Posted by David Post:
Fixing Health Care:
http://volokh.com/archives/archive_2009_08_30-2009_09_05.shtml#1251644481
Truth be told, I have not been following the great Health Care debate
very closely, and I do not pretend to any expertise whatsoever in the
subject matter of reforming the US healthcare industry. But David
Goldhill's recent article in the Atlantic ("[1]How American Health
Care Killed My Father") strikes me as an enormously sensible and
straightforward approach to the issue (one reason - that, and its
simplicity - that it will probably get little or no traction at all in
the discussion).
"All of the actors in health care�from doctors to insurers to
pharmaceutical companies�work in a heavily regulated, massively
subsidized industry full of structural distortions. They all want
to serve patients well. But they also all behave rationally in
response to the economic incentives those distortions create.
Accidentally, but relentlessly, America has built a health-care
system with incentives that inexorably generate terrible and
perverse results. Incentives that emphasize health care over any
other aspect of health and well-being. That emphasize treatment
over prevention. That disguise true costs. That favor complexity,
and discourage transparent competition based on price or quality.
That result in a generational pyramid scheme rather than
sustainable financing. And that�most important�remove consumers
from our irreplaceable role as the ultimate ensurer of value."
His focus in on consumer incentives -- because only a decentralized
information-processing system (like a viable market) can possibly
control and rationalize the billions upon billions of decisions that
need to be made at all levels in order for health care to work.
"To achieve maximum coverage at acceptable cost with acceptable
quality, health care will need to become subject to the same forces
that have boosted efficiency and value throughout the economy. We
will need to reduce, rather than expand, the role of insurance;
focus the government�s role exclusively on things that only
government can do (protect the poor, cover us against true
catastrophe, enforce safety standards, and ensure provider
competition); overcome our addiction to Ponzi-scheme financing,
hidden subsidies, manipulated prices, and undisclosed results; and
rely more on ourselves, the consumers, as the ultimate guarantors
of good service, reasonable prices, and sensible trade-offs between
health-care spending and spending on all the other good things
money can buy."
I won't do Mr. Goldhill the injustice of trying to inadequately
summarize his proposals - but it's the first thing I've read (and
again - I don't claim to have read all that much) about this issue
that makes a damned bit of sense to me.
References
1. http://www.theatlantic.com/doc/200909/health-care
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