In his column today, NY Times writer David Brooks discusses how President Obama's lofty goal of reforming the fundamental shape of health care has all but disappeared in light of the summer's uproar over the "public option" that the president proposed to cover the 45 million Americans without health insurance. Brooks reminds us that although expanding coverage was one of Obama's initial tenants of reform, the real promise lay in controlling the rising costs that have stricken our system, and recommends David Goldhill's article in The Atlantic, which examines health care from an economist's position and seeks to explain the inefficiencies that have driven health care costs up at an unparalleled rate.
This is the best analysis of the incredible level of dysfunction in our current system I've seen and is well worth the lengthy read. Goldhill's central premise is that providers and health insurance companies (private and public) have hidden the costs of services from patients by arbitrarily fixing charges and rates of reimbursement. This measure inadvertently creates a service that falls outside of the normal regulatory controls of markets: ieg. supply and demand, quality control, and transparent prices that enable competition and encourage efficiency.
Goldhill explains that costs per patient have risen largely because patients don't really know the true costs they are incurring. Instead, all we see are rising premiums at the end of each month and blindly point the finger at someone else, while continuing to seek out the newest drugs and treatment options. Obviously, if you are in a freak gasoline fight accident or similar traumatic event (keg jump?) and get hurt, you don't have the luxury of shopping around and comparing quality or prices for different procedures and providers. But Goldhill offers the example of LASIK and cosmetic surgery, procedures typically not covered by insurance, as models of what cost-transparent care might look like. Along the way, he debunks several myths about our spending on health care including the oft-cited claim that medical costs for the uninsured are higher than a similar patient with insurance or the idea that new medical technology is to blame for rising costs.
Forty years ago, doctors tended to think of patients as largely unaware. They diagnosed, treated, and discharged with little attempt at explaining what they were doing and why. Today, modern medical training emphasizes transparency in the doctor-patient relationship; in the new model the doctor serves as an adviser and educator, presenting the patient with facts about the relevant disease, discussing a range of treatment options, and then proceeding with treatment mutually agreed upon, thereby enabling the patient some level of autonomy. If we have achieved this level of transparency in explaining medical conditions and treatments, it follows that we should expect a similar level of transparency in knowing what we're paying for and what we can expect, rather than blindly throwing away money that could be put to better use.
