Monday, April 13, 2009

Ponnuru on Universal Coverage

The April 8, 2009 New York Times published an interesting OpEd by Ramesh Ponnuru entitled, "The Misguided Quest for Universal Coverage".

Overall, his economic analysis is good.

He notes that the magnitude of the cost-shifting caused by the uninsured has been greatly overexaggerated and that Massachusetts-style mandated insurance will simply drive up costs to benefit special interests with political "pull".

And he also correctly calls for eliminating the current employer-based system of health insurance (which only exists because of bad government tax policies giving those employer plans unfair preferential treatment.)

He also attempts to address the moral dimension as follows:
The moral case for universal coverage is that we have an obligation to see to it that the poor and the near-poor have access to good health care. But universal coverage is only one way of realizing that goal, and not necessarily the best one. For people with pre-existing health problems, for example, direct subsidies would probably be more efficient than rigging insurance markets to make sure they are covered.
In other words, he doesn't argue the case that one person should not be forced to provide another person's health care because it would be a violation of individual rights. Instead, he apparently grants the statists' premise that there is some legitmate government role in guaranteeing "access".

Although "direct subsidies" might be a good temporary intermediate step towards complete privatization of health care, it should not be part of any permanent free market reform. Instead, those who need health coverage but cannot afford it themselves should rely on private charity, as Dr. Peikoff notes in his essay, "Health Care is Not A Right".

Furthermore, if one wants to really improve access to health care, then eliminating various licensing laws that artificially restrict the supply of health care providers would be a far better approach.

Nonetheless, I'm glad that the New York Times has published Ponnuru's piece. His ideas deserve to be part of the debate.

But it also highlights the need for a more integrated economic and moral defense of free market health care reforms.