To extend [health care] coverage without changing these [cost-inflating] dynamics would add on another $77 billion of spending beyond what it should cost.
That is Ezra Klein, his post has some interesting data. Note that while we might shift some of the financial burden of pharmaceuticals to Europe and elsewhere, this hardly qualifies as a global welfare improvement. There are plenty of other ways to redistribute money from foreigners. I am, however, struck by this bit:
Another $147 billion in increased spending, much of it a consequence of
the fee-for-service system, wherein doctors are paid based on how many
procedures they recommend and carry out. Doctors with equity in
facilities where they can co-refer cases conduct between two and eight
times more tests than those without equity interests.
Some of this is third-party payment, but more generally the consumer as monitor is often either insane or asleep. To get what is really wrong with health care markets, we must turn to the academics, not as analysts but rather as examples:
One 47-year-old professor, a classic blunter who had received a
diagnosis of prostate cancer, told me: "I would be insulted if some guy
read 15 papers on theoretical physics, my own field, and then came in
and asked me to help him design an experiment. And I expect the same of
my doctor. I pay her. Let her sit down and tell me exactly what I need
to know — what are my choices and what do they mean? That’s her job. I
have other things to do."
Many consumers just don’t want to face the stark realities of how they are doing. How about letting me make the health care decisions for a randomly chosen partner, and vice versa? Here is much more, via Craig Newmark. On related topics, here is Arnold Kling.
I agree that my physician should not make a profit from care he provides me. Certainly, he should make a salary, but his primary motivation should be my care. I don’t want him recommending surgery when it is not called for, just so his surgical center can realize a gain. In the real world, we call that a conflict of interest. I expect my physician to recommend the treatment that is best for me – not best for his bottom line.
It is the same thing I expect from my financial advisor (I don’t want him churning stocks), my attorney (I don’t want him billing for useless research), and my mechanic (I don’t want him replacing a perfectly good alternator).
I do not begrudge qualified physicians making a profit. To the extent that the physicians provide better care, they should.
Cardianl Fang,
I belive that the clerks and administrator spend just as much time doing paperwork for medicaid and medicare than they do for any other system. The adminsitrators have to have intricate knowledge of billing codes, the rules for the billing codes, and how to complete the bill paperwork for medicare/medicaid.
Actually, there are seminars to help admnistrators learn how to complete mediciad/medicare paperwork.
“How about letting me make the health care decisions for a randomly chosen partner, and vice versa?”
I think this absurdity about sums up the ridiculous faith of the libertarian health care theorizers. It’s funny to contemplate as a thought experiment though–suppose Tyler’s random health arbiter was a Jehovah’s Witness.
And lying underneath this sentiment is an apparent loathing of medical doctors. What’s up with that? Why would I trust an economics professor on economic decisions, if I don’t trust a medical doctor on health care decisions?
The incentive system for doctors is completely messed up. I’d be curious what would happen raising Primary care physicians salaries (its almost 70K/yr less than the next physician on the totem-pole (ER-docs)) — and paying them appropriately for more time per patient visit. Lots of patients (not everyone), seem to have decent relationships with PCPs — would probably be more patients, if PCPs weren’t time constrained to 10 minute visits (just so they can make 70k less than everyone else).
Anyway, my anecdotal experience is that specialists game the system way more, order way more useless tests (@ $1000/per/useless test). Increasing primary-care expenditures, would seem like a good way to stave off, unneccessary secondary & tertiary care.
Could be wrong, have no #’s to back it up.
“Saying that people shouldn’t be expected to make those decisions is absurd.”
Nobody said that.
Doctors are humans practicing a profession that is nearly as much art as science. Yes, they have years of training and biological expertise, but that does not change the fact that each individual is different and therefore what works for some, doesn’t work for all. The only way doctors can intelligently make those determinations is with cooperation from their patients. I’m the only person who knows my body perfectly intimately (and even that is questionable), so ultimately I am the authority on what treatments I endure. In the end, the doctor is just a consultant.
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