Kevin Drum's Turkish Bazaar

I don't know why you bother arguing with idiots like this guy and Holt. There must be some intelligent voices on the left that are actually worth arguing with. Although with the evidence of Drum, Holt, and Krugman, maybe not.

However, while I support the privatization of health care, I don't think it will end up as a turkish bazaar. As everybody on the left will point out, the stakes are too high. They believe that the doctor is the only one who will have the patient's best interest in mind and be informed enough to choose the best treatment. This is patently false, as anybody who has been in a doctor's office can testify and as Drum did in his own story. Like any economic agent, the doctors are interested in maximizing their revenue and will skirt all the ethical lines they can to do so, with an eye towards malpractice suits as the big stick to avoid. No wonder they're so in favor of limiting malpractice liability.

The insurance companies can be the third party that steps in and helps the patient choose the best treatment for them. However, because of disincentivizing regulation and their own moral and intellectual bankruptcy, they have not done this. Their role in the future will be minor, relegated to catastrophic insurance, as Arnold points out. The question is who will step in and make sure the patient gets the best treatment? I believe a whole new medical broker profession will rise up to take their place. These brokers will collect information on treatment, prices and outcomes and advise patients on their best options. Right now, the doctors do not collect any information on patients in any meaningful way because they profit from their patients' ignorance. Have you ever looked at the computers in a doctor's office? They run highly profitable businesses yet they would not be out of place if they were still in the 1980's. EMR has never taken off for precisely this reason. The brokers can point patients to the best doctors for their problems and collect their treatment, cost, and outcome data in a central location. Future patients can then benefit from this aggregation. They will play the role that those on the left, in their ignorance, imagine that the doctors do now. While nobody has laid out a case for this new 3rd party yet, I believe they will be an integral part of a new free-market healthcare system and allow free market advocates to counter the left's argument that nobody can fulfill that role but the doctor, combined of course with their beloved solution to every problem, the government.

My Dr.put me on medicine for diabetes, and it was $90 a month. I complained to him about how expensive it was, and he said, isn't your insurance paying for it? I said yes, but I have a deductible and besides I don't want to run up my bill because I think they will raise my rates. Isn't there any generics I could take? Finally he said, well, there is an 8mg size that costs $130, (my size is 4mg) and you could get those and break them in half, thus reducing the cost to $65 a month. I said great and that is what I am doing. But I realized that no one ever says stuff like that to him and he would never have thought of it unless I made him think about it.

I am always on him about cutting costs like this, and he always gives me these funny looks, like, why bother? Well, because the US economy is going down the tubes because not enough people think about health care this way? Possibly?

Further evidence for my thesis that modern liberalism is driven by aesthetics, not Salus Populi.

Fundamentally, I see the issue as one of misaligned incentives. Medicare/3rd party payers all reimburse for "doing something" ergo our whole DRG/APC/CPT based reimbursement where a physician is basically rewarded for performing a procedure or a "visit". Basically if healthcare providers try to do the right thing, they invariably lose $$ (see article about Virginia Mason Hospital in the WSJ on 1/12). So basically every doc in the US is looking for ways to "do more" --be it order tests, prescribe a drug, perform a surgery--because his/her take home at the end of the day is how many of these he can do.
Word of advice for "napablogger" - I am an MD (surgeon); an 8 mg sustained release pill broken in half is sometimes not comparable to a 4mg tablet. The capsule coating ensures that the drug is released in a timely fashion over a 24-hour period. So breaking a 8mg sustained release tablet MAY be dangerous as the 4 mg is not released in a sustained manner. Please investigate before you engage in this strategy.