Gordon and Nilsson have attempted a massive review of Harvard University Press books and admit to not carefully reading all 494 of them. I was pleased to see my book, Total Cure: The Antidote to the Healthcare Crisis (2008) made it past their initial screen-out. Their assessment, however, raises some concerns about what must be quick, and in at least one instance superficial, reviews. They categorize my book as “Left” and describe it as “Calls for universal compulsory health coverage that would cover two-thirds of costs. The rest would be dealt with by a voluntary program that would allow free choice of physicians.” That assessment sounds like “Medicare for all with voluntary supplemental coverage.” That is far from what I proposed.
Even a quick read would indicate that the focus of the book is not on universal compulsory coverage, but rather on changing the medical care delivery system, with a far greater reliance on effective market mechanisms than we have now. While I do believe that universal coverage for major acute and chronic illnesses is critical to avoid gaming and selection, coverage for many things people on the Left feel should be covered is really an equity rather than an efficiency issue. There are better ways to achieve those equity goals.
I realize that the strict libertarian would argue against any mandated coverage. Until the US citizenry is willing to let people who fail to provide for themselves die on the hospital’s steps, a coverage mandate for major illness is warranted. I raise significant concerns about any major role for government beyond certain minimal things it can do reasonably well. These concerns are problematic for those favoring a single payer solution. I think such an approach would guarantee coverage, but otherwise it would be a disaster.
My concerns with public solutions arise, however, not from an anti-communitarian perspective, but rather from a recognition that our political system is too responsive to special interests. The appropriate use of market forces (which is quite different from letting existing players exercise their market power) is necessary to overcome that political power.
Gordon and Nilsson did note that physician choice is critical in my proposal, but this is not as a sop to those who argue for choice in general—as in “free choice of physician” without any responsibility for those choices. Instead, my design uses choice as a core feature allowing individuals (even different members within a family) to choose the style of practice they want, while bearing the full marginal costs implied by their own choices. The plan makes those cost (and quality) implications real and accessible to individuals without unrealistic assumptions about consumer sovereignty and rationality in medical care choices.
I don’t mind being attacked from both the left and right— that’s usually an honor. If one wishes to critique the literature for an ideological bias, however, it is best to get one’s facts straight.
(For an example of a review by someone “not on the Left” who read the book more carefully, see this link.)
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