Posted: March 3, 2010
like Sally Pipes. She is fun—inevitably cheerful, beautifully groomed, and exceedingly witty. These qualities are apparent in her stylish, upbeat, witty book. But more than that I like her consumer-driven ideas about health care reform; the tart, clearway she expresses them; and the economy with which she marshals an impressive array of facts to support them.
This little bantamweight of a book—smaller than a laptop with only 148 pages of text—effectively dismantles many of the alleged facts used to support the Democratic health care overhaul that was expected to pass easily in 2009. The reforms relied on the thought that Uncle Sam was good for your health—he would organize markets for health insurance, determine the prices health insurers could charge and how they could spend their money, and design the contents of the health insurance policies they could offer. To ensure perfect competition, Uncle Sam would compete with these neutered health insurers through a public plan. All of this would control costs, by virtue of the government's excellent management, and provide universal coverage.
Well, even the folks in my vastly liberal home state of Massachusetts did not buy this set of ideas, as their 2010 election of a Republican senator who opposed the plan clearly demonstrated. Scott Brown must have read Pipes's book because he echoed all her sentiments in his smart campaign.
As she notes, the U.S. health care system is pretty good, especially for the sick. For example, we have the world's best cancer survival rates due, in part, to our willingness to pay for the expensive drugs that palliate and sometimes cure it. If universal coverage denies needed care for the sick, as she demonstrates is the case in Canada and Great Britain, then it is a Faustian bargain. Universal coverage for the healthy? Surely you jest.
Pipes effectively skewers other myths: the purported efficiency of government-run insurance programs which are not only much more expensive to administer than is alleged but also fail to enroll the very people for whom they are designed,and treat them poorly to boot; the alleged incompetence of our pharmaceutical sector, which, as she demonstrates, has created a disproportionate share of the drugs that prolong life and save money along the way; and the magic bullet of government-run health information technology programs that, to date, are more like a bullet to the head of health care providers forced to comply with extensive, murky regulations.
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The president and CEO of the Pacific Research Institute, the free-market think tank based in San Francisco, Pipes is a bipartisan critic. Her sharpest digs are aimed at the Democrats who longed for single-payer health care. The Republican Mitt Romney comes in for his share of digs for launching the current ill-considered health reform movement when he was governor of Massachusetts. Universal coverage in Massachusetts has turned out to be a fiscal train wreck even for this wealthy state. She also mocks the nannyish Republican (wait, what month is this? Is he a Democrat, Independent, or Republican today?) mayor of New York City, Michael Bloomberg, who banned trans-fats from area restaurants.
But her most extensive indictment is reserved for the government-dominated single-payer systems around the world that our Democrats are so keen to emulate. Despite her support for market-based solutions—e.g., opening up an interstate purchase of health insurance, changing the federal tax laws to allow individuals to purchase health insurance with pre-tax dollars, and so forth—she has not swallowed the Kool-Aid that so many Republicans have drunk and that has so distanced them from the populace. Unlike them, she acknowledges that tens of millions of Americans need health insurance and offers some good ways of getting them insured, based on creating a consumer-driven market.
But here is where Sally Pipes and I part company. Absent community rates (charging everyone the same regardless of age or health status), I do not see how sick consumers will be able to afford the purchase of health insurance (as she notes, they account for about 80% of health care costs). And absent government-mandated universal coverage, community rates will be absurdly high because only the sick will enroll. Although she does not discuss this problem, the typical Republican solution of government-funded high risk pools for the sick means their care will be overseen by the very government whose competence she has so effectively skewered.
Other than that, Pipes is darn near perfect. If you want to read one book that cuts through the lobotomizing health care reformdebate and points to a clear path for solving the problems, this is the one.