Arnold Kling

Health Care Policy

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My latest essay on health care policy:


I think it is useful to divide the health care issue into three areas: general wellness; acute care; and discretionary procedures. The problems and solutions differ by area.

What I mean by general wellness is engaging in healthy lifestyles and reducing risky behavior. Sometimes the term "public health" is used to cover this, but to me that suggests that government bears the ultimate responsibility. In fact, we should recognize the importance of individual behavior...

in economic terms, it is not clear that the people who pay for cosmetic surgery are doing anything worse than people who pay to build ski chalets in Aspen. Either way, you are using up resources for a luxury good. If you build a chalet, that is your business, and if you choose cosmetic surgery, that is also your business.

There is a sense, however, in which the concern about discretionary medical spending is quite valid. Your medical decisions become my business when I pay for them through Medicare or other government programs.

Meanwhile, Nick Schultz points me to a New York Times article on Canada's healthcare system.

medical professionals and local officials say a major reason it may not be easy to address the problem of slow access to treatment is because doctors who do preliminary diagnostic work, refer patients to specialists and monitor the care of chronically ill people are less and less available - especially in small towns and rural areas...

Young doctors are more likely to seek the most lucrative work in cities or go to the United States rather than start more modest practices in small towns because of growing debts when they leave medical school.

For Discussion. Is there a reasonable way to distinguish discretionary care from acute care?


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COMMENTS (5 to date)
John Thacker writes:

Interestingly, as my recent trip to Vancouver showed, Canada has no shortage of doctors who do various cosmetic work like plastic surgery, eye surgery, and others things-- all of which are not covered under the public health system. Apparently their waiting lists are fairly short, and their prices are quite cheap since they're generally paid in cash.

Dave Schuler writes:
in economic terms, it is not clear that the people who pay for cosmetic surgery are doing anything worse than people who pay to build ski chalets in Aspen. Either way, you are using up resources for a luxury good. If you build a chalet, that is your business, and if you choose cosmetic surgery, that is also your business.

This is not quite true. A clever medical claim writer can produce an insurance claim that maximizes the proportion of the procedure covered by insurance. So we all pay for cosmetic surgery in higher medical insurance payments.

About 1% of all Canadian doctors move to the U. S. annually. Not a huge number in any given year. But over time it's a substantial (and IMO immoral) drain on their system.

John Thacker writes:

Is there a reasonable way to distinguish discretionary care from acute care?

Only slightly jokingly: Care which is advertised in order to increase sales is generally discretionary care. (This especially applies to pharmaceuticals.) Care which does not need to be advertised, since everybody gets the condition treated if they have it, is acute care.

Lawrance George Lux writes:

Acute Care is any course of treatment to forestall further deteroiation of the physical condition within the next year. So much for definitions which don't mean anthing.

The issue of Doctor supply can be answered by the award of State licenses to practice. All Doctors can be enjoined to maintain a diagnostic clinic for one-third of his practice--this means two days a week. We are talking GP work here. Oversupply of GPs by the practice, could include the alternative of ER substitution. lgl

spencer writes:

Is there a difference between Canadian and US doctors servicing poor rural areas. I know poor rural areas in the US suffer from a significant shortages of medical care and doctors. Is that also true of Canada? Your young doctors coments certainly applies to the US -- does it apply to Canada more or less than it does in the US? Your question or comment implies that it only applies to Canada because of their medical system and that clearly is incorrect.

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