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View Diary: Big Healthcare Reform News (333 comments)

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  •  This is a very good idea. (13+ / 0-)

    Studies in behavioral economics have demonstrated that people are far more likely -- for reasons having to do with both laziness and a subtle "nudge" effect -- to participate in a voluntery insurance or retirement plan when it's the default setting (a phenomenon Obama discusses in his second book). With this plan, only the very wealthy, who might genuinely prefer to overpay for boutique insurance; the very stupid, who might believe the propaganda; the ideologically rigid, who might opt-out on principle; and a small number of risk-taking healthy folks will either buy private insurance or go without.

    While there's no denying that some healthy young people are taking informed, calculated risks, as Krugman insists, I think we'll see the number of people in this category fall sharply as the efficiencies of the Medicare-for-all system become clear. Ditto with the duped. It's likely that before too terribly long, a de facto single-payer system would evolve due to the operating efficiencies of public health care. All we need is a government that's ideologically inclined to protect any nascent public system by ending massive federal subsidies to private insurers -- a philosophy Obama has given many indications he'd embrace.

    Of course, boutique supplemental care may become a fixture of the health care landscape. It's not fair, strictly speaking, but it's probably not worth a political Armageddon so long as everyone has the right to a minimum standard of care (defined by doctors, not insurers).

    The practical reason to adopt a gradualist "nudge" plan like the one I describe is, of course, to inure health care reform from the politics of fear and hysteria. Ideologically speaking, it's a free-market plan -- providing for a far freer market than the one under which so many of us currently flail and suffer -- it's just that one of the actors will be federally funded. That's not even an anticapitalist idea.

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