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Edwardscare: A Trojan HorseThe health-care primary, Part 2.

By Timothy Noah
Posted Thursday, July 5, 2007, at 8:02 PM ET

(Continued from page 1)

Cost: Edwards will bend your ear about how much his plan will save in wasteful health-care spending ($130 billion a year, he claims), but he's pretty circumspect about what this plan will cost U.S. taxpayers. I see no cost numbers at all in the two detailed proposals on his campaign Web site. On the stump, Edwards has been saying he would pay for the plan by canceling the enacted Bush tax cuts for families earning more than $200,000. How much would that raise? Well, Obama would pay for his health care plan by canceling the tax cuts for families earning more than $250,000 (which may reflect that Obama's supporters are wealthier than Edwards'; they're certainly more generous). Obama's campaign says that would raise between $50 billion and $65 billion. By that reckoning, Edwards' cancellation ought to raise more like $100 billion. My guess is that's too little to pay for Edwardscare, but I don't honestly know.

How universal? Waaaay universal. Everyone would be required to participate. The candidates compete with one another over whose plan is more "universal," but nobody ever explains how you "require" someone to purchase health insurance. This is one of the many virtues of a straight-up socialized-medicine scheme. If we had national health care, you wouldn't have to enroll in a plan. You'd automatically be enrolled if you were a citizen, and probably even if you weren't. Edwards' universality scheme, by contrast, summons for me the mental image of a housing project surrounded by police snipers and maybe a chopper or two. We know you're in there. Come out and sign this damned insurance policy! Nobody has to get hurt!

How socialistic? As I explained above, the "health markets" component is a Trojan horse (a very elegant one) to replace existing private health insurance with government funding. That's what I like about it. Obama's plan has a Trojan horse, too, a public health-care plan limited, as Edwards' is, to people who do not receive health insurance, or adequate health insurance, through their employers. In both instances I think the mere creation of these programs would create a stampede by companies to stop insuring their employees. For some reason, Obama's senior economist, Austan Goolsbee, chooses not to believe this about Obamacare, possibly because he figures the private-but-regulated health-care plans in Obama's National Health Insurance Exchange would be more generous than Obama's public health-care plan. (It's not clear to me that anyone in Obama's campaign has thought this through.) Edwards' "health markets" should be less susceptible to this sort of unraveling because the whole idea would be to set up a competition between public and private plans, and how could government compete if it were forced to limit what benefits it offered?

How disciplined? Not very. As I've explained before, the best way to limit medical inflation would be to end fee-for-service medicine and put all doctors on salary. Ending fee-for-service payments would eliminate the incentive doctors now have to perform unnecessary tests and procedures. Unfortunately, not even Kucinich is ready to take this on. But Edwards does endorse "evidence-based medicine" (i.e., greater uniformity in treatment methods), acceleration of the shift to electronic medical records, and allowing Medicare to negotiate what it will pay for pharmaceuticals. I see little difference here between Edwards' proposal and Obama's.

Impact on employers: Way great. Employers could get out of the health-care business, as they should. The Washington Post Co., which owns Slate, doesn't buy my automobile insurance. Why should it buy my health insurance? Only because it's too expensive for me to buy on my own, just as my police protection would be too expensive if I had to go out and buy that. For these sorts of expenses, we pay taxes, and the government provides for all.

Longevity: Way long. Patients who switched to public health insurance would be unable to find a better deal elsewhere, at least with regard to cost, and so would likely remain in the same insurance plan the rest of their lives. Their insurer would therefore realize directly any long-term cost savings achieved through preventive care.

[Update, June 6: Edwards campaign spokeswoman Colleen Murray informs me that Edwards puts the cost of his health care plan at $90 billion to $120 billion per year. Universality would be achieved, she says, as follows:

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Timothy Noah is a senior writer at Slate.
Photograph of John Edwards by Tim Sloan/AFP/Getty Images.
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