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September 22, 2006
Money-Driven Medicine
Since I mentioned Rashi Fein's wonderful quote earlier, might as well link to my review of Maggie Mahar's Money-Driven Medicine in the latest Washington Monthly:
[I]t’s precisely that fundamental overvaluing of the free market that Mahar forces us to question. She quotes medical economist Rashi Fein’s warning that “[w]e live in a society, not just an economy.” And our society has to decide if this is the care structure we want. Because the market has done nothing wrong here—it exists to seek profit, and thus provides no easy villains, just a plethora of unfortunate outcomes. It is up to us to decide if the ultimate goal of care should be cash, if our system of insurance should incentivize identifying those most in need of care so they can be denied access to it, if our hospitals should fret over the bottom line or the flat line, if our physicians should practice in a context that leaves them desperate to confide in the unknown reporter who leaves an unexpected message on their voicemail.
It is, in my humble opinion, the best review I've written, so interested parties should check it out.
September 22, 2006 | Permalink
Comments
As someone who used to toil away processing medical claims in the insurance industry, I feel rather strongly about this issue. I am in an entirely different field now - totally alienated from the medical insurance business. I reject my employer's health plan and maintain my own at a greater expense.
I so adamantly object to the notion of insurance being linked to employment that I want no part of it. I will hold out until I can no longer afford to protest.
Posted by: Jen Bailey | Sep 22, 2006 2:00:20 PM
I dont understand the point of Mahar's book. There is not a single industry in america that is not profit driven. Not one.
So whats the big deal again? Is medicine not supposed to operate according to the rules of the other industries? I never got that memo.
Posted by: joe blow | Sep 22, 2006 6:45:47 PM
Joe, is your local police department a profit center?
Posted by: me2i81 | Sep 22, 2006 6:58:30 PM
I think a lot of the problems with the medical system described by Maggie Mahar could be significantly mitigated by roubst pricing transaprency throughout the system from hospitals to doctors to imaging centers to labs coupled with relevant user friendly provider quality and cost-effectiveness ratings. Widespread use of electronic medical records could reduce medical errors while common insurance forms could cut administrative costs. Specialized health courts could bring objectivity and fairness to resolving medical disputes and, over time, reduce the need to practice defensive medicine. More widespread use of living wills and advance directives could significantly cut the often unwanted and futile but very expensive care rendered at the end of life. Higher insurance deductibles would give consumers more skin in the game and the incentive to care more about what services cost. For the very expensive cases, case managers could coordinate care and minimize duplicative testing.
Ms. Mahar's reference to unnecessary heart surgery and the Redding Medical Center and implying that this is an all too common occurrence is like saying that all corporations are like Enron. Yes, there are some spectacularly bad apples, but they should not be portrayed as typical of the whole industry's behavior.
There is an interesting experiment about to be launched in Massachusetts On October 1st to cover the uninsured at no additional cost beyond what is already being spent on the system in that state. I'm sure other states will try some innovative ideas as well.
I think there are lots of ways to make the health care system more efficient and cost-effective while covering the uninsured without going to full taxpayer funding. I'm sure Ms. Mahar disagrees strongly with me on this, and that's fine. This debate will likely move into ultra-high gear as when the 2008 presidential election approaches.
Posted by: BC | Sep 22, 2006 9:30:07 PM
The fundamental question here is whether or not medicine should be a for-profit enterprise.
At what point does it become acceptable to deny care? Is it acceptable to allow to someone to die because s/he cannot afford to pay for lifesaving medical care? What about preventative care?
The medical insurance industry already *is* efficient and cost-effective for the insurance companies. It's not cost-effective to provide health insurance to people who are likely to actually use it, which is why the people with serious and/or chronic health problems have the hardest time getting it. It's efficient to raise premiums while scaling back benefits.
Digging into deeper theoretical territory, the profit motive has created a system that is economically sound for insurance providers, but there has been a great social cost that the free market cannot correct. It's simply not cost effective to provide low-cost, high-quality health insurance to everyone.
This is the point at which the state should intervene.
Posted by: Max. | Sep 23, 2006 1:23:53 AM
"Joe, is your local police department a profit center?"
Uhh yes.. why do you think police officers are given "ticket quotas" that they have to meet every month?
Why do you think they are installing remote cameras on all traffic lights?
Its about the $$$$$
Posted by: joe blow | Sep 23, 2006 12:05:23 PM
Police departments don't charge you for protection from crime, do they?
Posted by: Max. | Sep 23, 2006 11:55:11 PM
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