Medicare, Rationing, Food Stamps, and Cigarettes
By Bryan Caplan
Robin wasn’t available for lunch today because he had a deadline. If this is what he was working on, my loss was the world’s gain. From the NYT‘s Room for Debate:
The British control costs in part by having the will to empower a
hard-nosed agency, the National Institute for Health and Clinical
Experience (N.I.C.E.), to study treatments and declare some
ineffective. Some hope the United States will create a similar agency,
but I fear it would be hopelessly politicized and declawed.
My solution: admit we are cost-control wimps, and outsource our
treatment evaluation to the U.K. Pass a simple law saying Medicare (and
Medicaid) won’t cover treatments considered but not positively
appraised by the Britain’s national health institute.
Even better, use clinical evidence evaluations of the British Medical Journal. They’ve classified more than 3,000 treatments
as either unknown effectiveness (51 percent), beneficial (11 percent),
likely to be beneficial (23 percent), trade-off between benefits and
harms (7 percent), unlikely to be beneficial (5 percent) and likely to
be ineffective or harmful (3 percent). Let’s at least stop paying for
these last two categories of treatments! And to put pressure on doctors
to collect evidence, let’s stop paying for “unknown effectiveness”
treatments after 10 years of use.
Robin ably heads off the public choice objection.
Yes, eventually, this evaluation source would become corrupted, as
were the asset risk rating agencies that contributed to the recent
financial meltdown. But we’d at least have a few more years to come up
with a better solution.
I suspect that many conservatives will call this “government rationing of health care.” I just don’t get this. Is it “government rationing of food” if you can’t buy cigarettes with food stamps?