Is it right to say, as the post says that Tyler links to below, that the “nationalize health care” view is silly on its face because we already have a 65-70% (estimated) public health care system?
Trent writes:
How do we define and measure the types of health care systems?
I think this is the easy question to answer in a way that all in the debate can agree. I would define it such that a perfectly nationalized health care system would be one in which the government (at any level) paid for 100% of total health care expenditures. Anything above 50% is marginally nationalized. Conversely a perfectly free-market system would be one in which this figure was 0%. Anything below 50% is marginally free-market. Anyone have a problem so far? Good, I didn’t think so.
I’m not sure “we,” the hypothetical Trentian readers (“Yes, Socrates”), should be so quick to agree there. When I think nationalization, I think not only of who pays but also of who controls. For instance, suppose the government stopped providing public schooling (where it controls the curriculum) but paid for all private schooling through generous vouchers (where the private providers would control the curriculum). By Trent’s definition, that’s still a perfectly nationalized system, but voucher advocates would characterize that as a free-market alternative, since government curriculum would have dropped from 100% to 0%.
Back to health care: I gather (I’m not that well informed on this issue, but I do gather) that the health-care nationalization argument goes something like this: the government currently pays a lot for health care, but unfortunately, people still get to make their own (reimbursed) decisions, and so, understandably — and as anyone with a sense of markets and incentives should understand — they’re profligate with our public funds. We’re in this uncomfortable no-man’s-land of partial regulation, where cash-flow rights and control rights are separated (think banking insurance), and that can be the worst of all possible worlds.
The two possible directions to go: keep the government funding but increase government control, or keep the private control but increase private funding. You might think one’s better than other for various reasons (Hayekian knowledge/innovations reasons and/or liberty reasons one way; safety nets and/or paternalism the other way). But either way, the theory would go, might be an improvement over the current situation where anyone can choose and everyone must pay for it. (Back to the education example above: this has a close analogue in the anti-voucher argument that goes “And we’re going to use public funds to subsidize Farrakhan schools and witches’ covens?”)
In any case, in this new two-dimensional model (with control on one axis and funding on the other) you can’t characterize it as Trent did, a la “How can you ask for more ‘nationalization’ when we’re already so ‘nationalized,’ so presumptively ‘nationalization’ is the source of our problems?” — a question that seems to rely on a loose understanding of “nationalization.”
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