John Goodman and I have a deal. Beginning in a week or two, I’m going to start reading his book Priceless: Curing the Healthcare Crisis, and I will write my reaction(s) to it on TIE as I do. He, of course, is free to react to my reactions by contributing to the TIE comments, posting on his blog, hollering out the window, or however he likes.
The crux of the deal is that our writings and window hollering about each other’s thoughts will be respectful, free of snark, or any implied or overt insults. No feigned shock that the other claims to be a health economist. No histrionics over those mixed up liberals or conservatives or libertarians (as applicable). No statements like, “What [Austin/John] fails to understand” or “Do you realize that …” In short, we’re just going to stick to the evidence and the ideas, not attack each other.
I look forward to the exchanges.
“our writings … about each other’s thoughts will be respectful, free of snark, or any implied or overt insults”
This is commendable, but it presupposes that the debate over the government’s role in health-care markets is a purely logical and empirical one, when in reality it is a highly political and emotional issue
No, it doesn’t. It presupposes that the role of academia in policy discussions should be to inform the public and decision-makers so that policy decisions can be more logical and empirical and less political and emotional. It presupposes nothing about how decisions are actually made or how academics actually behave.
I think it is wise to remove (or attempt to, at least) the emotional and political dimensions of the debate. This does not presuppose that those factors do not exist, but it does presuppose that there is great value in objectively figuring out what would be best and then seeing if the emotions and politics can resolve themselves around such a fact.
In a Platonic Utopia (or should I say “dystopia”), in which academics ruled the world, these points would be well taken. But don’t forget David Hume. The sad but undeniable reality is that the politics and emotions of this contentious issue are what are driving most person’s positions — with logic and empirical claims being brought in to justify one’s pre-existing politics after the fact.
I second what TC has said. Both Goodman and Frakt have thought long and hard about this issue and have quite different views. It will be good to see their dialogue!
“No feigned shock that the other claims to be a health economist”
What about genuine shock?
Isn’t Alex a health care economist? I’d like him to weigh in as well.
Considering Goodman comes out with a book whenever health reform comes up, but no one ever buys his ideas, in the market of ideas, his are “priceless”.
Although, “worthless” is perhaps a better word.
Note his earlier books:
Patient Power: Solving America’s Health Care Crisis (Nov 13, 1992)
Patient Power: The Free-Enterprise Alternative to Clinton’s Health Plan, with Gerald L. Musgrave (Dec 30, 1993)
In 1995, Taiwan implemented a single payer system, creating a national health care system when no existed.
In 1995, Switzerland voted by national referendum to implement health reform which can be seen as the health reform of Mass that Mitt Romney signed into law, but did not implement.
Lives at Risk: Single-Payer National Health Insurance Around the World, with Gerald L. Musgrave, Devon M. Herrick and Milton Friedman (Aug 13, 2004)
Mitt Romney chose the Swiss approach in 2005, spending essentially more than a year investigating and writing the law.
Priceless has a blurb on the cover by, but I can’t find a review by, Reinhardt. However, Reinhardt has written several times on Taiwan’s health system, recently in July:
http://economix.blogs.nytimes.com/2012/07/27/taiwans-progress-on-health-care/
“Since 1995, Taiwan’s 23 million people have enjoyed universal, comprehensive health insurance coverage under its single-payer national health insurance system, which is financed by a mixture of payroll contributions from employers and employees and government subsidies.
“The system is administered by the Bureau of National Health Insurance, whose administrative budget absorbs less than 2 percent of the system’s total spending for health care benefits. Over all, Taiwan spends about 6.9 percent of its gross domestic product on health care, compared with close to 18 percent spent in the United States. (More detail on the genesis of the system and its modus operandi can be found in this article in Health Affairs and on the bureau’s Web site.)
“About two weeks ago, I attended the Europe-Taiwan Health Dialogue, held in Taipei. That two-day conference was sponsored jointly by Taiwan’s Department of Health and the European Health Forum Gastein, whose European Health Forums are among the leading platforms for discussions on health policy and are attended by participants from around the world. (My travel to the conference, to which I was invited as an academic expert, was underwritten by the Department of Health.)
“As an American, I found myself humbled again by a presentation, “Information Technology and Patient-Centered Care – the Case of Taiwan,” delivered by Dr. Min-Huei Hsu, director of the Medical Informatics Center of Taiwan’s Department of Health.”
“I do not want to romanticize Taiwan health care. Like any health system, it has its share of problems, all the more so because, at only 6.7 percent of G.D.P., the system is underfunded by at least a percentage point or so, using international standards.
“I also am persuaded that Taiwan needs a larger supply of doctors. Nor would even Taiwan’s health experts assert that their health information system is perfect. It remains a work in progress.
“But a national health system must be judged not only by the level of health care it delivers, but by what it offers its citizens for the money they spend on it – by its cost-effectiveness, in professional jargon.
“In the United States, the Business Roundtable concluded in a 2010 study that given its high level of spending on health care, the American system shows a 23 percent value gap relative to what Europeans spend and get in return, and a 46 percent value gap relative to spending in Asian countries, including Taiwan, Japan, South Korea and Singapore.
“At its best, the American health system probably is unrivaled in the world, staffed by highly trained and hard-working doctors and nurses. For the most part, it boasts luxurious health care facilities.
“Oddly and sadly, however, the United States has yet to harvest the full benefits of modern electronic health information. Our nation’s engineers and entrepreneurs design smart hardware and software for health care, but we do not seem to use our own products as smartly as do many other countries.”
But while others read Goodman, he does not read anyone else, it seems. Why would Taiwan chose to “destroy” its wonderful free market health care system in 1995 when half the population not being covered by any insurance, and there was no private insurance market, and costs were about 3% of GDP? I find no reference to Taiwan in his Life at Risk subtitled: “single payer around the world” – where did Taiwan go? And it is the purest single payer system in the world and the newest.
Well, after reading his introduction for free, and his claims (apparently backed up on Wikipedia) that he played a large role in HSAs, and the fact that they are widely available and I participated in one of these (RAND approved) money-saving plans until a quasi-governmental firm forced me into a traditional money-wasting insurance scheme I’d have to say that you are incorrect in claiming that his ideas aren’t viable in the market.
I guess that counts mulp out. I read Priceless, and just went back to see if Goodman made any disparaging comments about Frakt, and could find none by name.
Garbage in, garbage out. It’s hard to listent o people “debate” this stuff with a straight face without disparaging both sides.
It’s like when someone asked Romney about gays adopting kids and he said “meh.” What..TF?!?
You start with the assumption that doctors are forced to treat, because not getting contraceptives is EXACTLY the same as letting people bleed out in front of the Emergency room, and you get total nonsense out the back end.
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