health care

Gino tried to get a conversation started about health care reform a few weeks back right before he went on sabbatical. I tried to comment, then quickly realized I had written far too much for any comments section. So I started working on this and never got around to editing it into something I liked. I still haven't but would like to try and at least get the conversation going again.

So...here are some of my random and disorganized thoughts about it all:

1) Yeah, socialism doesn't generally produce optimum outcomes of the most good for the most people, mainly due to fixing of prices at sub-market levels; and in a perfect world, an unfettered market ought to be much better at this. However, we have neither a perfect world nor an unfettered market in health care in this country, and by any reasonable metric (i.e., health outcomes) it is difficult for me to conclude that our system is objectively better than any of the well-run socialist systems in the world (esp., France, and yes, Canada)--particularly in terms of delivering the most good to the most people.

2) The biggest economic losers in the nationalization of US health care would be the managed care companies, who have increased the cost of care with excessive layers of administration and management. It's hard for me to get upset about middle managers losing their jobs. Doctors will still get paid plenty--no one is seriously talking about forcing them to work for peanuts at gunpoint. Even in a nationalized system, there is still a market in labor...and if doctors don't get paid enough, there simply won't be enough doctors.

3. I know it sounds like I'm advocating for socialized medicine here--I'm not really, but I do think it is worth pointing out that our current system is not vastly superior to it, and in truth, I think a nationalized/socialized/single-payer /whatever you want to call it system is probably preferable to any of the cumbersome half-measures we are likely to see in the next few years. (I'm mostly thinking of Ms. Clinton's byzantine plan here, but the same could probably be said about any of the major candidates plans.)

4) I think probably the best plan that could actually work in the US would need to include: a) an uncoupling of insurance from employment; b) meaningful deregulation of health insurance, enabling a greater diversity of coverage and the ability of individuals to negotiate a level of coverage that makes sense for them and that they can actually afford (think more like auto insurance); c) a safety net of some sort.

I realize that (c) might cost me my libertarian decoder ring, but there is simply no reason why anyone in the richest society in the history of the species should have to forgo basic and/or lifesaving medical care. I just don't see this as libertarian vs. socialist issue (anymore); it's a humanitarian issue.

5) A couple of less well-thought-out bits:

--I'm not ready to tell drug companies how they can and cannot market their products, but the proportion of pharmaceutical revenues spent on marketing is simply ridiculous. (It's been a while since I've looked into this, but when I was applying for a job at a certain biotech firm one of their big selling points was that they spent nearly 20% of their revenue on R&D, and this more than almost anyone else. This isn't a startup either...we're talking about a $10 billion a year company here. You do the math.) Figuring out a way to incentivize drug companies to invest more in R&D would be very worthwhile. I have no idea how to do this. Tax breaks? Better patent protections? I'm still chewing on this...

--More research into the marginal benefits (more precisely, into the marginal non-benefits) of newer, more technology-driven diagnostics and therapeutics needs to performed and disseminated. This is a prime example of research that simply will not get done in the private sector, because companies thrive on the new (and patentable.) If test A that's been around since 1955 is only 10% less accurate than test B that's brand new and sexy, is it really worth paying 10 times more for test B? If aspirin works almost as well as third generation COX-2 inhibitor, maybe you should just take aspirin. There is a lot of anecdotal evidence like this out there, but solid, population-level studies need to be performed and common-sense practices based on their results need to be implemented.

Is this sexy research that everybody at NIH is chomping at the bit to do? Hell no. But is it a damn worthwhile investment that will "enhance the Nation's economic well-being and ensure a continued high return on the public investment in research"? Hell yes.