Post here (abstract only, full article requires a subscription)
Gawande points to a study recognizing a group of people that disproportionately uses medical resources:
‘His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs.’
And a potential solution for these ‘super-utilizers:’
‘In addition to physicians and nurses, the Center employs eight full-time “health coaches,” who help patients manage their health.’
‘Health-coaches’ frightens me a bit. I’m still worried about politicizing the issue further; entrenching health-care as a right, which will also make it a political football (soon to be third-rail), potentially unionize it, open it to many more forms abuse and fraud (and diverging political and healh-insurance goals).
A reader sent in two quotes from Henry Hazlitt, libertarian economist:
“The art of economics consists in looking not merely at the immediate but at the longer effects of any act or policy; it consists in tracing the consequences of that policy not merely for one group but for all groups.”
“The first requisite of a sound monetary system is that it put the least possible power over the quantity or quality of money in the hands of the politicians.”
Addition: A friend points out that one barrier to free trade (and a talking point even on the left) is protectionism in our farm markets…so if you nationalize, be prepared to deal with unforeseen consequences down the road?
Gawande likens the state of health care to farming at the beginning of this century and what’s happened since. Individual doctors, patients and communities must make their own decisions, and work constantly to innovate, share knowledge, and solve the problems they have, alongside government officials (but not top-down mandates).
“At this point, we can’t afford any illusions: the system won’t fix itself, and there’s no piece of legislation that will have all the answers, either. The task will require dedicated and talented people in government agencies and in communities who recognize that the country’s future depends on their sidestepping the ideological battles, encouraging local change, and following the results. But if we’re willing to accept an arduous, messy, and continuous process we can come to grips with a problem even of this immensity. We’ve done it before.”
Like NOAA maybe? It’s a fine line to walk and maybe we can do it.
Anyways, a libertarian friend makes the argument that while this would be nice if it worked, it’s simply more of the same: extending health-care to is akin to extending home-ownership to all (Fannie Mae and Freddie Mac)…or college education to all. That’s too much egalitarianism, and look for the political and social consequences.
I don’t think she’s winning the argument right now…
McAllen, Texas, Gawande argues, could learn a lot from the Mayo clinic’s method of de-incentivizing some ways doctors make money, and feel pressure to make money:
“Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can.”
Some collectivism may be necessary, and practical, to reduce wasteful spending. It also could help to keep the discussion away from the top-down, and often once removed, visions of politics and political ideology.