A passionate critic of Obamacare, Levin calls for more market-based, consumer-driven healthcare reforms:
Market solutions would by no means eliminate all the grave difficulties involved in prioritizing health care. There would still be rationing, there would still be times when being out of money means you are out of options, there would still be decisions made by insurance company bureaucrats that strike patients and doctors as unjust. But there would be far fewer than under a system that assigned rationing decisions to public officials and gave patients far fewer choices and far less control.
In a properly regulated but competitive insurance market, we would have a much better chance of actually prioritizing health among the goods we value. Because while liberal political institutions are unsuited to such prioritization, we liberal citizens are often up to it. Families, which after all are not liberal institutions, can make difficult choices — balancing the needs of different generations and the importance of different needs and wants — in ways that democratic political institutions often simply cannot.
On the higher-order moral question posed by embryo-destructive stem cell research, I find Levin’s argument here persuasive. But I’m quite a bit less persuaded when it comes to ordinary healthcare consumption. The truth is, Americans visit doctors less often than their counterparts in other advanced democracies. Since the Great Recession hit, they’ve cut back on both those visits and prescriptions drugs, even as out-of-pocket costs for the latter have fallen. And where there is overconsumption, it’s often driven by the private marketplace, as Elisabeth Rosenthal has written:
There is, of course, economic impetus for American medicine’s “more is better” mode — at least when patients have insurance. In the United States, most doctors and hospitals profit more by doing more, and prices are particularly high for tests and scans. Also, we are one of the few countries where drug makers and hospitals advertise products and treatments directly to patients, creating demand from consumers who don’t actually pay their full costs.
The premium-support model advocated by Levin and others would change the fee-for-service structure of Medicare, and thereby, theoretically, reduce “more is better” spending on seniors, but I’m not sure how that would improve consumer decisions among those under 65. And I’m quite sure that market-based health reformers don’t favor advertising restrictions on the pharmaceutical industry.
The imbalance, as Levin sees it, in “our pursuit of safety, health, and comfort” is a problem tens of millions of Americans can only wish they had.