Magazine | July 08, 2019, Issue



‘No’ to Socialized Medicine, Cont’d

A recent article by Avik Roy (“Socialized Medicine Is Bad for Your Health,” June 3) gives me pause in my waning support for repeal-and-replace and my gradual conversion to support for single-payer health care. But I would like to draw his attention to two points not addressed in his article that seem to me to be fundamental to any health-care solution:

First, Roy makes no mention of mandating health coverage for all Americans. That so many people were uninsured is what led us to Medicaid and Obamacare. It seems this issue must be addressed: We need to mandate that all people in the U.S. purchase health insurance. It must be legal, constitutional, and enforceable. This will not only vanquish the liberal arguments that the government must step in and provide coverage (at taxpayer expense), but it will also drive insurance rates down, as actuarial models will improve substantially with 100 percent participation.

Second, Roy does not address the fact that, while many plans provided by large employers do indeed limit choice, they are often self-insurance — companies pay employee claims out of their own pockets and hire an insurance company to handle all administrative matters. It is unclear to me how giving me choice will result in lower cost for the same benefit; it seems it might get more expensive.

David Beers
Via email

Avik Roy responds: We don’t need to force everyone to buy health insurance to have a system in which every American can afford coverage. Indeed, doing so would be counterproductive, as it would allow policymakers to further drive up costs, knowing that they could pass those costs on to consumers. In a market-based system, insurers have an incentive to keep costs low, because they know you’ll choose to go without coverage if their products don’t provide enough value.

In another article, “To Stop Socialized Medicine, Expand Individual Choice” (National Review Online, May 27), I explain that the employer-based system “is far removed from an actual market for health insurance, because few workers have the opportunity to choose their own coverage with their own money.” Giving workers control over those dollars will in fact lower costs, because employers have shown little interest in bargaining with hospitals to achieve lower prices. Indeed, insurers often prohibit employers from seeing the rates insurers negotiate with hospitals and doctors. On the other hand, if insurers have to aggressively compete for individual consumers’ business by offering lower premiums, they will have to bargain aggressively with hospitals to get the best possible deal. That will make insurance less expensive.

But insurance reform isn’t the only thing needed to make health care less expensive. We also have to do much more to tackle the rising problem of crony capitalism in the hospital and drug industries, by reforming federal and state laws that restrict competition and entrench monopolies. I encourage those interested in these topics to read my paper “Affordable Health Care for Every Generation” at (the website of the Foundation for Research on Equal Opportunity).

NR Editors includes members of the editorial staff of the National Review magazine and website.

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