"It’s hard to believe we are still having this argument."

Twenty-odd years on from the fall of the Berlin Wall, and there are still a whole bunch of people who think that a centrally-controlled command economy is the way to go. (Well, sure. You saw the way people from West Berlin flooded into East Berlin to get their Zil automobiles and month-old potatoes, right?) In the Corner, Yuval Levin goes after one of them:

Zakaria then contends that the inefficiencies of the American health care system—and especially the frequent disconnect between costs and outcomes—are a function of there just being too many different players in the system, each with his own goals. This is the classic liberal complaint: disorder causes inefficiency. Citing a conversation with Daniel Vassela, the chairman of Novartis, Zakaria writes: 

“In America,” he said, “no one has incentives to make quality and cost-effective outcomes the goal. There are so many stakeholders and they each want to protect themselves. Someone needs to ask, ‘What are the critical elements to increase quality?’ That’s what we’re going to pay for, nothing else.” 

And from this, Zakaria does not conclude that we need to rearrange the financial incentives in our health-care system so that, like in other parts of our economy, providers of services have a powerful incentive (called the profit motive) to make quality and cost-effectiveness their goal. Instead, he concludes that government must take over decisions about how to provide coverage and organize the system because presumably government is very good at making quality and cost-effectiveness its goals. 

Right. The fact is that the incentives in our health-care system are all screwed up precisely because of government policies and programs.

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