Larner very graciously admitted to a couple of misstatements, and I must reciprocate. I wrote, “I challenge Larner to show where a Cato scholar … describes America’s as a ‘free-enterprise system of health care.’” Sure enough, Larner found an oped where one of my colleagues wrote, “I live in a country with a free-market health-care system.” Obviously, I disagree with that claim. But Larner was right, and I will have to look into this.
A few remaining areas of disagreement:
- I wrote that Larner “claims that people don’t die on waiting lists in Canada’s health care system.” Larner responds: “Actually, that’s not what I claimed. I claimed that people don’t often die on waiting lists.” Canada’s Supreme Court writes that “in some serious cases, patients die as a result of waiting lists for public health care.” Is some as many as often? I hope not.
- Larner: “the Canadian system has problems … [but] it worked better before a series of conservative provincial governments began to de-fund it.” This isn’t the first time that advocates of socialized medicine have blamed its shortcomings on politicians who (supposedly) oppose socialized medicine. But it is an inherent feature of such systems that they will inevitably fall into the hands of whatever viable political parties exist in that nation. As I explained to Paul Krugman, “Unless you have a plan to abolish Republicans, they’re part of your plan.”
- Larner writes: “a public health care plan is a public good.” Public good is an economic term with a specific meaning. A public health care plan is not a public good.
- Larner: “is Cannon saying that we do not have rationing in the US?” Hardly.
- Larner: “In a free-market system, what mechanisms would prevent insurers from cherry-picking their customers, and denying coverage to those who are likely to require expensive treatment?” The question presumes that insurance should do something that insurance cannot do: insure the uninsurable. In this chapter of the Cato Handbook on Policy, I explain the (amazing) things that health insurance can accomplish, and why “health insurance markets are completely justified in not covering preexisting conditions.”
- “So here’s my challenge to Cannon: show me a way that a true free-market system can provide decent coverage to everyone, regardless of ability to pay, without rationing.” Elsewhere in his post, Larner acknowledges this is an impossible task. In this magazine article, I explain that there is no way to reform health care that can guarantee that no patients will fall through the cracks. In this Cato paper, I explain how a free market would minimize the number of people who do.
- “Cannon is not in favor of universal coverage as a social right.” True, that. “As a libertarian, he doesn’t even recognize the concept of social rights.” I believe it was Friedrich Hayek who said there’s no better way to strip a word of its meaning than to place the word “social” in front of it. Try it yourself . I suggest using words like security, contract, justice, responsibility…