking; eating gorgeous, luscious almond croissants with irresistible hypnotic powers), but we want the system to somehow make allowances for the reality that with current pharmaceutical technology, we have little lasting ability to withstand entrapment by X (with X being beer, cigarettes made with organic tobacco, luscious croissants, or some other lure dangled by the unwellness demons).

So, we end up saying that we want the health finance system to be either market-driven or generous, depending on our inclinations, and then, if we have any sophistication or self-awareness whatsoever, we start adding qualifiers, and qualifiers to the qualifiers, until, if we know as much as Hillary Clinton and her advisors knew in 1993, we get something that would look, if carefully charted on paper, to be as confusing and tangled as those old Hillary Care charts looked.

Sunforester, who often posts comments after articles, is pretty much free from that problem. Sunforester believes that the government should simply stay out of health care finance, period. Sunforester believes that the idea of imposing taxes on one individual to pay for services for someone else is inherently wrong.

Personally, I respect that point of view, and I’d like to see the world make special arrangements for people who hold that point of view, but I just don’t share that point of view. I think that the government probably imposes too many taxes, offers too many tax breaks, and spends some of its revenue wastefully, but I’m grateful that the government takes over the burden of financing all kinds of great services, ranging from putting space stations in space to defending the country.

But one important point is that Sunforester wants to create a government health finance system that would be very simple and cheap for the government to run, because that system wouldn’t exist. Sunforester wouldn’t have to start adding footnotes to footnotes, because there’d be nothing to footnote. In her system, affluent people might end up so much extra cash left over that they would cheerfully donate enough of the extra cash to pay for care for the poor. 

Similarly, some people think that government should manage every aspect of health finance, and possibly for health care. Some would go so far to say that the government ought to be the employer of just about every doctor and nurse.

Most of my readers would hate that system, and my guess is that I personally would hate that system, but, like the pure free-market system, it could be pretty simple for the government to run.

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We wouldn’t have all of this back and forth about whether the doctors, hospitals and health insurers were obeying the rules or interpreting the rules correctly, or making decisions behind closed doors.

The health program would cover what Congress and the Executive Branch said it should cover, and any USSR-style gaps between the glorious promised benefits and the actual benefits would clearly be the fault of Congress, the Executive Branch and (assuming that electoral democracy still existed in any significant form) the voters.

Mitt Romney stepped into the quagmire of the middle ground between those two ends of the spectrum by daring this weekend to talk a little bit about what parts of the Patient Protection and Affordable Care Act (PPACA) he might keep if he went about trying to replace it with a “PPACA lite” package.

Romney suggested that he might, for example, keep a provision that lets parents pay to put dependents on their own health coverage up to age 26 and a provision that keeps insurers from denying coverage to applicants who have developed health problems while holding health coverage.

On the one hand: Those sorts of provisions seem to be popular, even with health insurance agents and health insurance company executives who have misgivings about PPACA as a whole. It’s hard to see how letting bottom feeder insurers shut out responsible consumers who happen to have health problems can do anything good for the health insurance industry.

On the other hand: The problem with those sorts of provisions is that preventing a “race to the bottom” through government intervention is hard. Once you impose any underwriting restrictions, you need mechanisms to detect violations, deal with violations, and deal with any antiselection pressure that ends up existing because of those interventions.

On the third hand: The mere of existence of any interventions seems to be likely to lead to other interventions. Once Romney says, “Well, maybe I’d keep Y,” with Y being a PPACA provision that does something that many swing-state swing voters who participate in polls happen to like, then PPACA fans might go on to figure out what other PPACA provisions swing-state swing voters like and find out that those voters actually like everything in PPACA but the tanning salon tax and the idea of the health insurance ownership mandate.

Pretty soon, Romney’s PPACA lite could look a lot like a PPACA — without the health insurance coverage ownership requirement that is supposed to make the rest of PPACA sustainable by protecting health insurers from antiselection.