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Health care
There's an interesting article in this week's New Yorker. The author, a doctor, visits a county in Texas that has (according to Medicare) the most-expensive-per-capita health care in the nation with the most-expensive-per-capita health care in the world, in hopes of finding what makes that county (and perhaps the US) so special. He concludes that it's not the general health of the population, nor the quality of care and facilities, [ETA: nor malpractice awards] but massive overutilization of tests, medications, and procedures. And why does this particular county have so much overutilization? Because of a culture of individual profit among the local doctors and hospitals. Kickbacks are routinely requested, and apparently given, for doctors referring patients to particular hospitals or specialists. The author contrasts the situation with other cities and counties that have unusually low health care costs and high quality, where groups of doctors pool their income so no one of them has a strong incentive to perform extra procedures or skimp on patient time.
A purely free-market health care system would probably be much cheaper and more efficient than our current system, with the usual free-market problems of distribution and fairness: hospitals and doctors would be only in rich neighborhoods, and millions of people would die of preventable or treatable problems.
A thoroughly socialized system would also be cheaper and more efficient, as witness almost every other developed nation. It would have some of the usual socialist problems of overutilization and freeloading.
Our current system is the worst of both worlds: private profit from public payment. Insurance (whether government or corporate) acts like a "common resource," and is predictably consumed at far above its efficient level. To avoid this, either the costs have to be more individualized or the benefits less so. Doctors in the low-cost, high-quality cities and counties mentioned in the article have taken the latter course.
A purely free-market health care system would probably be much cheaper and more efficient than our current system, with the usual free-market problems of distribution and fairness: hospitals and doctors would be only in rich neighborhoods, and millions of people would die of preventable or treatable problems.
A thoroughly socialized system would also be cheaper and more efficient, as witness almost every other developed nation. It would have some of the usual socialist problems of overutilization and freeloading.
Our current system is the worst of both worlds: private profit from public payment. Insurance (whether government or corporate) acts like a "common resource," and is predictably consumed at far above its efficient level. To avoid this, either the costs have to be more individualized or the benefits less so. Doctors in the low-cost, high-quality cities and counties mentioned in the article have taken the latter course.
Gaming theory on health care?
Re: Gaming theory on health care?
I read the dead-tree edition, but it's on the Web here.