July 20, 2007

It's just shameful. People---their Brothers' Keepers all---insist on finding ways nonetheless to force others to pay for their medical care. Strenuous efforts those are indeed, as employers look to employees, patients look to insurers, and insurers look to anyone they can find. And these efforts---one component of running the system writ large---are costly. If only we could find a way to put everyone in the same boat. Everyone would row, no free rides here, nosiree, and all those wasted resources would become available for the delivery of actual health care services. Another beautiful day in Mr. Krugman's neighborhood. Single-payer nirvana: It sings.

And so it is disorienting to find in the pages of the Memphis Commercial Appeal a report (July 19) to the effect that the state of Tennessee is going to fight tooth and nail against federal payment ceilings for Tennessee hospitals, as such payment caps "could cost Tennessee up to $400 million over the next three years."

So let's see here. Even in Krugmanland, the feds are trying to shift costs to state taxpayers, the state politicians are trying to shift costs to federal taxpayers, the patients couldn't care less who pays the bills as long as it's not them, and so on. But just wait a darned minute here. THIS IS KRUGMANLAND. This is not supposed to happen. It is only in that evil, selfish, uncompasionate, Hobbesian world of private-sector multiple payers that such shameless behavior is to be observed. Right?

Well, maybe the problem is that the feds and the states are different entities; if the Beltway ran everything, holistically as the New Age types might say, we wouldn't have to ask "Can't we all get along." Well, not quite. Someone still is going to have to decide who bears what proportion of the tax burden; and because resources are limited always and everywhere, some patients will get the services that they want, and others will not. "Universal coverage" is a mirage. And so cost-shifting in the larger analytic sense will be with us as a matter of first principle as long as third-party payment remains the elephant in the waiting room, private, public, or any combination you want. But don't tell Comrade Krugman: His system might not be able to take the shock. And I don't want to have to pay for that.

Posted by Benjamin Zycher at July 20, 2007 05:43 PM

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