Think Health Care's Expensive? Wait Until it's Free.

This story carries a perfect little microcosm about why the health care debate is so complex. Nutshell: a passenger from the U.S. Airways flight that landed in the Hudson wants the company's insurance carrier to pay her family's therapist bills. Here's the money quote, from the passenger:
I expect my family to be taken care of in the very best way possible, and I don't feel like that's happening when you're balking at my claims to a therapist and you are setting limits on that.
Her expectation is for the best possible care, as defined by the patient, exempt from limits imposed by the insurance company. Without debating the merits of her claim (I don't doubt them at all, BTW) therapy still has to be paid for by someone. Here are a few thorny questions a public plan that doesn't have to turn a profit will have to answer:
  • Will a therapist who treats patients "in the very best way possible" be legally compelled to service this level of demand?
  • Who decides what constitutes "best?"
  • What if reimbursement is, over time, inadequate and said therapists refuse to accept the public plan?
  • Will coverage be denied for some and not for others? On what basis? Who decides? Why will they be better allocators than private markets? Will it cost less? Why?
  • If some future Congress requires that a public plan accommodate this expectation, will taxpayers or policyholders be required to assume any excess costs?
  • Are these expectations price inflationary?
I don't believe for one second this woman is just being hyperbolic. I believe she believes she's entitled to the best treatment someone else's money can buy. Aggregate premiums will never overcome the cost of offering everyone the best treatment all the time. How could it? Cost improvement from electronic records, health care exchanges, wellness and prevention are all just spitting in the ocean compared to the force of unconstrained demand.

Mr. President, it won't be easy but please end the employer health care exclusion.

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