Finally, interesting conservative ideas on health care

David Frum says the way to reduce health costs is to exploit the market power of insurance companies. Regulate insurance companies at the federal level to prevent insurers from reducing the quality of insurance through lifetime limits and so on; eliminate state-level barriers to allow consolidation of the insurance industry on a national level; rely on the resulting small number of large companies to force cost reductions by health providers.



One way this differs from Obama's system is that under ACA the federal government tries to reform health care delivery practices whereas under Frumcare that job is done by large companies in competition with each other. There's a chance that Frum is right here - I'd guess that the government would do a poorer job of reducing costs of household items than Walmart.



I don't see how Frumcare could be implemented without an individual mandate or some other guarantee of universal access however. The same adverse selection problem would apply: if insurers can't discriminate against people with pre-existing conditions then they can't prevent healthy people from opting out of the system and opting in only when they get (expensively) sick.



I don't know if Frum's idea is preferable to ACA, but I appreciate that it is an actual idea from an actual conservative. I will start reading FrumForum more regularly.