Last fall, David Goldhill wrote an article that seemed to get a lot of attention. I finally read it this summer and now I’m finally posting about it. Sure, health care reform passed in March, but I don’t think anybody believes that will be the last word. Many liberals felt it fell short of their hopes and they will almost certainly press for future reforms along the same lines, and many conservatives want it repealed. So I think that it’s still a relevant topic, if only to become more informed for the whatever the next round of proposals is.
Goldhill, a Democrat, argues that the health care system is based on many faulty premises, like the idea that health insurance should pay for everything. Two of the subtitles in the article show some of his important points: “Health Care Isn’t Health (Or Happiness)” and “Health Insurance Isn’t Health Care.”
I could do the hard work of summarizing the article, but instead I’m going to give an excerpt the estimable Peter Leithart’s post (from which I originally learned of Goldhill’s article) in which he includes two key quotes that show the gist of the argument:
The problem is with the incentives built into the system: “Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value.”
The solution is not the kind of reform on the table in DC; insisting on universal insurance is only dealing out more of the problem in Goldhill’s view. Rather, the solution is to return the consumer to the center of the system: “To achieve maximum coverage at acceptable cost with acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value throughout the economy. We will need to reduce, rather than expand, the role of insurance; focus the government’s role exclusively on things that only government can do (protect the poor, cover us against true catastrophe, enforce safety standards, and ensure provider competition); overcome our addiction to Ponzi-scheme financing, hidden subsidies, manipulated prices, and undisclosed results; and rely more on ourselves, the consumers, as the ultimate guarantors of good service, reasonable prices, and sensible trade-offs between health-care spending and spending on all the other good things money can buy.”
I’d really recommend the article. I don’t know if all of his solutions are right, but the analysis of the system seems quite good.