September 28, 2006
Matt Holt Speak
September 28, 2006 | Permalink
It seems to me that Holt doesn't really engage what the NYT piece actually says. Leonhardt says that costs are higher than they should be because of waste, and speculates in response to a reader that the way insurance is done is part of the problem, but that doesn't change the fact that, as he says, the leading cause of increased cost is increased care. Holt challenges this by claiming that cost doesn't correlate with outcome, but that's a questionable claim that he doesn't explain the real meaning of. To the extent it's true, it probably doesn't contradict anything Leonhardt actually says. (Leonhardt also points out in that response that the US bears far more of the burden of research and teaching than other countries with lower costs, and that in some ways our care remains superior as well.)
There is no causal connection between the vague desire for increased life expectancy on behalf of the public, and the increase in health care system spending.
Posted by: Sanpete | Sep 28, 2006 1:45:27 PM
I'm inclined to agree with Sanpete somewhat. Incidentally, I went to a lecture today by Elliot Fisher, one of the Dartmouth guys who, with Wennberg, has compiled all that great data on variations in Medicare spending. The Dartmouth data shows that higher per capita spending = higher amounts of care = (counter-intuitively) poorer outcomes, and he went through a whole host of factors which might help explain that variation (fee-for-service payment systems, resident training programs in hospitals that encourage "high intensity care", etc.) What the NYT article seemed to be saying is that broadly, more health care spending is a reflection of how much we value new medical technology that can improve our longevity and quality-of-life. He's making a distinction between what we had in the 1970s and what we have today. In the short-term, in specific regions, for specific conditions, more spending may not be a good thing, and if the Dartmouth stats are right, probably isn't a good thing much of the time.
Posted by: Adrienne | Sep 28, 2006 8:27:27 PM
Unfortunately you kids have missed 90 years of political history in your assessment -- as did the NYT.
Posted by: Matthew Holt | Oct 2, 2006 2:11:52 PM
Gee thanks, pops. Can't get wisdom like that from us folks under 90.
Posted by: Sanpete | Oct 2, 2006 3:18:13 PM
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