Re: Afghanistan's Lessons for Health Care Reform
- From: Werner <whetzner@xxxxxxx>
- Date: Sat, 14 Nov 2009 14:03:02 -0800 (PST)
On Nov 14, 4:03 pm, aw...@xxxxxxxxxxxxxxxxxx (Arthur Wouk) wrote:
Economix - New York Times Blog
November 13, 2009, 7:43 am
Afghanistan's Lessons for Health Care Reform
By UWE E. REINHARDT
Uwe E. Reinhardt is an economics professor at Princeton.
...
What is loosely called "Afghanistan" and loosely called "the
American health system" both are basically tribal systems that
historically have fiercely resisted the constraints of any
coherent national policy. In fact, our health system even has the
analogue of fundamentalist extremists: the ideologues who scream
at us daily on the TV screen.
... The goal of this operation is as simple as
it is understandable: it is to increase the flow of health care
dollars to the particular tribe in question because, the
reasoning goes, if the tribe thrives, so will the tribe's
clients.
This would be the case with everything, not just health care.
....
Many Americans at the time and the political leaders they elected
dreamed of making the benefits of modern American health care
available to all elderly Americans and to desegregate health care
in a country that proudly but incongruously marched to the slogan
that all of us are "created equal."
We can call that he 'poor elderly tribe' which can also count costs
and benefits.
....
It effectively has barred Medicare, to this day, from acting as a
prudent purchaser in health care, saddling it with a serious
comparative disadvantage vis-` a-vis private insurers that can
interfere in the doctor-patient relationship through selective
contracting and managed care.
Isn't this like 'public option'? How can anyone compete with the
government? It has a monopoly on making self serving rules.
.....
Cost control -- otherwise known as "bending the cost curve" --
will be extremely challenging in this tribal system, as the
tribal chiefs inevitably will see any serious attempt to bend the
future cost curve down as a loss of their income. The tribes'
policy wonks vigilantly run every new wrinkle in health reform
through a computer to learn whether the wrinkle increases or
decreases the money flow to their particular tribe.
Just exactly why would people in the medical business want to work for
less? Why do you think they have unions?
If it's the latter, out go their insurgents to do some more
battle on the Hill.
After I had observed many flailing health reform efforts in this
country over three decades, Afghanistan finally helped me
understand the nature of this game. It is anybody's guess whether
unity of purpose will come first to Afghanistan or to the United
States health system -- if ever it will come to either place.
Wanting to work for less is not a united purpose. People want more for
less. Why should that be a surprise to an economist? Governing has
become a way to get privileges for some at the expense of others.
http://www.capitaldistrict-lp.org/what.shtml
http://www.investmentu.com/IUEL/2008/August/the-national-debt.html
http://www.youtube.com/watch?v=Dp8ZmQMCtqA&feature=related
http://www.youtube.com/watch?v=-FSoXKapKQs&feature=related
.
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