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Health Care: Public Skepticism, Expert Pride



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Ross Douthat’s column today argues that there are two consensuses on health care. The politicians’ consensus reflects the public’s belief that “health care reform shouldn’t alter or disrupt the way the majority of Americans get their insurance today.” The consensus of experts on the left and the right is that the system we have today, in which most people get their insurance through their employers, “is actually the problem, and that it deserves to be threatened, undermined and replaced as expeditiously as possible.” He adds that “Obamacare has an unwieldy, Frankenstein’s monster quality in part because the law is trying to serve both consensuses at once.”

By dropping the employer mandate for the next year, Douthat writes, the administration is moving closer to the expert consensus. It should eliminate the mandate altogether, and then “be fully committed to a more disruptive future, in which exchanges and subsidies gradually replaced the employer-based system.”

He concludes that “the White House’s decision is a step toward honesty in policy-making.”

That conclusion strikes me as a very peculiar way to characterize the administration’s decision to announce the mandate delay as essentially a footnote in a post about how it is “Continuing to Implement the ACA in a Careful, Thoughtful Manner.”

More important, I think Douthat sides too comprehensively with the experts against the public, is too eager to see existing health-insurance arrangements disrupted, and is too hostile to employer-provided coverage.

First: Employer coverage has its benefits, and in a free market where it had no special privileges over other forms of health insurance it might account for a large share of the market. That’s fine, and the government ought not to do anything to prevent it. Some conservatives and libertarians like the idea of everyone’s purchasing catastrophic insurance for himself (sometimes with help), and that model has its attractions too, but there is no good reason for the government to impose it on everyone.

Second: The public’s desire for stability reflects an entirely sensible disposition to beware experts who tell it that their policy ideas have fantastic benefits that amply justify getting rid of arrangements that seem to most people to work pretty well for them (even if they also have drawbacks).

It seems to me that, taking on board both of these points, we should gradually liberalize health-care markets so that employer-provided coverage is placed on a level playing field with other kinds while disruption to existing arrangements is minimized. This approach would work with the public’s rational preferences, and it would not assume that we know more than we in fact do about what health-care markets should look like.

There are a lot of reasons to end the employer mandate. Its effect on employment would be at the top of mine. Speeding up a government-directed transition away from employer-provided coverage isn’t one of them.

Update: Typo fixed.



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