Map of life expectancy at birth from Global Education Project.

Friday, May 29, 2009

Onward to the Final Victory of Capitalism!

You may have come across Atul Gawande's informative piece in The New Yorker, if not I recommend it.

In a pistachio shell, Gawande identifies a key reason for excessive spending on medical services as what ought to be the obvious incentive that doctors have to do more stuff to people so long as they are paid by the procedure. Proponents of "market based" health care have this notion that if we had to pay for at least part of it out of our pockets we wouldn't buy all those unnecessary diagnostic tests and gall bladder surgeries but they are missing -- or more likely deliberately ignoring -- the obvious fact that I have no idea whether the PET scan or the gall bladder surgery is really necessary or worth the money unless my doctor tells me so, and if the doctor says I ought to do it, I might decide to make the stretch even though in fact, I don't really need it; or alternatively, I might decide not to even though I do need it. Even worse, if I do happen to really need it, and I can't afford it, I'm shit out of luck, which is why we think people ought to have health insurance in the first place. So sorry pals at the Cato Institute, that really doesn't work after all.

Gawande points to a real solution, which is that teams of providers -- not individual physicians -- should be paid for keeping us healthy, not for doing more and more stuff to us. He doesn't think this basic structural change is necessarily related to whether insurance is public and single payer, or private and multiple payer, but I do. That's a somewhat longer story, however. Anyway, this important point, which he makes cogently, is one necessary step in sorting out this whole debate.

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