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Blog-Parents
Blog-Brothers
Callimachus
(Done with Mirrors)
Gelmo
(Statistical blah blah blah)
Other Blogs I Read
Regularly Often
Andrew Sullivan
(Daily Dish)
Kevin Drum
(Political Animal)
Hilzoy
(Obsidian Wings)
I'm ready to replace "Letters" with some other title, something more suggestive of a continuing conversation, but I'm not quite happy with any of the other ideas I have. Suggestions are welcome.
I wrote an email reply but then my computer went wild, the virus scan was ditzing -- probably trying to eat a worm -- and everything went goodnight.
When I recapture some time I will write about insurance. You are mostly correct, certainly about the byzantine labyrinth with many corners of coin changers. There are many tragedies of the commons in health care.
I favor putting all money from everything (insurance, co-pays, philanthropy, government payment to hospitals, safety net money, public health, workers' comp, employer insurance, everything into a common pot. The region-elected and appointed representative set priorities for the spending (immunizations vs. cath labs), hires competitively both a management organization and a quality oversight-improvement organization. National standards of data gathering and public reporting. Population health improvement. Regions are already defined for the most part. I lived on Guam because it was an island and an island is the easiest place to start such a concept.
Bricks and mortar facilities and offices along with people will remain, can be competitive but much better cost accounting, etc.
P.S. Company I work for just won the exclusive right to finalize a contract with British Columbia to manage all of their care. If care in Canada is really provincial, why is it called national?
Dr. Burgess is way more expert in all this than I am. I am just a partisan with belief in time for a change.
Oh, another main point. About 35% of health care costs are, by consensus, spent on overuse/abuse/results of underuse. Half or so, are spent on overcoming medical errors including wrong drug combinations or known side effects. Only 4-8% is really thrown down the drain on all of the coin changers, marketing, etc. The huge gains lie in operational innovation and reducing the variation in access to and the delivery of appropriate health care.
[When I blame the numerous "coin changers" along the way for the high overall costs, my point was not so much that the lost money goes directly into their pockets, but rather that their presence in the chain diverts rational decision-making -- which presumably contributes to the various abuses you list.
[Several months ago I saw on C-Span part of a symposium on health care in which someone presented a study of the effect on buying decisions when a patient bears the expenses more directly. The standard argument of the pro-privatization crowd is that the patients will purchase health care more rationally. That is, they will prefer those procedures which are more beneficial and more cost-effective, saving on extra costs like premium name-brand drugs or unnecessary marginal procedures which they would choose when someone else is paying the bill. That argument made sense to me.
[What the data actually showed is that the overwhelming difference between patient/buyers who bear the costs directly and those that don't is that the ones who must pay directly spend far less on any sort of preventive care, irrespective of its cost-benefit ratio, and thus in many cases end up paying more in the long run. I don't recall the details of the study, and presumably it doesn't reflect any change in consumer education that would likely come about if a change in the health care system were widespread. Still, I'm always intrigued when empirical data contradicts theory, not to mention my own expectations.
[As a general rule, I think that amateur economists -- which in my opinion includes virtually all pundits and journalists, including myself -- tend to rely on economic theories which are grossly oversimplified. It's not that their ideas are wrong, per se. It's that they're just limited to a basic idea without any of the numerous complicating factors, and thus yield answers which are sometimes wrong.]
I think your framing of the health care issue is interesting. Is this original to you? I don't think I've heard anyone else frame it in quite that way. I'm curious if any of your libertarian-minded or economically conservative friends find it persuasive. To be honest, it does seem a little like taking the long way around to me -- since I'm not ideologically committed to the idea that in general, market solutions are preferable to publicly financed solutions, it's not necessary for me to identify the "real" consumer, etc. It's enough to just look at the data and say, "Well, it looks like nations with a single-payer health system spend less and have better health outcomes than the U.S., so I'm for it."
[For me, free-market economics is an ideology only in the old sense of the word, and not in the new one. That is, it's a way of thinking about things. It's not a political agenda.]
However, I think your framing might actually be more effective at getting people to support single-payer. As we know, Americans tend to recoil at the very mention of "socialized medicine," but perhaps they would support it if they could be persuaded idea that single-payer is actually the real free-market solution, and that HMOs and the like are in fact anti-competitive.
If you can do this kind of jujistu on other liberal issues -- say, outsourcing, environmental protection, affirmative action, funding basic research -- John Kerry should hire you as a campaign advisor.
[John Kerry doesn't want to hire me, and I don't want to work for him. I'm not good at playing advocate for things I don't agree with. I'm not even good at tolerating promulgating populist bullshit in pursuit of a cause I ultimately do support.
[As for outsourcing, over on RMO they're starting to wonder if I've moved to the right, simply because I insist on denying the favored Democratic myth that free trade destroys jobs. Evidently Kerry's political advisors have determined that the campaign has nothing to gain from explaining to voters the difference between job loss and job shift. Probably they're right, but I couldn't play that game. I have a problem with that silly three million figure, too.]
Some more quick comments:
Yeah, but it's not like I actually resent the greedy corporations ripping people off. That's just their nature -- it would be like resenting the mosquito for sucking your blood. I'm all in favor of letting corporations go ahead and do what they do best -- selling stuff at a profit and making money for their shareholders. That's a good system, it works, I'm in favor of it, huzzah for capitalism and all that.
However, the corporation's desire to sell stuff at a profit and make money for their shareholders will inevitably at some point come into conflict with the public interest -- for instance, our interest in clean air, humane working conditions, equality of opportunity in hiring, or having some assurance in advance that the product you are purchasing will not fail disastrously at a critical moment and kill you. That's why we need regulation to take those kind of public interest decisions away from CEOs -- who, when faced with a choice between profit and and the public interest, will -- quite naturally and understandably -- choose profit (almost) every single time.
(I know that's not universally true, but regulation has the added benefit of resolving the dilemmas an ethically minded CEO is likely to face -- do I do the morally right thing, even if that puts my company at a disadvantage relative to our competitors? For instance, he/she might be thinking: "I want to reduce emissions, I just don't want to do it unilaterally." If the ethical thing to do -- reducing emissions -- is regulated and everyone has to play by the same rules, then there's no dilemma.)
I thought this poster ("Redshift") in Kos's comments thread put it very well (this was in response to an observation by Donald Trump that the economy tends to do better under Democrats than under Republicans):
Democrats give business what it needs.
For business and the economy, as in every other area, modern Republicans give big businesses what they cry out for now (tax breaks, bailouts, gutting or refusing to enforce regulations, etc.), while undercutting what they'll need (infrastructure, a healthy population, research in basic science) to be successful in the long run. A government that tries to serve all of the people for the long run will be better for business. And the economic statistics back this up.
5:19:05 PM [permalink] comment []
(For Mom and Pete)
I'm not nearly the birdwatcher that my mother and brother are, but even I can recognize a bald eagle. Yesterday afternoon I saw two of them making lazy circles over North Seattle, gradually working their way toward the northwest. I wouldn't have expected them here.
4:59:50 PM [permalink] comment []