Our Wasteful Health Care System PAUL KRUGMAN NYTimes
The Economist’s “Democracy in America” blog has a very good illustration of the reasons our privatized, market-based system is so much more expensive, for no better results, than everyone else’s:
A medical technology company is going public to generate the money it needs to advertise its products to hospital directors and insurance-company reimbursement officers. This entails significant extra expenditures for marketing, the new stocks issued to fund the marketing will ultimately have to pay dividends, banks will have to be paid to supervise the IPO that was needed to generate the funds to finance the marketing campaign (presumably charging the industry-cartel standard 7%)…and all this will have to be paid for by driving up the price the company charges to deliver its technologies. But beyond the added expense, why would anyone think that a system in which marketing plays such a large role is likely to be more effective, to lead to better treatment, than the kind of process of expert review that governs grant awards at NIH or publishing decisions at peer-reviewed journals? Why do we think that a system in which ads for Claritin are all over the subways will generate better overall health results than one where a national review board determines whether Claritin delivers treatment outcomes for some populations sufficiently superior to justify its added expense over similar generics? What do we expect from a system in which, as ProPublica reports today, body imaging companies hire telemarketers to sell random people CT scans over the phone?
The other key thing to pay attention to is who this marketing campaign was targeted at: key decisionmakers at providers and insurance companies. Those are the people who decide whether medical procedures get ordered. It’s not patients. Patients aren’t going to experience a loss of freedom or satisfaction because an expert reviewer at the Independant Payment Advisory Board makes the call as to whether a procedure is medically beneficial, rather than the corresponding bureaucrat at their insurance provider or at the for-profit clinic they’re attending.
None of this is particularly new — but it needs to be repeated, over and over again; maybe some of it will leak through the ideological armor of Very Serious People.