'Single-payer by attrition'
The Economist follows up on my argument that ruling the individual mandate -- and thus a hybrid universal health-care system -- unconstitutional would be a disaster for conservatism.
The clearest way to explain it is that right now, what we have already is a system that's getting ripped apart in a vortex of adverse selection. Health spending is rising at 8% per year. PriceWaterhouseCooper says medical costs will grow 9% in 2010; health insurance premiums generally rise even faster than costs. Premiums now amount to 18% of the average household's income, up from 11% in 1999. As insurance costs rise far faster than wages, unsurprisingly, the number of uninsured keeps rising too, to 46.3m in 2008. And those who aren't uninsured are increasingly insured by the government. Medicaid added 3m people to its rolls in 2008. The Children's Health Insurance Program (CHIP) picked up another 1.5m. As this process continues, federal spending on health insurance keeps climbing; it grew 10.4% in 2008. Sick people, poor people, and older people are increasingly unable to afford insurance, and many are winding up on the government's dime. As premiums rise, people at higher and higher income strata find they cannot afford them, drop out of private insurance, and end up being covered by the government or not covered at all.
This is single-payer by attrition.
January 15, 2010; 3:11 PM ET
Categories: Health Reform
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