Arnold Kling  

Health Care Op-Eds

Why Experiments are Misleading... A Patriarchy Complex?...

In the San Francisco Chronicle, one by your truly.

Those of us who propose market-oriented health-care reform need to spell out what this will mean for consumers -- how it will increase their responsibility to study the costs and benefits of alternative treatments.

Those who favor universal government-provided health insurance also have an obligation to describe how health-care decisions will be made. If we cannot afford all the health-care services that everyone might want, then we are going to need policies for rationing health care.

My point is that we are not ready for radical reform of health care policy, because the would-be reformers are not being forthright about the consequences. It's not a very sexy point to make, compared with saying, "We can have wonderful health care if we just do X,Y, and Z today!"

Meanwhile, Jo Ellen H. Ross writes,

A critical component for the future of health-care delivery is the adoption of health-information technology solutions that would allow individuals and their physicians to access vital health data when and where they need it.

My experience in the business world makes me skeptical. From a distance, information technology looks like magic fairy dust--just sprinkle it on, and productivity goes up. Up close, it turns out that in order to benefit from information technology, a business has to be organized to take advantage of it. I suspect that the practice of medicine needs to be standardized before information technology can have big impact. Whether standardization is desirable or feasible is an open question.

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The author at Life, Liberty and the Pursuit of ... in a related article titled IT and Health writes:
    I think, if I am reading him correctly, that Arnold makes a fatal assumption with the statement below. [Tracked on March 1, 2006 11:27 AM]
COMMENTS (7 to date)
aaron writes:

All health care reform proposed so far will drive up costs. They only address demand. Healthcare is bad at chasing demand. We can't take anyone seriously until they seriously consider how to increase supply. We need incentives for more students to become doctors. We need incentives for good doctors to educate and train more doctors. We need steamlined programs for highly demanded services. We need to loosen restriction on treatments so that more individuals can do self diagnosis and treatment.

Robert Speirs writes:

I've heard that cataract operations in India, for instance, can be done for as little as $50 when they would cost (the taxpayer) $5000 in Britain. This kind of distortion must be amenable to rationalization. Health care is not any different in principle from car repair.

David Thomson writes:

“We can't take anyone seriously until they seriously consider how to increase supply. “

I would rather put it this way: we can't take anyone seriously until they seriously consider how to make sure that individuals understand that they are paying the actual cost of their own healthcare. Too many people lie to themselves. They embrace the silly myth that somebody else, their employer or the government, is picking up the tab.

Duncan Brown writes:

Developing countries (Thailand, Brazil, India, and of course Cuba) have established themselves as destinations for high quality, high technology medical care of the highest standards, at astonishingly low prices. In Bangkok I saw big glossy, American style mdedical centers (they even have Starbuscks in the lobbies!), which market themselves to medical tourist. I know people who stop in for the routine medical diagnosis and treatment.

But Medicare won't reimburse care don overseas.

spencer writes:

Very good points and I think you are completely correct on this.

But your critism applies to the so called "market" solutions just as much as to the
"government" solutions.

Lord writes:

But Medicare won't reimburse care don overseas.

They don't have to. It is that much cheaper.

I wonder when we will face the fact that emergency room medicine is actually the cheapest way to provide healthcare despite the cost.

Dr. T writes:

Many aspects of healthcare can be (and sometimes are) standardized. Templates are used for taking the history and performing the physical exam on patients admitted to the hospital. Some conditions (such as prostate surgery, hip replacement, bacterial pneumonia, etc.) have 'clinical pathways' or 'care maps' that lay out (like a GANTT chart) necessary tasks and actions. Outpatient procedures can also be standardized. The timeline for prenatal care activities is one of the best examples.

However, in my experience, the only way we will get good care that is less expensive is via market forces. In most situations, the current system provides financial incentives for delivering less efficient, more costly care. Radical change will be needed to lower healthcare costs.

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