Any time those that shape society through policy task themselves to adjust the relevant laws — and those that have something to gain, lose, or nothing better to do make the endeavor a National Issue — it is worthwhile to wonder what is the problem that spurs the statutory readjusting; and, is that problem solvable with law.
The late health care policy debate has so far served as good theater for legal sausage-making, partisan strategy, political PR, and so forth. It has also, for a few, fostered discussion on those fundamental questions that ought be initially figured out, like: (1) what are the most basic problems in the Nation’s health care and (2) is policy-making the appropriate response?
(1)
I figure that a fundamental problem with health care is that the industry is a false market. For the patient, the falsity of the market is in the information gap; and is akin to that other false market, the car mechanic. There is no pure market where one party is always over the barrel, but that is precisely the case in visits to the doctor and mechanic.
NPR’s Planet Money has a good podcast on the issue, featuring a debate between David Goldhill and Richard Kirsch on the nature of the health care market. Goldhill recently penned a column in The Atlantic arguing, basically, that:
A more consumer-centered health-care system would not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care—with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.
His point is that a more direct market, where patients see the benefits or problems with what they pay for. To this extent, Goldhill’s argument reminds me of an old gripe I had with corporate expense accounts and the market for restaurants and hotels that I might wanted to have visited. It seemed to me that that prices are inflated for restaurants that cater to corporate credit cards, because the folks tossing down those cards are not making a quality for price determination. Whenever it is someone else’s money, there is not a market.
But, argued Kirsch, health care isn’t like other markets – you don’t want people to be cheap because early (sometimes seemingly unnecessary treatment) will often save money down the road. Also, “shopping” a market only works beneficially when consumers have good information.
But, argued Goldhill, in a real consumer marketplace, not every consumer needs good information. Some education consumers shop, and their decisions benefit the entire consumer base.
(by the way, also read this)
Both acknowledge that the current healthcare industry is not a market. But, what to do?
(2)
A false-market problem is not necessarily solved by truing the market. Indeed, in this case, the real problem in the false market is that the industry too often acts like a real market, most regrettably in television commercials for drugs.
If pressed to choose, I would rather doctors be more dictatorial and patients less consumerish. The doctors are the experts; most patients that are over the barrel wouldn’t know how to get down on there own.
The market needs truing in other areas. I suppose drug companies have an economic right to announce their new chemicals to a curious public that can then go “ask their doctor” about so and so; but, those companies better not sweeten the doctors’ propensities to prescribe with anything other than information. And, I’d rather see individually chosen insurance rather than through employers.
Anyway, I started this post to link to that Planet Money podcast and the Atlantic articles – so take that from this at least.
