Getting Extra Credit for Being Sane

Reading Harvard Business School Professor Regina Herzlinger once again misrepresent the Swiss health care system as a consumer-driven model of care that conservatives can get behind is just the thing that would normally set me off.  Yet I’m actually thrilled that she wrote it.  For one thing, she presents a clear conservative rationale for supporting health care reform.  For another, as much as I disagree with some of her analysis, there’s no doubt she’s actually using analysis and not using the worst case scenario sprung from significant leaps to conclusion to fuel an ideological-driven argument.  In short, she gets extra credit for being sane.

Herzlinger’s article in The Atlantic, entitled “Why Republicans Should Back Universal Health Care” offers as a conservative vision for reform the entirely private insurance-based model of the Swiss, which I wrote about at somewhat excruciating length six weeks ago.   It’s the same general point that she’s written about for years (at least as early as 2004), that the individual mandate and generous subsidies of the Swiss government create a consumer-driven market where patients shop for the best deals and the plan that best fits their needs, or “in which the people, not the government, control how much they spend on health.”  I won’t spend a lot of time refuting this because Maggie Mahar has already done a masterful deconstruction of this misdiagnosis (back in 2007), and Jonathan Cohn on The Treatment brings up Uwe Reinhardt’s counter-Herzlinger analysis that “One can just as plausibly ascribe that performance to the pervasive government regulation that guides the Swiss health system.”  Indeed, because the insurance companies are non-profit, charging government-set prices and have a government-fixed comprehensive set of benefits, comparing our insurance market to there is like comparing Earth’s atmosphere to Venus’:  sure, they both have carbon dioxide and similar weather system, but I’d avoid standing out in the rain and taking a deep breath on Venus, if I were you.

But despite my objections, I can’t help but rejoice to see an article like this.  I disagree with her on many points, but she’s demonstrated some deep analysis and some absorption of lessons from health care systems beyond our borders.  More particularly, she’s brought up the main reason why the conservative obstructionist stance against health care reform is short-sighted:  it’s in the natural interests of big business and the GOP’s fundraisers and constituents that it succeed.

CEOs rarely say "Know what I love about my job? Buying health care." The chore is so unrewarding -- corporate buyers have failed to create effective cost or quality improvements -- that many small business CEOs simply skip it. As a result, millions distort the efficient allocation of labor in our economy by opting for jobs in dying, big companies that offer health insurance, rather than productive ones in small companies that do not. Furthermore, our employer-based health insurance system forces American businesses to pack our massive health care costs -- about 70 percent greater as a share of GDP than other countries' -- into the cost of their exports, a huge albatross in a globally competitive economy.

What do you know – a free-market and pro-economy argument for supporting health care reform.  In order to get to her thesis, she doesn’t need to present an “everything you know is wrong/black is white” thesis like Weems and Sasse’s attempted takedown of the notion that public coverage is more cost-efficient than private coverage, despite years of data on Medicare and the VA to the contrary.  She doesn’t need to take the fact that many people would choose to have stable public coverage rather than unpredictable private insurance if it were an option and exaggerate it into a dystopian vision of a depleted Treasury, a bankrupt private insurance system, and waiting lines to the crack of doom if we even try a public option.  She's not disguising an obvious ideological push poll as an open form.  There’s not a tea bag in sight.  In a public debate where the conservative anti-reform message has been all about being anti-Obama, and whose connection to the reality that I and you and most of the people we know experience in our broken health care system is roughly as tenuous as The Hills’ connection to the working world, that counts for something.

It’s been so long since we’ve heard a reasoned, conservative vision on health care reform, I almost forgot what it sounded like.