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Avik Roy and Manhattan Institute colleague Yevgeniy Feyman discuss their new interactive map, published at Forbes, which explores the impact of Obamacare on the cost of health insurance in every U.S. state plus D.C.
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I listened to the podcast and read the Forbes piece. There was a WonkTalk debate between Avik Roy and Ezra Klein embedded in the Forbes piece. Though Mr Kein doubted aloud that anyone would, I listened to the end.
The overall impression Mr. Roy gives is that he has a few minor disagreements with ACA, but that a few tweaks would fix it. Exchanges are great, the Swiss approach is great, we can learn a lot from the Singaporean command-and-control model. The problems with ACA are technical. The podcast paints a rather different picture.
For me, the problems are more fundamental. What is the role of individual responsibility in healthcare? Why does healthcare cost so much less elsewhere even though outcomes are comparable if not better? [not entirely explained by other countries getting a free ride from US investments] Mr Roy touched briefly on the first of these, but largely agreed with Mr Klein on a highly redistributionist approach. It is a moral question, not a wonkish one, yet that is where some true disagreement lies.
[continued – 200 words are not enough]
Regarding the cost issue, Mr Klein is right that this is mostly a zero-sum game. Putting aside the issue of distribution of costs among consumers, the principal way to reduce the costs is for providers (including support staff, ancillary services, and medical education) to get paid less. There has undoubtedly been an analysis of these costs across countries of incomes for providers. This kind of data would seem to be relevant to the discussion.
How is it possible for a dozen or more countries to have much lower (~half) the per-capita cost yet enjoy higher life expectancy, lower infant mortality, and greater or comparable numbers of doctors per capita? Most western European countries fall in this category, along with Canada, Australia, Japan, and South Korea. I realize there are some demographic causes but it still begs explaining, while controlling for these differences. The discrepancy in cost (2X) is hard to justify in terms of outcomes.
Why has the cost of healthcare been increasing faster than inflation by such a large factor? This is reminiscent of the higher education, which is analogous in many ways.
These are the important questions about healthcare, not the minor tweaks about cost redistribution.