U.S. Health Care Reform Should Not Include Centralized Bureaucracy, Opinion Piece States

Main Category: Public Health
Article Date: 12 Sep 2007 - 5:00 PDT

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

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

As a potential model, Brooks cites a proposal made by Stuart Butler of the Heritage Foundation. First, it "would create tax-exempt 'insurance exchanges'" that would be "sponsored by trusted agents -- unions, churches and other social groups" -- and "would offer menus of coverage choices and create diverse risk pools." Second, "employers who did not offer their own coverage would oversee payroll deductions and tax withholdings, but they would no longer have to sponsor programs or make choices for employees." Third, "Congress would offer a health care tax credit to families making up to 200% of the poverty level and would tighten benefits for the affluent." Finally, "states could come up with their own ways to regulate this system."

Brooks concludes, "This isn't the laissez-faire social contract of the 19th century. But neither is it the centralized, big bureaucracy contract of the 20th century. It's a contract that envisions society as a dense but flexible web 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.

• Gregory Saltzman: Brooks "dismisses a single-payer health insurance system," and yet Medicare has "strong political support," Saltzman, a professor of economics and management at Albion College, writes in a Times letter to the editor. Saltzman continues, "Extending Medicare to cover all Americans would strengthen America's economy in three ways," adding, "It would reduce administrative expenses, replace costly emergency room visits for those now lacking insurance with more cost-effective preventive care and improve the global competitiveness of American manufacturers, who now bear much higher health care costs than do their foreign rivals" (Saltzman, New York Times, 9/10).
  
  
• Ronald Hikel: Brooks is "mistaken" in making "what he imagines to be two salient points explaining why single-payer health systems are not right for America: they are 'European' and invariably centralized," Hikel, former deputy minister of health for the province of Manitoba and co-chair of the federal-provincial council of deputy ministers of health, writes in a Times letter to the editor. He continues, "Canada has just such a system but is distinctly North American." Hikel notes that the health care system in Canada is regulated by provincial and territorial governments, not the central government. He concludes, "There are, in fact, substantial variations in structure, procedures, coverage and financing, and these mirror and accommodate many local realities. Canadian health care already is the continent-spanning flexible web of networks Mr. Brooks so admires" (Hikel, New York Times, 9/10).

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