Hats off to these two guys for engaging the left on what is actually happening around the world. Their latest post summarizes the back and forth in the blogosphere about their endorsement of the Swiss heath care system, sparked by their original post and Avik Roy’s previous writings. This discussion, however, is hugely dominated by a fixation on how much of health care is “public” versus “private.”
Here is what all the commentators are missing: the public/private distinction doesn’t matter. All over the developed world the market for health insurance has been so completely suppressed that you can find a real price for health insurance almost nowhere. In the U.S., BlueCross and other private insurers administer Medicare. They also administer private health insurance. Earth to the left: BlueCross is not good when it is called “Medicare” and evil when it is called “private insurance.” BlueCross is just BlueCross.
On my critique, they write:
We agree with John’s view of the ideal system: universal health savings accounts combined with catastrophic coverage. He writes compellingly about South Africa’s system in this regard. Avik has written in the past about Singapore, which blows away Switzerland on cost-efficiency by instituting universal health savings accounts. But John is making a mistake if he holds out for universal HSAs, at the expense of more politically feasible, market-oriented reforms that expand coverage and reduce federal spending.
Like so many of our friends on the right this focuses on form at the expense of substance. What is needed is a real market for medical care and a real market for health insurance. Not only is this feasible, it is the only thing in the long run that will work.