Another One of My Health Care Debate Peeves
By Arnold Kling
As you see in the comments on this post, the Left has an answer to my concern that Medicare is the fiscal equivalent of the Titanic. The answer is, “We need to control health care costs!”
Of course! Why didn’t I think of that? Just sprinkle some magic fairy dust, chant “Costs, costs, go away,” and all of our problems will be solved!
Where costs are coming from is more medical procedures. If you’re serious about cutting costs in government-funded health care programs, then you’re serious about having government say “no” to a lot of procedures where now it says “yes.” What that means is that “Medicare for all” does not mean Medicare-as-we-know-it for all. It means something else. Call it Medicare-Minus for all.
The well-informed patient, on the other hand, appreciates the grey areas of medicine. His doctor has been open in describing the uncertainties. As a result, this patient is more willing to accept answers like “We don’t know.” Or, “It depends.” And he is more likely to listen to a doctor who tells him that the most aggressive approach is not necessarily the best approach. He is more likely to hear a physician who says: “Try physical therapy first. Try drug therapy. Try a change of diet and exercise.”
This is why I think that, if doctors and patients work together, they can contain the cost of health care, paving the way for a sustainable, affordable, health care system that offers the right care to the right patient at the right time.
This is an issue where I have less confidence in the decentralized solution than Mahar. The Harvard-trained physician that I “fired” had neither the knowledge of elementary probability nor the temperament to operate this way. I suspect that more doctors are like him than not (and reading SuperCrunchers gave me some data that supports this view, at least as far as the lack of knowledge of elementary probability among doctors is concerned).
So I actually propose a Medical Guidelines Commission to obtain and analyze statistics on the impact of medical procedures and then present the results in terms that doctors and patients can understand.
I think that in order to cut back on the use of procedures with high costs and low benefits, we need to give consumers the means, the motive, and the opportunity to make different decisions. I agree with Mahar that without better information they lack the means and the opportunity. But I think they also lack the motive, and without it, you won’t see any widespread change in behavior.