Responses to Ponnuru on healthcare

Earlier I approvingly linked to Ponnuru's NYT opinion on the misguided case for universal coverage.

VC did the same and got some disapproving comments.  Other negative reactions at The Wonk Room and here.

I tentatively approve of Hal9000's proposal:

The problem with healthcare charity (i.e. giving it to people who don't pay for it) is that there is no ham-sandwich healthcare -- everyone gets Fillet Mignon.

When someone is starving, I don't mind offering them a sandwich... but I don't expect them to expect, demand, or be entitled to Fillet Mignon. But someone on the dole who is "starving" for healthcare, gets the top-shelf stuff. That is the disconnect.

There is no left over unused healthcare to be donated.

There are no fields of picked healthcare that can be subjected to gleaning.

There are no boxes of healthcare approaching their expiration date that can be sold at a discount.

We can't (and the countries that provide universal healthcare don't) provide top-shelf healthcare to everyone. They do it with rationing. I propose something different:

Let the government run clinics. Staff there can not be sued. Government can not be sued for what happens to you there. Then they won't have to practice defensive medicine. No heroics. No million-dollar treatments. Any negligence or malpractice -- use a workers comp model with set amounts for each item. Lose a finger? $500. Lose a thumb? $2000. No chemo. No transplants. Spend the bucks where it counts the most.

You want more? Then *buy insurance*

This seems like it could offer the best of all worlds...

1. New zero-liability gov-run clinics provide the most basic, preventative procedures on the cheap, casting as wide and shallow of a net as possible, maximizing total care per $.  This is ham sandwich and ramen noodles territory.


2. Separately, the status quo of hospital emergency rooms being open to all is preserved.  This is disaster relief.


3. If you want anything in addition to the above (as well you should) then buy it on the market.  These plans are the fillet mignon, sirloin, etc.