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Health care economics: what any real reform must include
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1) Any meaningful reform of health care should involve a uniform code for the billing of services. Right now, a great deal of health care expenditure goes to coping with different insurance billing methods. In a sense, competition has not increased overall efficiency and an antitrust exemption allowing for sharing and acceptance of uniform billing codes might be valid. It's generally accepted in the meat industry what a tenderloin or filet mignon are; we should insist on a mandatory uniform coding system. This alone would save a great deal of time and money. Note that this does not require the government to "drive the trucks", but only to enforce uniform laws on signals and signs, as it were.
2) National health care plans from non-socialist basket cases. The national health plans with which Americans are most familiar (or least unfamiliar) are the Canadian and the British systems. The former criminalizes doctors who offer services covered under the Canada Health Act outside that act under any circumstances; the latter runs essentially a public monopoly on hospital care under a significantly more socialist economic structure than we Americans are used to in (more or less) peacetime. We should be looking at the plans offered in relatively low-tax Ireland and Australia, not to France, Sweden or Britain. Though some call Obama a socialist, he's really not; in Sweden he would be regarded as an intelligent, persuasive economic right-winger.
3) Even in socialist Sweden, they imposed a co-pay to keep the hypochondriacs out of the ERs. Similarly, if we are going to have a national health plan, it simply should not be "free on point of delivery." Some minimal charge is appropriate; people take more seriously what they pay for on point of delivery and it's important, even if there will be a national health care plan or administration, that the concept of a patient as customer not be lost. In Canada all covered services are free at the point of delivery and that's a serious mistake, at least for adults. People should pay for a piece of what they get; deductibles and co-pays are parts of the current structure that are actually healthy and sane.
4) Government-run health services can work well. A visit to a VA hospital or to the University of Maryland's Medical Center downtown - both public - will make that perfectly clear. But a serious concern for the wiser visionaries of a national health service should be the risk of replacing or marginalizing the organically-developed medical institutions in local communities. A great deal of good has come from the voluntary community and philanthropic support for medical institutions alongside public financial support for those institutions. I fear that a nationwide Americare or the like would tend to press out the philanthropic spirit behind places like Sinai, Hopkins, etc., that donors will donate to other sectors instead. While that's not necessarily a bad thing - there are many worthy causes for philanthropy - it may constitute an unintended consequence of the good intentions of many advocates of health care reform.
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