A conservative case for universal health care coverage?

Published: Thursday, Jan. 23 2014 3:55 p.m. MST

Avik Roy, a prominent Obamacare critic and free market advocate, is making the conservative case for universal health coverage.


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In California, a maverick millionaire is making a conservative case for raising the minimum wage.

Now the other side of hell is threatening to freeze over as well.

Avik Roy, a prominent Obamacare critic and free market advocate based at the Manhattan Institute, is making the conservative case for universal health coverage.

In a Washington Examiner piece this week, Roy argues, first, that politically conservatives need to move beyond attacking Obamacare, and instead look for politically viable alternatives.

Second, he argues that universal health coverage is a worthy objective that should not be any more controversial among conservatives than universal access to K-12 education.

"To credibly advance this approach," Roy wrote, "conservatives must make one change to their stance: They have to agree that universal coverage is a morally worthy goal. No conservative politicians oppose universal public education; instead, we champion reforms that improve the quality of public education that poor Americans receive. Ensuring that every American has access to quality health coverage is a legitimate goal of public policy, and it can be done in a way that expands freedom and reduces the burden on American taxpayers."

"The Left believes that the only way to expand opportunity is to expand the scope and scale of government," Roy continues. "Our broken patchwork of health care entitlements gives us the opportunity to prove otherwise. And we can do so while bequeathing to our children and grandchildren something that is almost impossible to imagine: a fiscally sound country."

In an accompanying National Review piece, Roy points to per capita public spending on health care to argue that Singapore and Switzerland both have achieved universal coverage with market-centered approaches that empower consumers and offer subsidies to the poor, but do so at a fraction of what the U.S. already pays for far weaker results. U.S. public per capita health care spending, according to Roy's chart, is nearly $4,000 per person, while Switzerland spends just $1,628 and Singapore a mere $762.

Roy uses the data to dispute conservative critics who, he says, seem unaware that the U.S. is already spending more public dollars for health care than most European countries, and to argue that Singapore and Switzerland suggest market models for universal coverage that can work.

Roy's suggested approach would take Medicare and Medicaid and merge them into health care exchanges, allowing subsidized consumers to choose their own plans.

This misses the point, argues policy blogger Xpostfactoid.

"Roy scapegoats Medicare and Medicaid and would fold them into the exchanges, giving us a uniform exchange system something like Switzerland's. But he would eschew Switzerland's government-imposed pricing discipline, which is more encompassing, not less, than that of government in the U.S. Roy would also offload a higher percentage of overall health care costs onto individual citizens, as in Singapore. But he would do so without importing the Sinagporean government's heavy hand in making those costs affordable."

Roy has been talking about the Singapore model for some time, but this is the first time he has used it to forcefully call for universal coverage. Last summer, he debated Washington Post policy blogger Ezra Klein on the Singapore model, with Klein arguing that the lower cost figures in Singapore and elsewhere are a result of government price controls, not market forces.

"But in these systems, right, because when you talk about the one-seventh," Klein said, "Singapore is very cheap. Great Britain is very cheap compared to us. Canada is cheap. Sweden’s cheap. France is cheap. Everybody’s cheap. And what all of them do, the thing that they all do, is not health savings accounts, right?

"That is not the common denominator. The thing every single one of those systems do is the government is a primary negotiator. The government says how much can a drug company charge. The government says how much will a doctor’s visit cost. The government says how much a hip replacement will cost. And the per-unit price of health care in those countries is way, way, way down."

Roy conceded the point in that debate.

Email: eschulzke@desnews.com

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