Really great health care article in The Atlantic

[Lefty 0]

The most honest and impartial article I've seen yet. The solutions Goldhill offers at the end are not what I'd consider ideal from a libertarian point of view, but they're realistic, attainable, and productive (provided the government is able to control its gluttonous urges). His explanation of why our system is currently so wasteful and inefficient is spot on, though. It's six pages long so those with short attention spans need not apply.

Clicky

Provoking a reaction isn't the same thing as saying something meaningful.
-Calvin

[StreetScooby 5]

Good article. Thanks for posting it.

We are all engines of karma

[pirana 0]

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The most honest and impartial article I've seen yet. The solutions Goldhill offers at the end are not what I'd consider ideal from a libertarian point of view, but they're realistic, attainable, and productive (provided the government is able to control its gluttonous urges). His explanation of why our system is currently so wasteful and inefficient is spot on, though. It's six pages long so those with short attention spans need not apply.

Clicky

Just read the first page, will have to come back for more later. Definitely looking on the mark in the mention of incentives.

Isn't it one of the Demming principles that our processes are perfectly designed for the results they produce?

I see on page one he already mentions the employer emphasis, and hints at capacity issues.

Yes, thanks for posting.

" . . . the lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging them and kicking them into obedience." -- Aldous Huxley

[GeorgiaDon 340]

Thanks for that. Much to ponder.

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[billvon 2,426]

Cool article. His solution is similar to the solution I discussed a few months back - cover emergency care for _everyone_ and cover the stuff that's really cheap to cover and saves money in the long term (i.e. checkups, prenatal vitamins.) His suggestions for more transparency are good ones as well.

[GeorgiaDon 340]

After some pondering, I find myself agreeing with pretty much everything he has to say. Just a couple of things that might also help:

1) Increase the supply of doctors. Currently the medical profession restricts the number of med school slots, so doctors are in short supply especially in certain disciplines. More doctors will mean more competition, more being attracted to underserved areas (general practice, geriatrics, etc), and lower prices. This must include opening more medical schools, and maybe subsidizing the cost to expand the pool of candidates. Both are inherently expensive propositions, but perhaps cost-effective in the long run.

As some in the medical profession who post here have pointed out, such reforms could screw doctors who have gone through the existing system and are now saddled with huge student loans. Some loan forgiveness mechanism may also be needed.

2) Allow people to accumulate money in medical savings programs for more than one year. The system we have now only allows for a year at a time, and money in the account at the end of the year is lost. This should be a simple and non-controversial matter of "tweaking" the existing law.

3) Malpractice reform to lower premiums, while still allowing for appropriate restitution for real victims of medical malpractice. I don't think simple-minded caps on awards will work. That has been done here in Georgia and in other states; premiums have continued to rise, insurance company profits have risen, and it is now economically unfeasible for low-income people to seek restitution. The reason for that is awards are limited to $250,000 plus actual economic damages. A big chunk of economic damages is loss of future income, which is pretty small for most people. Since expert witness fees, court and legal fees, etc have to be paid out of the award, the maximum payment under the caps won't even cover legal costs unless you make a 6-figure income.

I wonder if it would be cheaper for the AMA or the various medical professional societies to "self-insure". The society would maintain a cadre of "special masters", who would be qualified to examine malpractice claims. If they decide the case is malpractice, they could negotiate a settlement. If they feel the case is frivolous, the society would contact with lawyers to fight tool and nail. Cost savings could be realized, because the profit skimmed off by the insurance company would be eliminated. Insurance companies often settle "smaller" claims because they can be expensive to contest, and anyway they can recover their payment to the "victim" by ratcheting up premiums. This feeds a "malpractice claim is like winning the lottery" mentality. If frivolous claims were contested instead of automatically paid, the incentive to sue frivolously would decrease. By "frivolous" I mean claims related to normal (and often temporary) side effects of treatment, which patients are told about in advance, and things of that nature.

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[Lefty 0]

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After some pondering, I find myself agreeing with pretty much everything he has to say. Just a couple of things that might also help:

1) Increase the supply of doctors...

Market forces can take care of this part. No need for a doctor czar.

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2) Allow people to accumulate money in medical savings programs for more than one year...

Agreed. Not taxpayer-subsidized HSAs, though.

Provoking a reaction isn't the same thing as saying something meaningful.
-Calvin

[GeorgiaDon 340]

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Market forces can take care of this part. No need for a doctor czar.

I didn't say anything about a "doctor czar". "Market forces" have had a long time to "take care " of the supply problem, and so far they haven't. Part of the reason is apparently that the AMA has lobbied to keep the supply of doctors relatively low. I'm not entirely sure that that really is the case. Another, probably bigger problem is that it's incredibly expensive to start up a new medical school. Building the thing is the smallest part, and that can easily be 20-30 million or more. Then you need to attract good faculty, which means competing with private practice to get the best people in each specialty. On top of that good medical schools all have active research programs, which generates the "cutting edge" medicine and keeps faculty up-to-date with the latest advances in their field. To equip a modern biomedical research lab costs about $500,000+ in startup costs, per faculty member, on top of a salary of at least a couple of hundred thousand/year (plus they have their private practice based at the school/teaching hospital). When you're talking about $60-80 million in up-front costs before the first student is even admitted, it's no suprise that no large private medical schools have opened in a long time. It really does require government input to get these things off the ground.

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Not taxpayer-subsidized HSAs, though.

Since they are tax exempt, in a real sense all HSAs are taxpayer subsidized already.

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[Lefty 0]

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It really does require government input to get these things off the ground.

And who does Obama like to appoint to tackle issues like this? A czar. Sorry, but if we have the taxpayers being coerced to fund everything, it is hard to determine whether the system is working or not.

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Since they are tax exempt, in a real sense all HSAs are taxpayer subsidized already.

By that logic, so is all the income you're allowed to keep.

Provoking a reaction isn't the same thing as saying something meaningful.
-Calvin