Ezra Klein offers a theory to explain my prediction that he will die a libertarian. I'm going to keep my reasons for that prediction close to my vest. But I will say that his recent comment about "intellectual disagreements" is not among them.
A few observations in response to his most recent post:
- A libertarian health policy would not prescribe $30,000 health insurance deductibles, or any size deductible. But Klein knows that.
- A patient on a gurney has no bargaining power. I know that. Klein knows that. He knows that I know that. He also knows that most treatment settings are non-emergent. But let's see if this straw man is really so easily razed. I'm guessing we could also agree that the patient has more bargaining power later, once his situation is no longer emergent. And I think we could likewise agree that a good way to protect the most vulnerable gurney-jockey from being gouged would be to make sure all gurney-jockeys care about the cost of their treatment (whether at the point of service or when they purchase their coverage).
- Best Buy and Sony are inapt. Think GEICO. Like Humana, GEICO is for-profit. Like Humana, GEICO takes its customers' money and every claim paid is a loss to the company. Those incentives are the same. Yet we don't have an auto repair crisis. In fact, GEICO boasts on the radio that it pays claims so quickly, it steals other insurers' customers. Why the difference?
- The key question is what type of system best reduces vulnerability. Is it a laissez-faire system, where (a) individuals would control the money now controlled by government and employers and (b) competition would ensure that insurers and providers could profit only by reducing others' vulnerability? Or is it a system with greater government involvement, where the link between self-interest and reducing others' vulnerability is more attenuated?