The Obama Administration is counting down the days and rounding up “navigators” to get Obamacare off the ground. (Those navigators, by the way, will get $58 for each person they sign up, on top of their hourly pay.) The big question: Is Obamacare going to work? Will it deliver better health to Americans? There are a lot of skeptics, including Forbes’ Paul Howard. Howard’s concern is that Obamacare is using mid-20th century assumptions about health and insurance in a 21st century world.
Washington’s view of health care remains deeply entrenched in mid-century assumptions about health and illness. Health care via industrial policy makes sense if illness is an Act of God to which all are equally vulnerable and a known quantity of health care can be delivered to everyone at a fixed price. If these assumptions are true, the largest payer – the government – can set the rules of the road, from which all (or almost all) benefit.
That was a reasonable picture of medicine well into the 20th century…when infectious diseases dominated U.S. deaths. But by 1950, heart disease and cancer had displaced infections as the nation’s most potent killers. (“Diseases of early infancy” was still the fourth-leading cause of death in 1950. By 2010, they had dropped off the table entirely.)