A few days back, Kevin wrote a very helpful explanation of the factors that make health-insurance reform so difficult, and proposed some ways that market forces could be combined with widespread coverage. His ideas are unassailable, as usual, but I do have a couple of tangential comments:
1. One reason that conservative health-care schemes are less popular than we’d like is this: They assume that what Americans want is choices, when in fact what most Americans want is a comfortable default. The same goes for school choice, even in otherwise conservative areas. New York City has a vast number of options for schooling your kids — large, small, public, private, parochial — and I have yet to meet parents who consider it anything but a burden. Customizing health insurance and education options is like customizing Microsoft Word — yes, that little elevated “th” every time you type an ordinal number is annoying, but hardly anyone bothers to fix it. That’s why people say they like their employer-provided health insurance: It’s not because of the benefit structure or the customer service, but because you don’t have to do anything to get it; it’s just there.
2. I have always thought that the main reason people on the left want “Medicare for all” is not because of the purported (and illusory) cost savings, which have the air of an after-the-fact rationalization. The real reason, I suspect, is that they believe that if rich and poor alike have to use the same system, either (a) the rich will make damn sure that quality and service are improved or (b) if somehow that doesn’t happen, then the rich will suffer along with everyone else. Our experience with highways, airports, the DMV, etc., has shown that (b) is a better bet than (a), which is great for the Left from a schadenfreude perspective but less so from a political one. The trouble with applying option (b) to health insurance is that imposing a single universal system would end up punishing today’s truly privileged elite — government workers. Nowadays government workers have significantly better coverage than those in the private sector — and they often get it from private insurers. So if government employees get stuck with the same crummy insurance as everyone else, it would be a large step backwards for a group that has long been the backbone of the Democratic party.