Jacob Hacker: Thinking Realistically About National Health Care

Over at TPM Cafe, Jacob Hacker asks readers to think realistically about our health care problems.

The essence of Sick -- and yes, you still need to read it -- is an animating argument as simple as it is profound: The problem of health insecurity is not a problem experienced only by those on the fringes of American society; it is a problem increasingly affecting all Americans, both directly and indirectly. And the implication of this core argument is equally simple and profound: Any real solution will have to address the problems faced by us all -- rapidly rising costs, widespread gaps in coverage for the insured as well as the uninsured, health care that's not producing a healthy society as well as it could. We can no longer content ourselves with yet another round of gap-filling half-measures aimed at correcting the most egregious failures of our rickety financing structure.

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Now, when it's clear that private employment-based coverage is failing much of the rest of the population, too, many are calling for an even balder rescue package: huge new subsidies for private insurers, mandates on individuals to enroll in costly insurance that may not even cover their needs, and a new framework for obtaining coverage that will allow private insurance to thrive even as employers' commitment to financing insurance withers.

Jon rightly implies that this is the wrong approach on both substantive and political grounds. Where I think he goes too far is in suggesting that, in thinking about alternatives, political and fiscal considerations should not be a major concern, or that reaping the gains of public insurance necessarily requires moving toward "Medicare for All" or some other universal public framework in a single fell swoop.

While I agree that the cost factor needs to be addressed, there is also the humanitarian factor of providing health care to all Americans. There is also the savings that will take place because of the economies of scale. There would also be the savings from the external costs (see definition 2b) because workers cannot move to a job of which they are better qualified because the currently need to take into consideration the health benefits that each employer offers.

A well-designed national health care program would also allow Americans to receive treatment anywhere in the U.S. without concern of being "out-of-network." An American citizen, at least in theory, should be able to move from New York to Texas and receive the same quality of care that they would have received where they came from. After all, medical knowledge should not be discernibly different in Alaska than it is in California -- especially with the advent of the internet and the rapid communications and access to information that it provides. Such rapid communications also would allow a doctor who is not ordinarily familiar with a patient's history to get access to information that would reduce the risk of mistreatment.

A national health care system would also open the door to treaties with other countries so that both Americans who are traveling to get treatment abroad, and probably more importantly, alleviate some of the anti-Mexican sentiments and arguments that people from Mexico are draining our hospitals resources because they are treating uninsured patients.

But first, we have to have a consensus that the creation of a national health care system is in our best interests. It seems patently obvious to me that it is, but I'm just an Okie lawyer.