Together with Michele Bachmann
By Arnold Kling
You will find me with her in the latest dead-tree issue of National Review. The cover story is on her surge in the Republican race for President. The author raises questions about her ability to execute a successful national campaign. My instinct is that her relatively short political resume will work against her, because it will remind people of Barack Obama’s short resume before he ran for President, causing a visceral nervousness among voters. But I do not earn my living making political prognostications.
After that article comes a piece that I wrote predicting a two-tier health care system. The editors entitled the article “Haves and Have Mores.”
I deliberately wrote the piece in a way not to pander to conservatives. I would have written essentially the same article for a liberal magazine, although in that case I would have been particuarly careful not to pander to liberals.
One way to state the logic of the piece is this.
1. Currently, government programs for health care involve open-ended commitments to reimburse doctors for whatever services they deem appropriate. This is too expensive (although you can see why key constituencies would find it popular).
2. The government needs to get control of its health care budget. It is likely to do this by reducing its reimbursement for discretionary health care services, such as diagnostic screening, futile late-stage care, and other procedures that have been found to have high costs and low benefits.
3. Regardless of how government draws the line between necessary procedures and discretionary procedures, it will not allow people to be deprived of necessary procedures for lack of money. Nor will it prevent people who can afford discretionary services from obtaining them using their own resources.
4. Hence, we will see a two-tier system. Necessary procedures will be available to all (which is pretty much true today, through the proverbial emergency room). Beyond that, wealthier people will be able to purchase more costly discretionary medical services, just as they can purchase fancier cars or more expensive food.
I am curious to see the reception to the piece. On one hand, the phrase “Blinding Glimpse of the Obvious” comes to mind. On the other hand, I think it will bother some people, particularly those on either the right or the left who want to believe that health care policy is a simple matter.