I told you, I told you, Paul Krugman is setting us up as patsies for his prefered solution to health care.

Isn’t competition supposed to make the private sector more efficient
than the public sector? Well, as the World Health Organization put it
in a discussion of Western Europe, private insurers generally don’t
compete by delivering care at lower cost. Instead, they "compete on the
basis of risk selection" – that is, by turning away people who are
likely to have high medical bills and by refusing or delaying any
payment they can.

Yet the cost of providing medical care to those
denied private insurance doesn’t go away. If individuals are poor, or
if medical expenses impoverish them, they are covered by Medicaid.
Otherwise, they pay out of pocket or rely on the charity of public
hospitals.

So we’ve created a vast and hugely expensive
insurance bureaucracy that accomplishes nothing. The resources spent by
private insurers don’t reduce overall costs; they simply shift those
costs to other people and institutions. It’s perverse but true that
this system, which insures only 85 percent of the population, costs
much more than we would pay for a system that covered everyone.
….

First, in the U.S. system, medical costs act as a tax on employment.
For example, General Motors is losing money on every car it makes
because of the burden of health care costs. As a result, it may be
forced to lay off thousands of workers, or may even go out of business.
Yet the insurance premiums saved by firing workers are no saving at all
to society as a whole: somebody still ends up paying the bills.

Second,
Americans without insurance eventually receive medical care – but the
operative word is "eventually." According to Kaiser Family Foundation
data, the uninsured are about three times as likely as the insured to
postpone seeking care, fail to get needed care, leave prescriptions
unfilled or skip recommended treatment. And many end up disabled – or
die – because of these delays.

Think about how crazy all of this
is. At a rough guess, between two million and three million Americans
are employed by insurers and health care providers not to deliver
health care, but to pass the buck for that care to someone else. And
the result of all their exertions is to make the nation poorer and
sicker.

He pointed us, in his first article, to the example of France, where they apparently get better treatment at lower cost. Now he’s blaming  the US problems on the insurance industry and choice, plus the fact that the insurance is a tax on jobs. But as I said about the French system:

This
is where I think the bait and switch will come in, for he has, as
above, rightly praised the French system. Yet the French system is not a single payer system at all.
The compulsory insurance element collected through pay packets pays for
only a portion of treatment costs (35-65% on prescriptions, 70% in
general, except in some exceptional circumstances like cancer
treatment). There are myriad private insurers who offer a variety of
plans to cover the un-reimbursed costs and sometimes the extra costs
that can be charged over the prixe fixe. One could with a straight face actually state that this is less generous than the current Medicare and Medicaid systems in theUS.
Anyone want to try and get the AARP behind the idea that the old
geezers should be paying 65% of their Viagra prescriptions and 30% of
the cost of their GP visit?

 The
second thing is that it is not a single provider system. There are
indeed publicly owned hospitals, as there are non-profit or charitable
ones, as well as profit seeking private providers. All patients have
complete freedom to seek treatment from whomever they wish, so
certainly an amount of personal choice there.
 
What worries me is that the Professor will point to a decent system, that of France, and use it to propose a terrible system, that of the UK.

He’s setting us up, mixing and matching his examples and arguments to get to his preferred solution, rather than the one that the actual evidence leads to. If we are to think of the French system as being superior (which it certainly seems to be, both to the US and the UK systems), then we should (and he should) be arguing that there is compulsory insurance derived from wage packets, run separately from the general revenue stream, high co-payments, optional private insurance to cover those, private insurance companies offering the plans   and a mixture of state owned, charitable and for profit companies offering treatment.

Doesn’t look like he is going to propose that, does it?

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