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US Health Care Reform Should Not Include Centralized Bureaucracy

Armen Hareyan's picture

US Health Care

The U.S. health care system has "worked well for decades," but "nowit's coming apart at the seams," columnist David Brooks writes in a New York Timesopinion piece. He continues that in considering changes to the system,policymakers should realize that U.S. residents "will not likelyembrace a system that forces them to defer to the central governmentwhen it comes to making fundamental health care choices."

Instead,Brooks writes that "some distinctly American social contract is goingto be required," adding that the "worst thing we could do is get thesmartest people in a room and build one system from Washington."Rather, the federal government "should set parameters, and statesshould be left free to innovate and compete," he says.

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As apotential model, Brooks cites a proposal made by Stuart Butler of theHeritage Foundation. First, it "would create tax-exempt 'insuranceexchanges'" that would be "sponsored by trusted agents -- unions,churches and other social groups" -- and "would offer menus of coveragechoices and create diverse risk pools." Second, "employers who did notoffer their own coverage would oversee payroll deductions and taxwithholdings, but they would no longer have to sponsor programs or makechoices for employees." Third, "Congress would offer a health care taxcredit to families making up to 200% of the poverty level and wouldtighten benefits for the affluent." Finally, "states could come up withtheir own ways to regulate this system."

Brooks concludes,"This isn't the laissez-faire social contract of the 19th century. Butneither is it the centralized, big bureaucracy contract of the 20thcentury. It's a contract that envisions society as a dense but flexibleweb of social networks, the perfect vision for 21st-century America"(Brooks, New York Times, 9/7).

Letters to the Editor

The Times on Monday published letters to the editor responding to Brooks' opinion piece.

  • GregorySaltzman: Brooks "dismisses a single-payer health insurance system,"and yet Medicare has "strong political support," Saltzman, a professorof economics and management at Albion College, writes in a Timesletter to the editor. Saltzman continues, "Extending Medicare to coverall Americans would strengthen America's economy in three ways,"adding, "It would reduce administrative expenses, replace costlyemergency room visits for those now lacking insurance with morecost-effective preventive care and improve the global competitivenessof American manufacturers, who now bear much higher health care coststhan do their foreign rivals" (Saltzman, New York Times, 9/10).
  • RonaldHikel: Brooks is "mistaken" in making "what he imagines to be twosalient points explaining why single-payer health systems are not rightfor America: they are 'European' and invariably centralized," Hikel,former deputy minister of health for the province of Manitoba andco-chair of the federal-provincial council of deputy ministers ofhealth, writes in a Times letter to the editor. Hecontinues, "Canada has just such a system but is distinctly NorthAmerican." Hikel notes that the health care system in Canada isregulated by provincial and territorial governments, not the centralgovernment. He concludes, "There are, in fact, substantial variationsin structure, procedures, coverage and financing, and these mirror andaccommodate many local realities. Canadian health care already is thecontinent-spanning flexible web of networks Mr. Brooks so admires"(Hikel, New York Times, 9/10).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.