Randall Parker says no. He wants:
B) More medical research spending by the government.
I have yet to come across a better idea of how to deal with the market failure that underrewards and hence underfunds innovation and research. So I say better for the government to spend tens of billions on medical research than to spend hundreds of billions more in medical care.
C) A percentage (say 5% or even 10%) of Medicare spending should be allocated as an entitlement to medical research. As Medicare spending increases research should increase at the same rate. As it stands now medical research is going up more slowly than inflation while medical spending goes up much faster. That is stupid.
For example, if Medicare spends $100 billion then the scientists should get $5 billiion.
To address the market failure that comes from expired patents and unpatentable treatments a lot the Medicare money should be aimed to test treatments which may lower costs to the government and to the population as a whole. A large portion of the Medicare spending should be aimed at trials of drugs that are off-patent and also at treatments that are cheaper to compare their efficacy against more widely used treatments that cost more.
My take: Under one view, health care markets will never work well, with or without "corrective government interventions." Our best hope would be to turn difficult health care problems into easy health care problems, as quickly as possible. Of course if we cut Medicare spending, some people will die in the meantime. But should we be giving current "identified lives" such a high value, relative to future "statistical lives"?
Here are Randall's other reform ideas...
(I am quoting from Randall’s email here, Typepad won’t let me indent beneath the fold…)
"A) For anyone who is dying the lack of FDA approval should not prevent the use of a treatment.
While I would favor complete revocation of FDA ability to keep drugs off the market that is not going to fly politically. But selling a more limited change where those with, say, a projected 12 month or 24 month life expectancy get a basic "I’m free of the FDA tyranny" card would accelerate drug development. Phase I and Phase II drugs would be more widely available….
D) The coercive power of the state should force a percentage of all income to go into medical spending accounts.
The goal here is two fold:
- Decrease the number of people who need state medical funding.
- Also, increase the amount of medical treatment purchases that are paid directly by patients. That will increase market forces in medicine.
E) Self-employed people should be able to buy medical insurance pre-tax.
F) People should be able to make tax deductable donations into medical spending accounts for their future children before the children are conceived. Then the money should be usable to buy medical catastrophe insurance against the possibility of birth defects and also for more mundane medical care.
G) People should be able to bring their own medical insurance policies with them to a job and have their employers pay on those policies rather than on the employer’s group policy.
That way a person could move around between jobs and never reach a state where their COBRA runs out and a pre-existing condition makes them uninsurable (assuming they can even afford to make COBRA payments while unemployed). The way things stand now the tax law forces people to go uninsured between jobs. When you have no income coming in you suddenly have to try to get coverage. That problem must be fixed.
H) Medical records should be made electronic and more widely shareable by researchers that most medical patients effectively become enrolled in "virtual" medical trials."
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