{"id":1223,"date":"2011-04-22T07:06:09","date_gmt":"2011-04-22T11:06:09","guid":{"rendered":"https:\/\/dwan.org\/?p=1223"},"modified":"2019-10-27T07:06:47","modified_gmt":"2019-10-27T11:06:47","slug":"medicine-part-2-in-which-i-admit-my-error","status":"publish","type":"post","link":"https:\/\/dwan.org\/index.php\/2011\/04\/22\/medicine-part-2-in-which-i-admit-my-error\/","title":{"rendered":"Medicine, part 2, in which I admit my error"},"content":{"rendered":"\n

I rely you people to correct me when I screw up \u2013 and I made something of a howler in that last post<\/a>. Fortunately, Krugman\u2019s actual column today<\/a> caught it.<\/p>\n\n\n\n

I claimed that the current debate is about how best to reduce the size of the medical industry. That\u2019s wrong. What we\u2019re really arguing about is how to reduce the amount of government spending (taxes) going into that industry.<\/p>\n\n\n\n

As Krugman puts it:<\/p>\n\n\n\n

Before you start yelling about \u201crationing\u201d and \u201cdeath panels,\u201d bear in mind that we\u2019re not talking about limits on what health care you\u2019re allowed to buy with your own (or your insurance company\u2019s) money. We\u2019re talking only about what will be paid for with taxpayers\u2019 money. And the last time I looked at it, the Declaration of Independence didn\u2019t declare that we had the right to life, liberty, and the all-expenses-paid pursuit of happiness.<\/em><\/p>\n\n\n\n

And the point is that choices must be made; one way or another, government spending on health care must be limited.<\/em><\/p>\n\n\n\n

Unfortunately, we\u2019re going about it wrong. Both parties are trying, somewhat ham-fistedly, to \u201cstarve the beast,\u201d which screws up health care for everyone. Republicans appear to want to return some small fraction of our taxes to some subset of the people as tokens that can only be used for private insurance. That sounds idiotic. It also sounds like their old bugaboo \u201cforced redistribution of wealth.\u201d I would rather keep the money and buy insurance, or not, as I see fit. Of course, because most of us are really bad at life \u2013 we probably need to provide some baseline social services for the idiots who don\u2019t (or can\u2019t) buy insurance under those circumstances. Otherwise we\u2019ll have poor people dying of easily preventable diseases. Whether or not you perceive a moral requirement to help the less fortunate \u2013 it\u2019s embarrassing and bad for the appetite to have to watch them die.<\/p>\n\n\n\n

Democrats have a different problem. In the current system, there are lots of incentives leading to \u201ceveryone gets the absolute top of the line.\u201d Litigation (less tests = vulnerability to lawsuits), fee for service (more tests = more money), and lack of cost transparency (my $3k MRI doesn\u2019t cost $3k to anyone involved. That\u2019s just a magic number that allows the insurance company to set profits) are the big three. Democrats appear to want to add another layer of bureaucracy to compensate for that moral hazard \/ profit seeking. I think that the panel that Obama has proposed would do something like deciding what services are \u201cappropriate\u201d for medicare \u2013 but then they would use ham fisted financial methods to pay doctors less for providing these services and hope that the market worked its magic. So we layer a flawed system on top of another flawed system.<\/p>\n\n\n\n

Of the two, I prefer the latter. It\u2019s an inelegant solution, but at least it acknowledges the really interesting question: what services are we going to provide for people who cannot pay for them.<\/strong> We can\u2019t buy everything for everyone, and at some point we need to have the real debate about when we let grandma die and move on to caring for the newborn in the next room over.<\/p>\n\n\n\n

Neither of them can pay. Who\u2019s it gonna be?<\/p>\n\n\n\n

I\u2019ll cut to the chase here. The correct answer \u2013 assuming that we want to provide some level of health care to people who cannot afford it \u2013 comes in two steps:<\/p>\n\n\n\n

1) Decide what\u2019s included and what\u2019s not.
2) Hire care providers to implement those services.<\/p>\n\n\n\n

I.e: If we want to provide health care \u2013 let\u2019s provide health care<\/strong> rather than insurance or vouchers or whatever. You want to cut out the middleman? Cut out the damn middleman! Hire a doctor!<\/p>\n\n\n\n

As above, nobody is talking about limits on what health care you\u2019re allowed to buy with your own (or your insurance company\u2019s) money<\/em>. Seriously. There\u2019s no death panels here unless you\u2019re too dumb (or unlucky) to save some money or buy insurance. You\u2019re expected to look after your own health. You\u2019re expected to be sensible enough to eat healthy and save some money for end of life care. Social services are what we stand up when we acknowledge that most people are neither sensible nor terribly lucky \u2013 and when we also acknowledge that we don\u2019t want those people dying preventably on our front porches.<\/p>\n\n\n\n

The question of health care costs for those who can<\/strong> pay is a substantially different rant. There\u2019s a simple solution there as well \u2013 but it\u2019ll have to wait.<\/p>\n","protected":false},"excerpt":{"rendered":"

I rely you people to correct me when I screw up \u2013 and I made something of a howler in that last post. Fortunately, Krugman\u2019s actual column today caught it. I claimed that the current debate is about how best to reduce the size of…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[37,42],"tags":[],"class_list":["post-1223","post","type-post","status-publish","format-standard","hentry","category-genomics","category-real-life"],"_links":{"self":[{"href":"https:\/\/dwan.org\/index.php\/wp-json\/wp\/v2\/posts\/1223","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dwan.org\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/dwan.org\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/dwan.org\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dwan.org\/index.php\/wp-json\/wp\/v2\/comments?post=1223"}],"version-history":[{"count":1,"href":"https:\/\/dwan.org\/index.php\/wp-json\/wp\/v2\/posts\/1223\/revisions"}],"predecessor-version":[{"id":1224,"href":"https:\/\/dwan.org\/index.php\/wp-json\/wp\/v2\/posts\/1223\/revisions\/1224"}],"wp:attachment":[{"href":"https:\/\/dwan.org\/index.php\/wp-json\/wp\/v2\/media?parent=1223"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/dwan.org\/index.php\/wp-json\/wp\/v2\/categories?post=1223"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/dwan.org\/index.php\/wp-json\/wp\/v2\/tags?post=1223"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}