Becker & Posner om sundhedsreformen

Professor Gary Becker og professor Richard Posner har indlæg om sundhedsreformen på deres blog. Normalt argumentere Becker og Posner for og imod, men denne gang er lidt af en undtagelse. Becker er imod reformen og Posner mener, at den er en fejl med få enkelte positive elementer.

Becker begrunder:

"Clearly, however, the American health system does have many defects, which contributed mightily to the growth of the share of medical spending to 17% of American GDP. Yet when I was recently asked whether I prefer the present healthcare bill to no change in the health delivery system for a decade, I answered “no change”. Even though the American healthcare system can use many reforms, regrettably the bill that passed the House and Senate is a messy compromise to attract reluctant Democrats that is short on needed reforms. Instead, the bill is filled with many complicated, and generally bad, new regulations, higher subsidies, and greater taxes".

Posner begrunder:

"Although on balance I think the new law is a mistake, there are three things that can be said in its favor".

Det første er, at sundhedsreformen er et rendyrket social eksperiment, som man kan lære af, herunder om elasticiteten i efterspørgslen efter sundhed, budgetkontorernes evne til at forudsige omkostningerne ved sundhedsprogrammet mv.

"Second, the very cost of the health-care program, which is likely to be far higher than predicted by its sponsors and not nearly offset by tax hikes, spending cuts, or economies in the provision of health care, may act as a wake-up call for the need for fiscal reform. Greece is making real reforms in its economic system, because it has to; it’s broke. If the new health law, piled on top of all the other measures that are causing the federal deficit to explode, causes real damage to the United States, the stage will be set for real reform."

Det tredje er, at reformen har få tiltag til begrænsning af omkostninger. Det er primært skatten på dyre sygeforsikringer, som reelt svarer til, at skattefradraget begrænses.

Posner fortsætter:

"That’s the bright side of the new health law. The dark side includes the timing of the measure: the uncertainty that the health law and the deliberations leading up to it have generated for business and consumers alike has probably retarded our economic recovery from the financial crisis. But the law’s biggest negative is its costs. The $100 billion or so of annual subsidies that the law mandates is just the beginning, but it is an ominous beginning. It is true that these are transfer payments, rather than costs in an economic sense; but they are federal transfer payments and so increase the federal deficit, which even without them is growing by more than $1 trillion a year. The subsidies will grow at the rate at which medical costs grow, which is between 5 and 10 percent a year—much greater than any plausible estimate of annual economic growth. Indeed, as Greg Mankiw has argued, the health bill is likely to reduce the nation’s annual growth by increasing the income taxes on the well to do.

The biggest cost is likely to come from the law’s effect on the demand for health care. One effect that can be expected is that, if one assumes (plausibly) that the supply curve of health care is upward-sloping, meaning that unit costs increase as demand increases, adding 30 million people to the health-insurance rolls (whether private or Medicaid) will increase overall health-care costs by more than the percentage increase in the number of persons insured".

Der er ikke meget i sundhedsreformen at råbe hurra for.