The Catholic University of America
Oct 23 2009

The debate over health care reform

Posted by Ernest Zampelli at 4:04 PM
4 comments
- Categories: Economy | Social Justice | Government & Civil Society

The debate over health care reform, though at times uninformed and uncivilized, has again focused attention on the longstanding issue of government’s proper role in a (predominantly) market economy.  It is not my intent to address this issue per se except to admit without apology that I am a firm believer in and strong proponent of private markets.  With participants acting in accordance with their own self-interest (not to be equated with greed, please) and with no coordinating mechanism except prices, markets are extraordinary at allocating resources to their most socially productive and valued uses.  Of course, this itself would be impossible without government at least providing a legal infrastructure that defines and protects private property rights, enforces contracts, and offers recourse to those victimized by the unscrupulous and fraudulent.

When the issue is narrowed to the proper role of government in the provision of health care, however, serious complications arise that the market, without broader government involvement, cannot resolve.  First and foremost, if access to adequate and affordable health care is defined to be a basic human right, the market by its very nature cannot be expected to deliver it.  Markets provide goods and services to consumers not because consumers have a right to them but because consumers are willing and able to pay for them.  Further, a willingness to pay in the absence of an ability to pay garners the consumer nothing.  Practically, then, any claim that access to adequate and affordable health care can be ensured for all without an expanded government role in the health care market is simply not to be believed.

So now the crucial question becomes “How should the government expand its role, not only to guarantee access and affordability, but also to improve the efficiency of health care delivery and to reduce the rate of health care inflation?”.  The simplest, most effective, and most palatable way is through the often maligned and feared public option.  Claims that such an option will destroy the private insurance market because it will tilt the playing field away from private insurers are simply overblown and inconsistent with most empirical estimates.  Having an affordable public option will force private insurers to exact efficiencies from their operations and processes that they have heretofore ignored largely because of the market power they and large hospitals possess.  The only other viable alternative in the absence of an affordable public option is a heavily regulated private health insurance market modeled after the Switzerland system.  This model does not seem to fit very well with United States tradition and culture nor do I think does it create enough room for creative and entrepreneurial solutions to a number of health care problems. 

Comments

Michael Zampelli

Michael Zampelli wrote on 10/23/09 6:57 PM

Thanks for this! Very clarifying--particularly in terms of the point you make regarding the employment of "rights language." Classifying health care as a human right automatically broadens the possible menu of options to include--necessarily--a government option alongside others. The existence of such an option does not foreshadow--as has been predicted in the past--the takeover of the US economic system by either the German Kaiser or Communists! Is it fair to suggest that there are some who simply don't believe that all people have the right to health care?
Stephen Schneck

Stephen Schneck wrote on 10/26/09 2:23 PM

The argument that adequate health care is a right has come from several American bishops and is rooted in both the common good arguments of traditional Catholic social teachings and the personalism of John Paul II's theology. (See, for example http://www.usccb.org/sdwp/national/2009-10-08-healthcare-letter-congress.pdf) Some Catholic conservatives, however, are challenging the bishops on this, such as Fr. Michael Orsi in Human Events. (See http://www.humanevents.com/article.php?id=32911) As Dr. Zampelli notes, if health care is a right, than we are morally obliged to assure it, whether the market works to provide it or not. And, again as Dr. Zampelli notes, this does recommend the public option--at the very least as a safety net when private competition fails to provide an acceptable level of coverage.
scott montgomery

scott montgomery wrote on 11/10/09 6:03 PM

dr. zampelli is right in his assessment with the exception of health care being a right. medical care is a good or service jsut like an automobile. it is not a public good like water or electricity because there is a finite number of doctors who provide medical service. until we discuss tort reform, there is no point discussing any health care reforms because all of the current reforms that are being debated will not improve health care but destroy it. to make health care affordable means you have to take the monied interest out of the system and that starts with tort reform. insurance costs can be greatly reduced by not making insurance a necessity. it should only be used for catastophic illnesses. doctors can make other arrangements with patients to provide better care such as a payment schedule. doctors should not have to practice in mega-practices. each should have their individual offices and have many patients and not have to jack up prices to cover costs so that the insurance industry monopolizes the medical profession. instead of offering these fixes, the government wants to replace the insurance industry and monopolize and control our medical profession. if they care about people, they will not proceed with this destruction of our health care system. nothing in the current health care bill that the house passed insures that the insurance agency with the largest printing press (the governemnt) gets to dictate who lives and who dies, and that is not catholic teaching.
Bart Pollock

Bart Pollock wrote on 01/29/10 10:55 AM

Thanks for such a clear and logical perspective on this issue that has been so obscured by political posturing. If health care is a right, as the Catholic bishops assert, then some sort of government option is essential in a market economy in which many people cannot afford adequate health care. Those opposed to a public option - any public option - must either disagree that health care is a right, or are simply obstructing the discussion for political purposes.

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