Some talking points for how national healthcare might rein in costs

Via Washington Monthly, Ezra Klein’s “It’s not about age” post on the rising cost of healthcare got me to thinking about possible ways a national healthcare system done right could generate some real savings. That’s whether it’s a straight-up single-payer system or we allow some room for private insurance companies.

Several thoughts on savings:

First, national healthcare would mean, or should mean, standardized paperwork, whether we have a single-payer system, or let insurance companies be part of the game, or whatever. Big administrative savings right there, I think.

Second, if it means the government regulating the amount of fMRI machines in a certain area, or saying that it's only going to be a payer to 12 out of 17 hospitals in a major metropolitan area that have fMRI equipment, so be it.

Let's go further and think of this in terms of medical market care pooling in broader ways.

Third, that in turn may drive some doctors away from some specialties. But, many doctors go down that road in the first place to recoup the high U.S. cost of medical school. This backdoor pressure itself wouldn't be enough to drive down med school costs, perhaps. Maybe other things would, such as higher student loan rates for specialization, or to flip that, lower student loan rates for non-specialization. Expansion of programs, such as working in Indian Health Service hospitals, to ameliorate loans, could be part of this.

Fourth, national healthcare, to me, implies at least some degree of national regulatory standards superceding state ones, such as state insurance boards (at least the health insurance regulatory part; a national insurance regulatory system in general might be a good idea but that's neither here nor there).

Yes, I know big-business conservatives, and the AMA, will both call this “rationing.” On the other hand, people who aren’t knee-jerk worshipers of the myth of Adam Smith, including a fair amount of doctors, surely would buy off on the reduction in paperwork hassles, overhead, etc.

Things like this are why any Ron Wyden-type proposal doesn't well meet my smell test. It’s not so much the issue of single-payer or not, it’s the incrementalism. And, with Fortune 500 companies begging for relief, progressives who really want to do something different on healthcare have them by the short hairs.

That said, this is an area where a presidential bully pulpit can be a big help. So, rather than a Wyden-type proposal being brought to the current Congress, it would be much better, in terms of the big picture, to wait until 2009, assuming the election of a non-Republican, non-Libertarian president.