Arnold Kling  

Massachusetts Health Care Reform

How a Rational Politician Trea... Rick Santelli: My New Hero...

These critics sound like me.

Massachusetts members of the Physicians for a National Health Program released a report today faulting the state's experiment with health reform for failing to achieve universal coverage, being too expensive and draining funds away from safety-net providers.

...the reform is financially unsustainable, as it does "nothing about a major driver of high health care costs, the overuse of high-technology care such as CT scanners and surgeries, and the underdevelopment of primary care."

Actually, these critics want a single-payer system. That's not what we have now, but we're getting closer every day. I want something even more radical--a free-market health care system, with government giving people vouchers rather than providing insurance.

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COMMENTS (10 to date)
The Snob writes:

Don't CT scanners and other non-invasive imaging technologies represent an ideal example of "preventative care?"

Zac writes:

How about something even more radical - a free-market health care system, with government doing nothing?

manuelg writes:

> a free-market health care system, with government giving people vouchers rather than providing insurance.

This would work perfectly, if:

* we removed patent protection for pharmaceuticals and medical devices

* we removed the monopoly licensed physicians currently enjoy

otherwise, only a single-payer could posses the leverage to extract the maximum concessions from the monopoly holders.

The same reason why a company can buy HMO coverage for 100 employees, for much less than writing each employee a check expressly for buying the equivalent coverage on their own. But writ large, over a whole state, with corresponding savings earned by much greater leverage.

Is this (removing monopoly protection for pharmaceutical companies and physicians) part of your idea of a free-market health care system?

Dan Weber writes:

Don't CT scanners and other non-invasive imaging technologies represent an ideal example of "preventative care?"

Not really. This post by Orac goes into heavy detail, but a lot of the diagnostic tests we've developed have yet to show that they actually improve patient health.

Knowing you have thyroid cancer is one thing. Knowing you have thyroid cancer of which you will die if left untreated is something else entirely.

Neel Shah writes:

The release of this report is not surprising, considering the heavy bias of the organization. The founder/director of Physicians for a National Health Program works at the Cambridge Health Alliance -- one of the safety nets

Carol Ward writes:

In my job I occasionally get involved with workers compensation claims. In most states the amount an employer/ insurer pays medical providers for workers comp bills is defined by regulation. In this particular state, hospital bills are to be paid at 60% of what the hospital bills. The hospital billed $36,000 for outpatient hernia surgery. The hospital first submitted this bill to a private market group insurance company, who marked the bill down to $6,000 and paid it, based on its pre-negotiated rate with the hospital. Upon discovering that the claim was a workers comp claim, the hospital submitted the bill through that channel, and because of the regulation, was paid 60% of the original bill, or $21,000.

If you can get past being appalled, there are a lot of lessons about gaming a system and government price regulation and the ability of a private market to negotiate/ failure of the public market.

By the way, the hospital was a "non-profit".

z writes:

You want to fix healthcare - you have to have the willpower to turn people away at the door. I am a physician at a prominent east coast teaching hospital, and I see the waste daily.

Take for example, the gangbanger that gets shot by the cops during the commission of a crime. His 3 surgeries, months in the ICU, and subsequent rehab, not to mention the disability he'll collect now that he's paralyzed, will cost millions over the years. Money he won't pay, and benefit that society will never see.

Or, go the neonatal ICU at any major hopsital. Up there, you'll find a number of preemies and kids with unfortunate congenital conditions, who any physician will tell you have no chance at living past the age of ten, if that long. Yet, we'll spend millions of dollars on surgery, medicine, and ICU care for months on end. All the while the parents leave work and collect benefits. To what end? No insurance covers those expenses, and few if any of the individuals have the means with which to cover such costs.

Or, take the 90 year old with three cancers, that get's $100k treatments that, according to research that lead to the medications approval, will extend that patients life expectancy from 2 months to 3 months. If they pay for it, great, but should you and I be burdened with that expense?

You can do all the shennanigans you want with health insurance and co-pays, etc, trying to suck and extra $50-100 bucks out of some patient, but with any one of the situations I list above, you obviate any of those gains thousands of times over with the expenses incurred by one leach to the system.

Biomed Tim writes:


I think protecting the intellectual property of pharmaceutical companies can still be consistent with a "free market health care system."

Those companies need incentive to take on the R&D costs.

Stella Baskomb writes:

About reducing health care costs, I wonder if financial savings from "preventive care" are less than many people seem to believe. Specifically, does preventive care save money overall? Would it save money even if universally dispensed?

For example, will the total cost for universal diagnostic testing of apparently well persons be less than treatment of diseases it detects? Asking this question is not to suggest that preventive care has no benefit for anyone. Only to question whether the total cost of dispensing preventive care universally may outweigh the financial savings.

I suppose that adverse outcomes (e.g., from immunizations) should be counted as a cost of preventive care.

And beyond that, analogous to the fact that in the long run we're all dead, it seems to me that in the long run most of us develop some chronic condition, too. Preventive care cannot avert the chronic conditions in all circumstances, and cannot avert aging.

Remember 25 years ago, there was considerable belief that getting a second surgical opinion was not only beneficial for the patient, but saved money overall. In time, researchers generally confirmed that many costs were not avoided but simply deferred. Again this is not to say that getting a second opinion benefits no one - only that universal second opinions were eventually found not to save money overall.

So I wonder - is the same true of preventive care? I'm sure there must be credible research on this subject, I've not found it.

charles writes:

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