[EAS] Health Care Costs -- What's Missing in the Debate
Peter J. Kindlmann
pjk at design.eng.yale.edu
Sat May 30 15:31:15 EDT 2009
Dear Friends and Colleagues -
With shock I realize that it has been almost
three months since my last mailing. A few of you
have inquired after my health. All is fine, I'm
glad to say.
I've been on a photographic project of the long
abandoned Bigelow Boiler Co., on River St. in New
Haven, CT, and also using this subject matter, so
different from my usual landscape photography, to
explore different aspects of printing. I'll tell
you more about that soon.
While on the subject of health, let me recommend
the finest article on health care costs I've read
to date, by Atul Gawande, in the current New
"Providing health care is like building a house.
The task requires experts, expensive equipment
and materials, and a huge amount of coördination.
Imagine that, instead of paying a contractor to
pull a team together and keep them on track, you
paid an electrician for every outlet he
recommends, a plumber for every faucet, and a
carpenter for every cabinet. Would you be
surprised if you got a house with a thousand
outlets, faucets, and cabinets, at three times
the cost you expected, and the whole thing fell
apart a couple of years later? Getting the
country's best electrician on the job (he trained
at Harvard, somebody tells you) isn't going to
solve this problem. Nor will changing the person
who writes him the check.
This last point is vital. Activists and
policymakers spend an inordinate amount of time
arguing about whether the solution to high
medical costs is to have government or private
insurance companies write the checks. Here's how
this whole debate goes. Advocates of a public
option say government financing would save the
most money by having leaner administrative costs
and forcing doctors and hospitals to take lower
payments than they get from private insurance.
Opponents say doctors would skimp, quit, or game
the system, and make us wait in line for our
care; they maintain that private insurers are
better at policing doctors. No, the skeptics say:
all insurance companies do is reject applicants
who need health care and stall on paying their
bills. Then we have the economists who say that
the people who should pay the doctors are the
ones who use them. Have consumers pay with their
own dollars, make sure that they have some "skin
in the game," and then they'll get the care they
deserve. These arguments miss the main issue.
When it comes to making care better and cheaper,
changing who pays the doctor will make no more
difference than changing who pays the
electrician. The lesson of the high-quality,
low-cost communities is that someone has to be
accountable for the totality of care. Otherwise,
you get a system that has no brakes."
If the New Yorker URL has gone stale by the time you read this, email me.
All best, --PJK
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