Four years ago, on the eve of Obamacare, David Goldhill wrote one of the best pieces about healthcare reform. If you didn’t read it then, you should read it now because it is still one of the best things written about healthcare.
(Second place would go to Steven Brill’s expose of hospital billing. Brill’s piece, which is now behind a firewall, has some issues (see here and here) but is a must-read if you can. I caught it before it went behind the wall.)
Given that Obamacare is now resulting in millions of cancelled policies and increased premiums, it’s worth asking what Goldhill thinks now. Reason did a half-hour interview with him. Again, it is very worth your time:
Goldhill hits a number of great points, pointing out how preventative care doesn’t really save money, how “first dollar” coverage will drive costs up, how the incentives in healthcare are all aligned toward more spending and less efficiency, how, in the words of P.J. O’Rourke, when buying and selling are controlled by legislation, the first things to be bought and sold are legislators. This is all basic economics. But something surprised me: Goldhill is a Democrat who believes in universal healthcare. He’s just honest enough and smart enough to see that the way we’re going about healthcare reform is about 180 degrees from how we should be. There are points on which I disagree with him (the Medicaid expansion in particular). But what he’s saying is correct: we could have a better healthcare system at a fraction of the cost by understanding how markets work instead of pushing us closer and close to monopsony.