West wing, adverse selection och Medicares administrationskostnader
3 apr 2008, kl 10:20
bergh in Samhälle och politik

Avsnitt 139 (säsong 7) av West Wing är en enda lång debatt mellan Matt Santhos (dem) och Arthur Vinick (rep).
Debatten behandlar mängder av ämnen inom ekonomi och politik på ett stundom briljant sätt.

Adverse selection inom sjukvårdsförsäkringar dyker exempelvis upp så här (transcript):

SANTOS [...] But if you all had the option, the option, of using Medicare, you could save a lot of money.
Private insurance companies, they spend about 25% of your money on administrative costs, on paperwork.
Do you know how much, anyone want to guess, how much administrative costs...


WOMAN IN AUDIENCE
35%!

SANTOS
Sorry? 35%. Anyone else?

Several people shout out their guess.

SANTOS
You would think that it would be higher than the private companies, right?
A massive, government bureaucracy can't be more efficient than the private companies, right?
The Republicans have been telling you that forever. Two. That's right, 2%.
Medicare's administrative costs are 2%, that's 23% lower than private insurance companies and HMOs.
The best kept secret in the world in our country is that Medicare is the most efficient health care system in the world.
Now, if you had the option of choosing Medicare instead of your private insurance companies and HMOs, you would save big money at least 20%.

VINICK
That's crazy. Medicare taxes would skyrocket.

SANTOS
Well, yes, the Medicare tax would have to go up but it still would be much lower than health insurance premiums are now. Look, I don't know about you, but if you give me a choice between paying for something called a premium and something called a tax, my only question's going to be 'Which one's cheaper?'

VINICK
I literally don't know where to begin. I mean, to force everyone in the country to go to...
Påståendet att Medicares administration bara är 2 procent har naturligtvis ifrågasatts, men den kanske mest citerade rapporten kommer ändå bara upp i 5-8 procent. I grunden är det alltjämt så att ett obligatoriskt system som inte behöver bry sig om premiediskriminering, riskbedömningar och marknadsföring därför kan bli billigare än en marknadslösning.

Å andra sidan glömmer man ofta bort beslutskostnaden i offentliga system: den politiska processen och rent seeking. Debatten är väl (även) på denna punkt aningen vinklad åt det demokratiska hållet.

Andra exempel på detta är när Vinick hävdar att det går dåligt för Afrika pga höga skatter. Och mycket riktigt: Enligt NBC:s tittarundersökning, vann Santos debatten med 79 mot 21 procent.

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