Transparency, Accountability, and Personal Responsibility in Health Care

Following a series of semi-unplugged staycations, I’ve been doing too much reading and not enough writing. Since I haven’t quite managed to recover my blogging mojo tonight, let me point readers to David Goldhill’s article on the problems with American health care and why the reforms working their way through congress are unlikely to improve outcomes and lower costs.

Goldhill is a Democrat who recognizes that his party’s proposed solutions are, at best, mommy kisses and a Dora the Explorer Band-Aid applied to a critical systemic illness.  His piece is very, very long, but very much worth your time.  He proposes a transparent, consumer-centered health care market in which comprehensive health insurance is no longer the primary mechanism for financing routine and predictable care.

While Goldhill characterizes his ideas as “radical,” they’re hardly as extreme as, say, tossing out the Constitution and starting over.  I don’t necessarily agree with his implementation recommendations, but the article is thoughtfully constructed and his ideas (thankfully) don’t hinge on the false notion that prevention of diabetes and heart disease would be a cost-controlling panacea.  Here’s a taste:

Some of the ideas now on the table may well be sensible in the context of our current system. But fundamentally, the “comprehensive” reform being contemplated merely cements in place the current system—insurance-based, employment-centered, administratively complex. It addresses the underlying causes of our health-care crisis only obliquely, if at all; indeed, by extending the current system to more people, it will likely increase the ultimate cost of true reform.

I’m a Democrat, and have long been concerned about America’s lack of a health safety net. But based on my own work experience, I also believe that unless we fix the problems at the foundation of our health system—largely problems of incentives—our reforms won’t do much good, and may do harm. 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.

Take the time to read the whole thing.

Hat tip: Peg Kaplan


5 Responses to “Transparency, Accountability, and Personal Responsibility in Health Care”

  1. Rob Taylor on August 14th, 2009 2:05 am

    Sounds like the good kind of Democrat, one who’s at least conversant with reality.

  2. Eclectic Radical on August 14th, 2009 7:13 am

    Hrrrrm. The article makes some good points about the flaws with the current discussion in Congress. It’s certainly far from ‘comprehensive’ reform. Everything being discussed in Congress right now, sadly, is essentially another industry bailout… this time bailing out the health care/health insurance industry. He’s also right in his skepticism of whether even truly comprehensive reform can reduce costs. He’s certainly right about the immense cost of the administration and management side of the health care industry.

    He’s wrong on quite a few things as well, such as the fundamental reason that Medicare costs keep rising is not failure but success: Medicare keeps getting more expensive because before Medicare, old people died a lot more. Medicare is one of the single basic factors most closely involved in the dramatic difference between average lifespans in the latter half of the 20th century in America and the first half. Hence, more people alive to collect Medicare, hence rising costs.

    Thanks for linking this article, Jenn. There’s too much to reply to in it to just list here, so I’m going to do some writing of my own.

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