So I'm reading Tim Wu's The Master Switch and I was struck by a couple of quotes. Wu wrote "in the immediate aftermath of the AT&T breakup, consumers saw a drop-off in service quality utterly unexampled since the formation of the Bell system. In fact, the "competitive" industries that replaced the imperial monopolies were often not as efficient or successful as their predecessors, failing to deliver even the fail-safe benefit of competition: lower prices." But there is a payoff. Wu writes that "the breakup of Bell laid the foundation for every important communications revolution since the 1980s onward. There is no way of knowing that thirty years on we would have an Internet, handheld computers, and social networking, but it is hard to imagine their coming when they did had the company that buried the answering machine remained intact."
This got me think of the Ryan Roadmap's approach to reforming health care. The Roadmap (and other conservative proposals like the one offered by James Capretta and Thomas Miller) would transform our system from one with little or no visible price system for consumers and where health care providers are used to billing either private insurers or government for routine medical costs, to a system in which providers would compete for health consumer dollars (for noncatastrophic costs) directly through price and quality. While I'm all in favor of this shift, I wonder if a sudden transition (even one phased in over several years) would produce similar problems to the ones that Wu described as providers initially flounder around trying to adjust to a new model. I'm even more worried about whether our politics would ever allow such a sudden shift to happen. People are a lot more risk averse about their health care security than they are about their phone service. That is why I think it is important to push primarily for incremental reforms that increase the number of people on consumer-drive health insurance policies and that show concrete benefits to subgroups of the population (and also regulatory reforms to improve price transparency.) This would allow providers to partially reorient themselves towards customers as well as insurers and the government and show the broad public that moving to a more market-oriented system has more benefits than drawbacks.
So what would this market-oriented system look like? Well when I first read this Walter Russell Mead post I thought it sounded too science fictional, but really it presents a change no weirder than the change from the rotary phone my parents had in 1980 to the cell phones that are now available to the middle-class (and often the nominally poor.) I don't think conservatives should promise those kinds of benefits if conservative reform proposals are adopted. Greater take home pay with continued health care security should be enough. But we will only get there piece-by-piece and every gain will be through political trench warfare. Staking reform on one huge radical-sounding change probably reduces the chances of averting government-run health care.