Go to your neighborhood Walmart and walk straight to the pen isle. That's correct. The pen isle. Now just stand there and look. Look at the number of companies that make pens. The types of pens. The sizes. The colors. The "bacteria free". The "check book proof". The prices. Look at the various prices. A vast array. Pennies to dollars.
Every pen you could ever imagine is there. Why? Competition. Something as simple as a pen has hundreds of variations. Cheap to expensive all priced to perfection? How do I know that it's priced to perfection? Because they are on the wall. If you, the consumer didn't buy it, it wouldn't be on the shelf for very long. You do not have pen third party isurance. If you like it, you will buy it.
What the heck does all this mean to health care? There is no competition in health care. Medicare sets the rate, all other third parties follow suit. Hospitals cloak their product prices in secrecy. You the consumer don't pay. You don't care. You're insurance picks it up. The status quo has flattened the system.
Where's the competition. Where's the innovation? Everything in this world is getting cheaper (except gasoline and subsidized agriculture) and better with more variety. Health care is not getting cheaper. And I'm hard fetched to say its getting better (for the money being spent)
Where is the drive for innovation? Where is the 100 different pens per say? It's bottled in the Medicare highway. Price controls create artificial limits to productivity. Success is determined by somebody else, not yourself. You are the slave of someone else. There is no sky is the limit.
Competition forces innovation on the top line and bottom line. To survive, change must occur, and quickly, or you go bankrupt. That is the American way. That is innovation. Not universal health insurance. It will kill innovation. It will perpetuate a status quo and create one pen instead of a 100. I can assure you of that.
I agree that entrepreneurial free market economy stimulates and rewards innovation. There are some exceptions. Does your computer run Windows? The emerging market of software in the 90's allowed for a positive feed back loop, like thistles growing in a denuded grassland.
ReplyDeleteAnd the railroad monopolies of the early 1900's did not encourage innovation. Both done in a "free market".
This is the problem I have with a free market solution. You have time to shop for pens...try one, buy a different next time when this one was lousy...When the sweat is dripping down your face and you are clutching your chest will you want to be transported to Mayo Clinic for that bypass?
I think alot of what I see in the current Primary care situation is that docs are responding to the market forces(poemd/ market forces) and doing BAD medicine to "compete"...giving the patient what they want so the patient doesn't go down the steet...This speaks to an over supply...
I spent a while working for the Guvmint and have no illusions of their "efficiency" or quality...
I think we ought to go to an overt two tiered system, since nearly 50% of healthcare dollars are Federal now anyway. And discard the silly formulas we have for compensation( Maximum allowable, RVRBS, etc) and go to ones that are transparent and predictable...
I am so often amused by the hypocrisy of doctors calling for "competition." Why don't we remove the guild monopoly that artificially depresses the supply of medical care, i.e., credentialing.
ReplyDeleteLet anyone practice medicine who wants to--and let the market sort out quality.
If you really want competition, that's what we should have.
HH: No you're totally wrong on the law. The power of prescription and performing most medical procedures is, by law, restricted to those who have the appropriate medical degree.
ReplyDeleteThat's a barrier to entry--which physicians continue to use to make more money at the expense of access and choice.
"Alternative medicine" by law cannot use presciption druges, perform surgery, attend at births, etc.
Get your facts straight before you mouth off HH
in many states, pa's and np's can write prescriptions. it sounds like you want credentialing restrictions for physicians relaxed so that credentialed other medical people can perform procedures and take care of patients? where do you think the pa's and np's learned their skills from?
ReplyDeletei'm not even sure why you would trust your friend the hospital administrator to know who would do the best job of doing stitches? because he/she systematically studied the results of the people involved or because he just kind of thought so based on limited interactions with a few patients?
that's not to say the medic wasn't very good or highly qualified, just wondering how the administrator determined it would be better than a plastic surgeon.
Innovation in Canada and the UK; More on medical innovation.
ReplyDeleteWe've heard the innovation argument several times over. I don't buy it.
I like the gas station analogy because i've used it myself when speaking about the problem with managed care - 'competition' is measured in pennies, fractions of percents. There is no best HMO; there are simply plans that afford greater financial risk in the name of larger deducibles and copays.
ReplyDeleteI have family in Italy where healthcare is socialized, and the taxation rate is high to cover the costs. However, a cousin of mine needed to be seen urgently for a skin infection and had to pay 150 euros to be seen urgently. Far from ideal.
One the top of my Christmas list is a NON FOR PROFIT HMO that won't get greedy down the line. If anyone knows any philanthropist billionaires out there, pass along the idea. Then we'd see what the true market value of healthcare really is.