Healthy, young families would choose the least expensive plans with the highest allowable deductible, and those with health problems would be forced to choose plans with the lowest allowable deductibles but higher premiums. The premiums or the required co-payments of the latter plans would spiral upward because of the greater use of services by sicker beneficiaries, so it would become even harder for those with the greatest need for insurance to afford coverage. In this way, one of the most important values of insurance—the sharing of risks over a broad population base—would be lost.
To whatever extent hospitals absorbed these costs themselves, they'd have even less money left over than they do now to pay for computerization. What's really needed is to make private hospitals more like VA hospitals. Even Bush has recognized that "the VA has got an advantage because the—all the administrators work for the same—same outfit, the same organization." But he doesn't want to think about what that says about the virtues of socialized medicine. He doesn't want to face flakts.