Lots of reaction to Sunday's column on Dr. Donald Berwick, the self-described "radicalized" doctor appointed by Obama to take over Medicare and Medicaid. I'll respond to some of the objections.
This will lead to socialized medicine.
Medicine is already socialized. Get used to it. Private insurance is the socialization of risk with a corporate fig leaf. Nobody pays for health care the way they pay for cars and coffee.
But I paid my fair share into Medicare. I deserve whatever care my doctor wants to give me even if the cost far outweighs the benefits.
Sorry, but one serious illness usually wipes out what anybody paid into Medicare over their career. Medicare is spending hugely more than it takes in. That's the problem.
If only we could stop giving money to people on welfare with seven kids and no jobs, we could keep paying for Medicare for responsible people like me.
A safety net for the poor is an integral part of a rich, modern society, but leave that aside. There's not enough money there to pay for Medicare. Medicare is so huge and threatening that it overwhelms and renders irrelevant other social programs except Social Security, which isn't in nearly as much trouble. You could pay for Medicare growth by sharply cutting defense spending, but I hear that argument much more rarely.
We can fix health care by privatizing it. Just end all the government programs and give people tax credits to buy health insurance.
Besides the moral problems -- extreme privatization would leave millions uninsured in the richest country in the world -- privatization will wouldn't stop extreme medical inflation. Economist Kenneth Arrow showed years ago that health care isn't like any other product and defies attempts to treat it like coffee and cars. There's a knowledge problem. Patients can't intelligently buy health services that they don't have the training to understand. There's an agency problem. The decisions on what to buy are made by one third party -- the doctor -- and paid for by another third party -- the insurance company. And demand for health care is extremely inelastic. We want more more more, especially when somebody else is paying.
Free markets are wonderful. They have brought millions of humans out of poverty. But there are large problems when applying markets to 21st century health care.