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To extend [health care] coverage without changing these [cost-inflating] dynamics would add on another $77 billion of spending beyond what it should cost.
That is Ezra Klein, his post has some interesting data. Note that while we might shift some of the financial burden of pharmaceuticals to Europe and elsewhere, this hardly qualifies as a global welfare improvement. There are plenty of other ways to redistribute money from foreigners. I am, however, struck by this bit:
Another $147 billion in increased spending, much of it a consequence of the fee-for-service system, wherein doctors are paid based on how many procedures they recommend and carry out. Doctors with equity in facilities where they can co-refer cases conduct between two and eight times more tests than those without equity interests.
Some of this is third-party payment, but more generally the consumer as monitor is often either insane or asleep. To get what is really wrong with health care markets, we must turn to the academics, not as analysts but rather as examples:
One 47-year-old professor, a classic blunter who had received a diagnosis of prostate cancer, told me: "I would be insulted if some guy read 15 papers on theoretical physics, my own field, and then came in and asked me to help him design an experiment. And I expect the same of my doctor. I pay her. Let her sit down and tell me exactly what I need to know -- what are my choices and what do they mean? That's her job. I have other things to do."
Many consumers just don't want to face the stark realities of how they are doing. How about letting me make the health care decisions for a randomly chosen partner, and vice versa? Here is much more, via Craig Newmark. On related topics, here is Arnold Kling.
Posted by Tyler Cowen on February 14, 2007 at 06:55 PM in Medicine | Permalink
Comments
I agree that my physician should not make a profit from care he provides me. Certainly, he should make a salary, but his primary motivation should be my care. I don't want him recommending surgery when it is not called for, just so his surgical center can realize a gain. In the real world, we call that a conflict of interest. I expect my physician to recommend the treatment that is best for me - not best for his bottom line.
It is the same thing I expect from my financial advisor (I don't want him churning stocks), my attorney (I don't want him billing for useless research), and my mechanic (I don't want him replacing a perfectly good alternator).
I do not begrudge qualified physicians making a profit. To the extent that the physicians provide better care, they should.
Posted by: Allan at Feb 14, 2007 11:28:51 PM
I notice you don't comment on the almost $100 billion being wasted on administration: all those clerks at doctors' offices and hospitals, fighting with the insurance companies. That $100 billion of waste doesn't happen in single-payer systems, because they have insure everybody, not just healthy people, and they have to pay.
Posted by: Cardinal Fang at Feb 14, 2007 11:54:33 PM
Cardianl Fang,
I belive that the clerks and administrator spend just as much time doing paperwork for medicaid and medicare than they do for any other system. The adminsitrators have to have intricate knowledge of billing codes, the rules for the billing codes, and how to complete the bill paperwork for medicare/medicaid.
Actually, there are seminars to help admnistrators learn how to complete mediciad/medicare paperwork.
Posted by: superdestroyer at Feb 15, 2007 4:31:05 AM
Tyler, you can't be serious. You really expect everyone to be able to make informed decisions regarding esoteric and complicated medical treatment? There's a reason doctors have a lot of schooling. Sure, a bright person in a relatively cush job like yours can take the time to read the literature and go through various treatment possibilities. But you have to accept the fact that this just isn't feasible for most people.
superdestroyer, you aren't even arguing the same point as Cardinal Fang. Read the study, read Cardinal Fang's post again and then respond. Medicare and Medicaid aren't part of it.
Posted by: eriks at Feb 15, 2007 10:36:35 AM
"How about letting me make the health care decisions for a randomly chosen partner, and vice versa?"
I think this absurdity about sums up the ridiculous faith of the libertarian health care theorizers. It's funny to contemplate as a thought experiment though--suppose Tyler's random health arbiter was a Jehovah’s Witness.
And lying underneath this sentiment is an apparent loathing of medical doctors. What's up with that? Why would I trust an economics professor on economic decisions, if I don't trust a medical doctor on health care decisions?
Posted by: Russell L. Carter at Feb 15, 2007 12:04:20 PM
So the 47-year-old professor should go bone up on oncology, the latest innovations in monoclonal antibodies, cost-benefit analysis, etc.? Isn't medical care a credence good on some level?
The solution isn't to make "every man a doctor" (a not-so-strained evocation of Luther given the place of health-as-religion in today's society). The solution is to deal with the doctor (and nurse) shortage, which is finally acknowledged even by the groups that have the most to gain from it.
Posted by: Frank at Feb 15, 2007 12:54:44 PM
The incentive system for doctors is completely messed up. I'd be curious what would happen raising Primary care physicians salaries (its almost 70K/yr less than the next physician on the totem-pole (ER-docs)) -- and paying them appropriately for more time per patient visit. Lots of patients (not everyone), seem to have decent relationships with PCPs -- would probably be more patients, if PCPs weren't time constrained to 10 minute visits (just so they can make 70k less than everyone else).
Anyway, my anecdotal experience is that specialists game the system way more, order way more useless tests (@ $1000/per/useless test). Increasing primary-care expenditures, would seem like a good way to stave off, unneccessary secondary & tertiary care.
Could be wrong, have no #'s to back it up.
Posted by: Jor at Feb 15, 2007 1:52:44 PM
People make decisions about medical treatment every day because they don't have a choice. Just because the decision is difficult doesn't mean someone else is going to magically make it for you. Sometimes, you have treatment alternatives that each have benefits and drawbacks. There's no way your doctor can weigh those for you, and know what they mean for your life, because he's not you. Saying that people shouldn't be expected to make those decisions is absurd. It's like saying that you should appoint an expert to choose your spouse, or your career, or where you're going to live. How could that person stand in your shoes and make a better decision than you could?
Posted by: LisaMarie at Feb 15, 2007 4:31:11 PM
"Saying that people shouldn't be expected to make those decisions is absurd."
Nobody said that.
Posted by: Russell L. Carter at Feb 15, 2007 7:26:48 PM
Carter,
Maybe I misunderstood. When someone says "You really expect everyone to be able to make informed decisions regarding esoteric and complicated medical treatment?" what are they suggesting the alternative is? Having your doctor make your choices for you? Having someone else do it?
Posted by: LisaMarie at Feb 16, 2007 12:25:35 PM
Doctors are humans practicing a profession that is nearly as much art as science. Yes, they have years of training and biological expertise, but that does not change the fact that each individual is different and therefore what works for some, doesn't work for all. The only way doctors can intelligently make those determinations is with cooperation from their patients. I'm the only person who knows my body perfectly intimately (and even that is questionable), so ultimately I am the authority on what treatments I endure. In the end, the doctor is just a consultant.
Posted by: Christina at Feb 16, 2007 2:27:04 PM
LisaMarie, if you're confused I can elaborate. I was addressing the "consumer is king" mentality as applied to healthcare. Most people simply do not have the resources, time, or opportunity to research every possible treatment option. Often health decisions must be made fairly quickly. It's not something that people can take their time and shop around on the internet for. Even if they did have the time it can be difficult to get into to see a doctor, much less many doctors. And then, people would probably only be going to another doctor hoping they may be able to offer some advice they haven't heard. Yes, people can and should make decisions based on the options their doctors give them. But we can't assume that it's open to choice like any other good.
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