The Wall Street Journal has posted another economics debate. This time it is between Mark Thoma of EconomistsView blog and Andrew Samwick of Vox Baby blog, on the topic of Social Security, Medicare, and Health Care Reforms (No subscription needed for
30 15 days).
The debate can be found here.
My favorite parts:
We do several things wrong in the way we provide health insurance to non-retirees, and our first tasks should be to undo these mistakes. The first mistake is to make insurance voluntary when we don’t subsequently exclude those who need care from getting it at the public’s expense. We should make health insurance mandatory, but we should do so by putting the mandate on the individual, not the employer. Those who cannot provide proof of insurance on their tax returns should be charged an amount that corresponds to an insurance policy in their area. Implementing this on the tax form allows for family resources to be taken into consideration.
But Medicare already offers us a glimpse of whether a single-payer system generates enough preventive care and superior opportunities to resolve conflicts of interest. I am less persuaded here. I do not see Medicare as it is currently implemented as a model of preventive care. Practitioners get paid for providing inputs to health, not necessarily for achieving a healthy outcome. And recent research has documented that there are wide disparities in how much Medicare pays by geographic area. My colleague Jonathan Skinner and his co-authors find that, other things equal, Medicare spends twice as much in Miami as it does in Minneapolis. I don’t think Medicare has made much progress in providing useful resolutions to the conflicts of interest Mark is considering.