HEALTH CARE AND CHOICE

Eugene Robinson writes about his experiences after contracting a serious bacterial infection and draws some conclusions about health care from his experiences. Leaving aside that such anecdotes are far from the best way of making policy judgments, his first bottom-line conclusion is at least sound:

If I were among the 46 million Americans who are uninsured, I'd be looking at a huge hospital bill. No one should face financial ruin because of a mishap with a fork and an avocado. The way we ration health care now -- according to the individual's ability to pay -- is immoral, and if higher taxes are needed to ensure that no one has to choose between health and bankruptcy, I'll pay.

This is right, and it's nice to see someone in a major op-ed page point out that the American system does, in fact, have rationing. It's just that the rationing is done on a class basis rather than being based on the importance of one's medical problems.

Curiously, however, Robinson goes on to argue that he "also feel[s] more strongly about the ability to make [his] own choices," all after having a surgeon explain that "if you and Obama had your way with health care, it wouldn't be me doing this operation. It would just be some guy."

I don't know about what policy Robinson favors, but despite his implication, Obama's plan would almost certainly increase choice in the American health care system. First of all, many people who have insurance are seriously restricted in their choice of physicians. There's nothing about private insurance that guarantees that patients will have wide discretion in choosing who will perform their medical care. For example, Canada's single-payer system would even provide more patient discretion. And then, of course, people without insurance effectively have no choice at all. Obama's plan will at least give many of them more options than they have now. People who can afford to pay out of pocket for the doctor of their choice can still do so. It is, I suppose, true that having more people with insurance may slightly lower the odds that Eugene Robinson can get surgery from his first choice doctor, but this doesn't strike me as a very important public policy objective.

--Scott Lemieux

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