Things I Wish I Said
Free markets and health care
One thing that is just about guaranteed to help (a lot) is to make sure people are consuming their own health insurance. That is, they should not be in company-based risk pools, but should have the freedom to join risk pools on their own. That is, the same regulations and tax structures governing employer-based healthcare should apply to other forms of risk pooling. That is, any organization should be able to enjoy the same collective bargaining and regulatory advantages as companies do when negotiating rates for members. This makes consumption of health insurance a lot more direct for basically everyone, and removes some of the distortions caused by the current indirect consumption system.
Another change that would be advantageous is to remove some of the artificial barriers with respect to things like prescribing drugs. Anyone should be able to write prescriptions for drugs for their own use after having gone through sufficient training. For most regularly-prescribed drugs, a day would suffice. This would free the healthcare system of a tremendous amount of waste and friction, as people with chronic conditions needing various common drugs wouldn't have to wrestle with doctor's offices and pharmacies to get them lined up. There are probably some medications for which "sufficient" probably means "medical school." Fine. An approval process for the training program would be needed (and it probably wouldn't hurt to put physicians and pharmacists through it, too, before they were allowed to prescribe or prepare the medication), to be administered by the FDA.
In addition to greatly relaxing prescriptions requirements for self-use, an accompanying change would expand prescription authorization to other healthcare professionals, allowing commonplace treatments to proceed without high-cost, low-value physician supervision.
We also need to examine the way we do quality assessment of treatment and caregivers. The current system of lawsuits and punitive damages and malpractice insurance and hidden outcome data is pretty untenable. An alternative that would release a lot of tension in the medical community is raising the bar quite a bit for non-negligence torts. In exchange, outcome statistics ought to be available. Negligence probably ought to be treated much the way it is now, but the criteria for determining negligence might need to be changed to make it more restrictive. The current system is very easily abused, which leads to a lot of defensive medical practice that is hugely costly. When caregivers see clients as potential litigants, they feel obligated to use a lot of unnecessary and expensive treatment options, for fear of how the failure to have used them might play out in front of a jury. So while the litigation expenses in the current system are themselves only a few percent, those get magnified substantially by the change in behavior among healthcare providers in response to that threat. ¶ 10:46 PM 0 Comments
Monday, June 29, 2009
What is the role of free markets in figuring out the level of resources we should dedicate to healthcare? There are several problems with how the market works in our current system, including:
- The healthcare marketplace is full of distortions: monopolies granted to drug and equipment companies in the form of patent protections,
- Indirect consumption of virtually all healthcare products, leading to an enormous decoupling of the cost assigned and the cost actually paid,
- Rent-seeking by the medical profession in artificial barriers to entry,
- An enormous lock-in factor that occurs at the point of consumption in many cases, when the patient is not in a position to make critical decisions,
- Distortions caused by information presented to non-experts (by which I mean drug company advertisements on televisions)
One thing that is just about guaranteed to help (a lot) is to make sure people are consuming their own health insurance. That is, they should not be in company-based risk pools, but should have the freedom to join risk pools on their own. That is, the same regulations and tax structures governing employer-based healthcare should apply to other forms of risk pooling. That is, any organization should be able to enjoy the same collective bargaining and regulatory advantages as companies do when negotiating rates for members. This makes consumption of health insurance a lot more direct for basically everyone, and removes some of the distortions caused by the current indirect consumption system.
Another change that would be advantageous is to remove some of the artificial barriers with respect to things like prescribing drugs. Anyone should be able to write prescriptions for drugs for their own use after having gone through sufficient training. For most regularly-prescribed drugs, a day would suffice. This would free the healthcare system of a tremendous amount of waste and friction, as people with chronic conditions needing various common drugs wouldn't have to wrestle with doctor's offices and pharmacies to get them lined up. There are probably some medications for which "sufficient" probably means "medical school." Fine. An approval process for the training program would be needed (and it probably wouldn't hurt to put physicians and pharmacists through it, too, before they were allowed to prescribe or prepare the medication), to be administered by the FDA.
In addition to greatly relaxing prescriptions requirements for self-use, an accompanying change would expand prescription authorization to other healthcare professionals, allowing commonplace treatments to proceed without high-cost, low-value physician supervision.
We also need to examine the way we do quality assessment of treatment and caregivers. The current system of lawsuits and punitive damages and malpractice insurance and hidden outcome data is pretty untenable. An alternative that would release a lot of tension in the medical community is raising the bar quite a bit for non-negligence torts. In exchange, outcome statistics ought to be available. Negligence probably ought to be treated much the way it is now, but the criteria for determining negligence might need to be changed to make it more restrictive. The current system is very easily abused, which leads to a lot of defensive medical practice that is hugely costly. When caregivers see clients as potential litigants, they feel obligated to use a lot of unnecessary and expensive treatment options, for fear of how the failure to have used them might play out in front of a jury. So while the litigation expenses in the current system are themselves only a few percent, those get magnified substantially by the change in behavior among healthcare providers in response to that threat. ¶ 10:46 PM 0 Comments
