Monday, May 11, 2009

What's Wrong with US Healthcare?

There are many things wrong with health care generally in the "advanced" world, including the US.

Because health care (and education is similar) exists outside the realm of competitive choice, there are not good options for people in terms of price and level of care (ranging from awful to outstanding). There are no analogues to the situation where one can link to and choose among some tremendous computers . . . at lower prices than in 2007 or 2008. On, you can find lawyers' abilities evaluated by their peers, but there's really nothing similar in medicine.

Health care costs rise dramatically (doubling every 8-9 years), but the health "product" available improves slowly. Mediocre doctors and hospitals "charge" roughly the same prices as excellent ones. It's an absurd situation, where organizations like the AMA do little or nothing to bring about necessary changes.

Hospitals and doctors, most of whom are "average" by definition, don't want to provide more information about outcomes, because doing so would cause many of them to lose business. (The situation is similar in education, where most teachers and schools are "average," but everyone gets paid about the same amount. The truly excellent teachers are out of luck in terms of compensation.)

Doctors and hospitals are extremely hesitant, as Dr. David Gratzer points out in The Cure, to evaluate their counterparts. That means patients -- "customers" -- lack necessary information. So, heath providers get chosen mainly on issues of geography (how close are they?) or personality ("is he/she 'nice?'").

I haven't mentioned the biggest problem, which is that employer and government-financed health care makes health consumers assume that the product is "free" (or close to it). That of course sharply reduces the incentive for patients to make wise choices. When people are spending their own money, they will almost always make better decisions.

Relatedly, when anything is (presented as) "free" (or relatively low cost), people tend to over consume. Many elderly people visit doctors (and even hospitals) as largely a social activity. Have a cold? Hey, go to the emergency room. Lonely? Hey, go see that nice, sympathetic doctor and his friendly nurse. Is your doctor competent? Hey, look he's got a degree up on his wall, right?

A generation ago I had a doctor/friend in Athens, GA. He told me, as he chain-smoked his Camels and talked about his former problems with "substances," that he had been "a C student at the University of Tennessee medical." He was a good guy, but if you needed brain surgery, well, I don't think he was your man.

On costs: If a local bar offered free beer, a lot of people will end up very drunk. If health is essentially perceived as free, medical offices and hospital emergency room will regularly be full. And costs will keep spiraling out of control.

The points I'm raising here are real issues -- important ones. But you'll rarely if ever hear them discussed in the so-called "national debate" about health care. Instead, you're going to hear many proposals -- especially from Obama -- that will make the situation worse.

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