I keep encountering discussions of health economics in which patients are referred to as “consumers”, after which the usual mantra of freedom of choice is invoked on behalf of voucherizing Medicare, or whatever.
We used to know better than this.
Medical care is an area in which crucial decisions—life and death decisions—must be made; yet making those decisions intelligently requires a vast amount of specialized knowledge; and often those decisions must also be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.
That’s why we have medical ethics. That’s why doctors have traditionally both been viewed as something special and been expected to behave according to higher standards than the average professional. There’s a reason we have TV series about heroic doctors, while we don’t have TV series about heroic middle managers or heroic economists.
The idea that all this can be reduced to money—that doctors are just people selling services to consumers of health care—is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.
Wednesday, April 20, 2011
Health Care Vouchers are a Really Bad Idea
Paul Krugman has an excellent post explaining why we shouldn't treat health care as a free market commodity.
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I really can't get behind this. This just the other side of the plugged-nickel coin that the right has been shilling, emotionalizing and oversimplifying healthcare issues. The fact is that while healthcare can't be reduced to just money, we have a healthcare financial crisis on our hands driven by the ever-soaring costs. Those can best be addressed by economic analysis & remedies, and that's a dish much better served cold.
ReplyDeleteWhile Ryan's voucher system seems to be pretty transparent cost shifting (mentioned herein), the fact is that hard decisions are necessary and the more we get mired in death panels and the heroics of doctors the more difficult that will be.
I think you are misreading Krugman. He does not argue that hard choices need not be taken to bring down health care costs. He only argues that among the options available, treating health care as a commodity whose price is determined solely-- or even largely--by market forces and consumer choice is a really bad idea.
ReplyDeleteThe PPACA relies on a series of mechanisms designed to actually reduce health care inflation, instead of just shifting the costs from the government to the individual. Also, Krugman in particular has endorsed allowing Medicare to use its bargaining power to get lower prices for prescription drugs (as the VA currently does) as a cost-saving device.
Ezra Klein has written a lot on how Health care Reform controls costs. For example:
"Medicare, for instance, is going to experiment with paying hospitals a flat sum for all successful care associated with a particular condition. This will mean that doctors make more money when they do less and are successful at it, rather than making more for doing more, as is the case now. The tax on expensive health insurance plans is meant to drive people — and employers — to seek plans that better control costs.
The Independent Payment Advisory Board is a group of stakeholders and experts charged with helping Medicare control costs and empowered to make changes to the system even if Congress is too paralyzed or distracted to act. It will be fed ideas by the new Center for Medicare and Medicaid Innovation, which will test ways to improve care and cut expenses. The exchanges will make it easier to comparison-shop, and the subsidies are linked to the lowest-priced plans in the exchanges to reward cost-efficient insurers. New information about what drugs and treatments work best and for whom will come from trials, and if combined with electronic-medical records, could help doctors make more cost-effective decisions."
http://www.washingtonpost.com/blogs/ezra-klein/post/column-explaining-health-care-reform/2011/03/10/ABB7IUCB_blog.html