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June 16, 2008

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Health care costs will be controlled by (1) rationing care and (2) stiffing the providers. The first has a direct effect on quality; the second has a slower effect, because most (though not all) existing providers don't have much ability to change professions. However over time we can expect that many of the most capable young people will choose more remunerative professions. That doesn't mean the medical care system will stop functioning, it just won't function at quite so high a level. (We've seen this phenomenon before: NYC rent control, which stiffed the landlords but led to a serious decline in the quantity and quality of rental housing.)

Back in the late 60's and early 70's, the reformers all touted managed care as the magic bullet for more affordable health care. Health maintenance organizations are the direct result of that movement. It apparently didn't occur to the reformers that HMO's would have a motivation to ration care (both through fiat and by making access to care more time-consuming and difficult) in order to increase their profits. Now when an HMO is mentioned in a movie, the audience jeers.

Will the same thing happen 35 years from now when Obama-care is mentioned? Probably not--because there won't be movie theaters by then.

Obama also requires that insurers issue every applicant a policy, and employers that do not offer or make a meaningful contribution to the cost of quality health coverage for their employees will be required to contribute a percentage of payroll towards the costs of a national plan.

Policy analysts and politicians frequently refer to the projected costs of health care plans to the government rather than their net effect on national health spending.

I have to side with Klein here. You aren't quoting a debate between policy experts, you're quoting a statement Obama directed at the country at large. From the quote you cited:

John McCain doesn't have a plan to make health care affordable and accessible to every American.

This implies that the costs Obama is addressing are those ultimately paid by each of us, not the government.

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