What follows is my response to the post of an acquaintance of mine about health care reform. The original post can be found at http://embracedashadow.blogspot.com/2009/08/health-care-reform-avoiding-darwnian.html.

Mike, I think you're missing the boat by assuming a great number of things about people based on stereotypes. Granted, stereotypes exist for a reason, but still I think it's unfair to base post after post on them.

You, like all of the mass media, seem to consistently assert that there are two general points of view (so called liberal and conservative, embodied by Democrat and Republican respectively) and there are only degrees between the two -- a linear, two-dimensional measurement. Yet people, even groups of people, are more complex than this. One cannot correctly interpret popular sentiment of the public while assuming that they all slide between two points on a line.

You write, "I am in no way in favor of any plan that would ration health care." While that's a great ideal, it's simply impossible. Health care is a limited resource (limited equipment, limited facilities, limited supplies, limited doctors, limited nurses, etc.). All limited resources must be effectively rationed by virtue of their limited nature. This is truly unfortunate as it doesn't "feel good." But if health care is truly limited, then to be intellectually honest, we must shift the debate from "we cannot accept the rationing of health care" to "how can we minimize the need for and maximize the availability of health care to as many people as possible?"

To ration something like healthcare, there are a few different approaches. One is that someone in power decides what will and will not be covered and for whom it will be covered. Today that decision is largely made by employers and insurers. This is not good and I believe you agree.

The push to move to government managed healthcare simply changes who is in power making these same decisions. It does not and will not change that the same decisions are being made.

Another approach to rationing things is based on title, position, influence, etc. This is what you describe in the USSR's old system. I agree with you that this is not good either. However, I disagree that this is the fundamental problem with today's system. It is however, the kind of thing that happens when a market fully finishes breaking down.

Yet another approach is a true market approach. The key here is to understand what a true market approach is (hint: it doesn't have much in common with what happens today). An efficient market has many buyers and many sellers, leaving each buyer a number of sellers to choose from and each seller a number of buyers to sell to. If each side has a large number of participants, then you have suitable and appropriate competition. This also is how you get an efficient market -- one that maximizes the efficient use of limited resources.

If either side (buyers or sellers) are not sufficient in number, you don't have a true market. Today we have a small number of insurers. Adding one more in the form of a government program doesn't change this small number.

This last approach, an efficient market, is what I'd like to see because it's what I believe will provide the highest overall quality of health care to the greatest number of people. Sadly, making the market more efficient as the basis for reform isn't being talked about by either major political party or any of the mass media that I'm aware of.

There are a few major things I believe we could do that would dramatically alter health care for the better.

First, require everyone to buy their own and forbid employers or anyone else from buying it on their behalf. Eliminate group plans and any other form of pooled or bulk buying. Individuals (and families) should make their own choice for an insurer based on their own financial risk tolerance, desired levels of coverage, and other preferences (because one-size fits all health care really fits almost none). Removing employers from the equation will create many more buyers and the consumers of health care become the buyers instead of a third party. Individuals as their own buyers will make better evaluations of insurers, something that is critical to a functioning market. This is basically how auto insurance works now and seems to be much less problematic for people than their health insurance.

Second, force insurers to sell the same plan at the same price to different people within a broad area. Rates are generally managed at a zipcode level today and that's probably okay. We need to eliminate pre-existing condition exceptions and other individually-based rate determinations. After all the point of insurance is pooled-risk.

Third, we could also require the industry to come up with standardized ways of handling insurance paperwork and streamlining it. I've heard that roughly 50% of today's healthcare dollars are spent on paperwork and other administrative overhead. Taking this at face value, if we eliminated insurance entirely, we'd eliminate half of the cost of healthcare. That's staggering. Further, if people had to make their own choice about spending their own money for health care (instead of externalized payment via a third party), even less health care would be consumed because some of what's done today isn't necessary. I'd hazard a guess this would be at least several percent more.

It might make a lot of sense to force certain general reporting requirements on insurers. Things like: percentage of claims paid on first submission, total percent of insurance dollars spent on overhead, exact details of every plan offered along with rates, etc. The goal of such reporting would be easy comparison of insurers by the public. This would increase competition and result in lower costs and better coverage.

Another important thing we can do here in America is increase the supply of health care, which mostly will mean the supply of health care workers. Right now medical school is terribly expensive (as all higher education has become) and the regulatory and legal overhead (malpractice insurance, licensing, etc.) increase the cost of pursing that line of work even further. Anything we could do to make it easier and more desirable to become a doctor or nurse would help result in cheaper health care. Tort reform would help to this end too.

The Democrats may be claiming to improve affordability of health care but without a proper understanding of markets and how affordability really comes to be, it's all hot air and will likely result in higher costs (which /will/ implicitly result in /more/ rationing). They may mean well, but their ignorance of economics will not be overshadowed by their motives. It's also possible they don't mean well and are just spouting off soundbites to ensure they get re-elected (like politicians of every party).

Your assertion that we'll get USSR-style healthcare if we don't reform is speculation at best and dishonest at worst. That kind of outcome is only possible if our society is a generally totalitarian regime. In a totalitarian regime, you don't have much of a functioning market at all (instead it's all command or centrally controlled), and thus have scarcity of products and services. Any centrally controlled (including democratic socialist governments) economy (or part of an economy) will always have unnecessary scarcity because the few people who make the decisions simply cannot understand, model, or predict behavior of masses of humans. They don't have the capacity as mere humans to do so; only God has that kind of capacity.

If we're in danger of such a totalitarian regime (either communist or facist), then we have a far worse problem than healthcare frankly. If you don't believe we're in danger of such a regime, then suggesting we're about to end up with USSR-style healthcare is fear-mongering and not the substance of a well reasoned argument.

You have not given any basis for arguing that Cuba's government run health care is good for Cuba's citizens. In fact, it's quite possible that because the communist regime in Cuba is sending their doctors to other countries that their citizens are worse off. Claiming communist Cuba has better health care is a straw man argument.

You note that Hugo Chavez is importing doctors, leveraging supply and demand on a global scale, and improving health care. This is a good example of the market at work (and still has no bearing that two totalitarian countries are participating). Even better would be if the doctors themselves were making the decision to move and provide their own services to other countries instead of having communist countries (acting like mega-corporations) doing it instead.

"The G.O.P. has for a long time been the party of the monied elite." Because the Democrats don't also have money? This is irrelevant to the discussion unless your goal is merely to bash Republicans (which then isn't helpful to discussing health care reform.)

"Those who can afford to self-insure." This is dramatically overstated. There may or may not be a leaning in this direction, but it is unfair to make such a blanket statement.

"Those who are poor are poor by choice." This too is oversimplified. There are many who are poor who /are/ poor by choice. Not directly, of course, but as a result of various life choices. Others of course try hard to change their lot and don't succeed.

"It's no skin off their noses if 45 million Americans are uninsured." Really? Are you sure all of the GOP believes this? Perhaps they simply believe that government intervention in health care won't actually solve the problem. Maybe even for reasons like I've already outlined. Maybe for different reasons.

"Glenn Beck and Rush Limbaugh don't bear the cost of treatment for these folks at emergency rooms, because Beck and Limbaugh and their friends can afford the lawyers and accountants it takes to weasel out of the taxes that pay for it. Wall Street doesn't foot the health care bill for the poor folks who live on the side streets that branch off from Main Street. Main Street foots the bill." Please quit just spouting Democrat party platitudes. You're also just inciting class-warfare, the opposite of encouraging people to live at peace with one another. Both the wealthy (Beck, Limbaugh, etc.) and Wall Street do pay for emergency services (along with millions of middle-class Americans) already. Today a large part of emergency services costs are rolled into everyone else's costs -- you know, the people that have health care coverage now.

The GOP is tens of millions of Americans (just like the Democratic party is also tens of millions of Americans). It's a poor argument to assert that these tens of millions of Americans are the "wealthy-elite". By definition "elite" refers to a small group and tens of millions is far from a small group.

Your ranting against Republicans using traditional Democratic party lines and your specious reasoning make it really hard to take any argument about health care reform seriously.

You ask, "can we really afford to see health care reform go down the drain again?" I would say no. But I would also say that we cannot afford anything even resembling the current proposals for reform either. The current proposals do need to go down the drain again. They were wrong before and they're still wrong. The law of supply and demand and other laws of economics have not changed and current proposals are made on assumptions that economics work differently than in reality.

For the record, I am far removed from fully agreeing with either the Democratic or Republican platforms. The two parties seem awfully alike if you get past their surface-level claims.