Ezra Klein: recommendation

Transcript context

…That’s not an accident. If you look at the pure or single-payer systems — Canada or the UK — they’re very fiscally strapped. They grossly underinvest. Most of the incentives are to stint and drive down prices and not actually want to see too much innovation. In Canada, they even send a lot of people to their deaths under possibly dubious circumstances, which is a pretty radical place to end up in. So, why trust these systems to fine-tune where the incentives ought to be when they’re just basically fiscally, if not quite broke, badly ailing? My view has always been that you want a floor, not a ceiling on your system. I’ve never actually been a supporter of . . . People often mean different things when they say single-payer systems, but when we’re really talking about something like Canada or the NHS — that’s never been the structure I would move towards. I much prefer the kind of system you see in a place like France, where what you have is a significant healthcare, a basic provision floor. A huge amount of the value of healthcare comes out of basic healthcare. Then you have supplementary insurance which you can buy on the open market — and people do — or if you can’t afford it, there are subsidized versions of it. So, you have what I used to describe as a floor without a ceiling. I prefer multi-payer systems. I do want things provided universally at a basic level, and then I do think, for some people who can’t afford above that, there should be public provision of it. I think you want to be very, very careful about not having any exit from either the government pricing regime or the structure of government insurance because there are things that come into the system that it’s hard to know how to ration them. It’s hard to know how to provide them, and you do want to make sure there is sufficient incentive to develop them. What if someone said, a true abundance agenda — of course, this could never happen — but it’s basically to zero out Medicare and Medicaid, which is a lot of money, and spend all of that on science and birth subsidies and social security for that matter. Why isn’t that the true abundance agenda?…

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