What Every Worker Believes
By Arnold Kling
1. I should have more autonomy.
2. I should be rewarded more for my own ideas that work.
3. I should be penalized less for my own ideas that fail.
4. Competition that is innovative or inexpensive is unfair.
That is the Universal Worker World View.
Brad DeLong and Mark Thoma make health care management sound really, really simple. Step one, government takes over. Step two, government creates new goals and objectives. Step three, behavior changes. In fact, given the Universal Worker World View, getting from step two to step three is not so easy.
In this country, health care providers are administered remotely. The doctor fills out the form and sends it to a remote office at an insurance company or government agency.
A naive view is that we can change behavior by tweaking the forms. Instead, I have a more radical view, which is that doctors need hands-on supervision.
The reason I think that health care providers need hands-on supervision is that most of the health care spending in this country goes for complex patients, such as my late father in his final stages. Our current treatment processes for those patients are what is most wasteful and ineffective about our health care system. If you are going to reduce costs significantly, you need very different management systems. I made this argument at length in this essay and on this podcast.
With more hands-on supervision, I see doctors having less autonomy, less reward for their own ideas that work, more punishment for their own ideas that fail, and more uncredentialed competition. Given the Universal Worker World View, I expect them to raise objections, to put it mildly.
Every doctor wants to be Marcus Welby, the beloved sole practitioner. But the most expensive patients require teamwork. They require a very different management approach.
The only way I can see the health care delivery process changing is under the competitive pressure of the market, driven by consumers. Instead, the more you bring health care under the political process, the more you entrench the existing system.