Arnold Kling  

Quarterback, Shepherd, Project Manager

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Jane Gross writes,

Looking back on the last few years of my mother’s life, single biggest mistake was not finding a doctor with expertise in geriatrics to quarterback her care and attend to the quality of her life, not merely its length.

I give her credit for taking ownership of what happened, rather than heaping blame on the system. What Gross calls a quarterback, I call a project manager and Russ Roberts calls a shepherd in our podcast ten days ago.

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COMMENTS (5 to date)
RobbL writes:

The problem is who hires/oversees the manager if there are no surviving children/relatives? Do we really want to regress to a society that requires a person to have a bunch of kids just to ensure their old age is handled gracefully?

Publius writes:

(For full version, see link)

I envision patients choosing between different GP corporations who would advise patients on which insurance plan makes the most sense for them, which specialists delivers the best value, how to choose between a generic drug and a more expensive brand drug, and sets up appointments at local clinics (e.g., Wal-mart one-stop shops or more expensive, more typical practices).

It would be relatively inexpensive, as one GP could oversee the health management of hundreds of patients a year, with the assistance of health care professionals (you don't need to be a GP to gather information, or setup appointments, or chart blood pressure; just like you don't need a construction team of architects to build a house).

The GP would be a health advisor, similar to a financial advisor (tangentially, I think if you want to help poorer people, subsidizing financial management could improve outcomes).

Currently, insured patients choose a general practitioner (also known as, primary care physician, etc.), who, in theory, manages their care; the doc will give you a physical, make sure you're blood pressure's at a decent level, etc.

Of course, most of these tasks are actually done by a nurse, with the GP popping in for a quick hello, write a prescription, or hand out a referral.

This dynamic is not only grossly inefficient, but it fails to deliver the expertise that would most improve a patient's health. I would like to see the GP hand over a lot of his/her clinical duties to the nurses (which means buy-in from the American Medical Assocation...), and take on managerial duties.

caveat bettor writes:


I'm not sure there any good substitutes for family advocates. It pretty much starts out in the womb, continues through parenting, and then in old age. Social outcomes are completely different. My wife clerks for a guardianship court part, and while there is an organized state system for dealing with the interests of the aged and incapacitated, it is not an equal substitute to responsible children.

Dog of Justice writes:

Do we really want to regress to a society that requires a person to have a bunch of kids just to ensure their old age is handled gracefully?

It's the current system that is not evolutionarily stable. An arbitrarily long comfortable retirement is a privilege, not a right (at least until scarcity is not a problem at all), and to earn that privilege you should create enough value so that others (not necessarily your children) want to make sure you're taken care of.

Kurbla writes:

Leaving that individuals destiny depends on his ability to earn and invest ends with lot of homeless people, on the borderline of crime and hunger, due to various reasons. For each of these people, one can say "he should do better in his youth", but, do you try to make the society for people as they actually are, or for the people as they "should be?"

There is the paradox of old criminals. If old homeless man commits minor crime, he is sentenced on few months of jail, and society takes care about his basic needs; warm and dry place for living, clean clothes, three meals a day, probably some medical care - everything for free, because old criminal cannot work for compensation. If society provides all that to old criminals, then it doesn't make sense it doesn't do the same for honest old citizens.

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