Friday, August 07, 2009

15 Years Later, The Healthcare Issues Are the Same

Bellow are some excerpts from the excellent article: "Health Care Reform: A Free Market Perspective," co-authored fifteen years ago (1994) by Harvard's Dean of the Medical School, Dr. Jeffrey Flier (MD), and featured yesterday on Greg Mankiw's blog:

Introduction: Problems with inflation of medical costs and increased numbers of uninsured individuals have resulted in widespread calls for reform of the U.S. health care system.
Proposed reforms have generally emphasized increased regulation of the medical and insurance industries, but disputes over the cost and consequences of these proposal has so far prevented legislation from being passed. This paper is presented from an alternative perspective that views the current symptoms on cost and access as the results of decades of flawed public policy, rather than government inaction (bold added). We trace the origins of dysfunctional health care markets in prior public policy, and outline an approach to healing the health care system based on a new dedication to free market principles and individual choice.

Licensure, supported as a means to ensure physician competence and prevent fraud, has been an effective means for the profession to restrict its numbers and limit competition from alternative, often lower cost providers. Certification might work equally well, while authorizing increased services from an array or non-MD practitioners.

The health policy community has paid insufficient attention to the role of past policies in accelerating costs and diminishing access to insurance and has been too quick to recommend solutions based on optimistic projections of new regulatory efforts. Reform and aid to those in need based on free market principals are unique in recognizing the values of diversity and the desirability of choice in the highly personal realm of medical decision making. Freed of perverse incentives and regulatory obstacles, including those that would be exacerbated by much of the recently proposed reform legislation, markets in medicine, as in other areas, will outperform politics in making desirable health care available to Americans.

MP: I especially liked the section on licensure, a very refreshing viewpoint, especially coming from an MD. And speaking of allowing increased services from non-MD practitioners, I became aware yesterday that there is a movement in the field of dentistry to allow lower-cost dental hygienists to offer increased dental services like filling cavities. I think the
American Dental Hygienists' Association is pushing for increased services for hygienists, but they are up against a very powerful trade group: the American Dental Association, which I think is resisting the change. I'll find out more and post about this later. If anybody has information about this issue, please let me know.

Originally posted at Carpe Diem.


At 8/07/2009 5:50 PM, Blogger QT said...

Licensure is only a small item in this paper. The portion of the paper outlining the rise of cost-plus, and first dollar coverage as well as tax policies favoring employer provided health care are fascinating.

9 pgs. but worth the read to clarify the issues.

At 8/07/2009 6:01 PM, Blogger juandos said...

Sadly I don't think going back 15 years is really getting a grip on the problem...

From the National Center for Policy Analysis, dated Feb. 2001:

Managed Care -- A Creation Of Congress

There is more here: Blame Congress for HMOs

"Only 27 years ago, congressional Republicans and Democrats agreed that American patients should gently but firmly be forced into managed care. That patients do not know this fact is evidenced by public outrage directed at health maintenance organizations (HMOs) instead of Congress"...

At 8/07/2009 6:40 PM, Blogger QT said...


Isn't it worth examining the history to understand why health care costs have spiralled? If anything, your links to HMO legislation seem to support a review of the history of public policy.

The alternative would seem to be accepting the rhetorical confections, fantasy accounting and strawmen of Obama & friends. None of which seem capable of generating anything aside from fiscal insolvency.

There are other ways to address health care. Another perspective from another doctor.

At 8/07/2009 10:50 PM, Anonymous Anonymous said...

Increase the number of health care providers to bring down costs. Subsidize medical students the way we subsidize law students.

The only sound ways to lower costs.

Government only interferes. Restricts supply of doctors, drugs, medical diagnostics, machines, hospitals, etc.

Politicians are crazy.

At 8/08/2009 7:54 PM, Anonymous Ἐγκώμιον Shill said...

movement in the field of dentistry to allow lower-cost dental hygienists to offer increased dental services like filling cavities. I

Since a lot of you boys and girls out there in the blogosphere land do not know what it is a dental hygienists thus here is my Glossary of Dental Terms :

Mother: The one who buys dental mirror at Wal★Mart along with pointed metal pick for cleaning calculus off my teeth once every month.

Wife: Similar technician who does it for her husband until she runs away forever to do it for someone better looking. No, dummy, we are talking about teeth here.

dental hygienists: The lady you interview to detect the hidden secrets of your dentist and her foibles. E. g., when she says, "Your dentist is very careful to make your crown fit extra deep under your gum", you can just bet the bugger will give you a sore mouth until you cough up the money for a better dentist to grind a swath of gold molecules off the surface of your expensive crown.

Dentista: The lady who makes you proud of your good health by giving you painless tooth nerve injection then explains to you, "I will have to go out and run 5 other patients through my assembly line while your anesthetic wears off. [much later] I am back now. Were you sleeping? I'll start the grinding now ZZZZZZ Whoops, I guess I'll need to give you another shot. Because the first shot knocked out your vasoconstriction nerve the second shot may go into your vein to make your heart beat faster, irregular, or both. But don't worry, you are young and strong and will survive even if I forget to use second shot without epinephrine. Sometimes I pick up the wrong bottle because I can't see well with this big mask on. Then again anonymity helps me to avoid tort procedures at the county court house. Whoops. I guess I picked up the wrong bottle that time. Don't worry at all about your irregular heartbeat since you are so muscular and since this expensive dental chair will lean you back so easily. Hygienista, turn up that relaxing music real loud."

"This one?"

"No the requiem."

At 8/08/2009 9:47 PM, Blogger juandos said...

"Isn't it worth examining the history to understand why health care costs have spiralled?"...

Well personally QT I think so since all these problems didn't just start last week or last year...

Leave it to Krauthammer to cut through the B.S. but I do have one small bone to pick with his commentary: "Yet today's ruling Democrats propose to fix our extremely high-quality (but inefficient and therefore expensive) health-care system with 1,000 pages of additional curlicued complexity..."...

'inefficient and therefore expensive'

How much of that expense is driven by externalities like government intrusions or tort lawyers?

Well course there could be reams of commentary on just those two aspects...

Still Krauthammer does make some good suggestions but they still sort of smack of socialism to some small degree...

I noted your t-shirt link in another posting and I thought you might find this T-shirt an entertaining party favor...:-)

At 8/10/2009 12:25 PM, Anonymous Anonymous said...

This is great stuff...


Post a Comment

<< Home