Finally, we do not like the idea of being denied health care because of a
bureaucrat's decision. This is the objective of Accessibility, because
we want to be able to access whatever our doctor recommends.
These objectives conflict with one another. For example, managed care
was an attempt to move toward Affordability, but it reduced
Accessibility.
We cannot slow the growth of health-care spending in this country without changing health-care practices. Experts agree that new technologies make medical care more expensive. In addition, the rapid rise of physician specialization accounts for a large share of our health-care expenditure growth.
We cannot slow the growth of health-care spending in this country without changing health-care practices. Experts agree that new technologies make medical care more expensive. In addition, the rapid rise of physician specialization accounts for a large share of our health-care expenditure growth.
Reining in health-care spending would require wrenching cultural
changes. A market-based approach would be to reduce Insulation and
instead steer people toward catastrophic health insurance, requiring
them to pay more out of pocket for routine care. A government-based
approach would be to set a national budget for health care and provide
only the services that fall within that budget. The consequences of
either approach are not well understood by policy-makers or the general
public. The better plan would be to experiment with different approaches
at the state level instead of suddenly lurching in one direction for
the country.
We lack information about the effectiveness of health-care protocols.
Critics complain about "information asymmetries," in which doctors know
more than patients. But that problem pales in comparison to the
information gaps shared by doctors and patients alike. For example,
after a heart operation, no one knows how often a patient should be seen
by a cardiologist. Is it cost-effective to be followed up once a month,
once every six months or once a year? Researchers at Dartmouth
University found that the main factor in determining follow-up visits
was cardiologist availability. Cardiologists with a lot of room in their
calendars will see a given patient more often than those with more
crowded schedules. Overall, the researchers documented a shockingly
broad pattern of differences in health-care practices that appeared to
have no relationship to medical outcomes.
Those of us who propose market-oriented health-care reform need to spell out what this will mean for consumers -- how it will increase their responsibility to study the costs and benefits of alternative treatments.
Those of us who propose market-oriented health-care reform need to spell out what this will mean for consumers -- how it will increase their responsibility to study the costs and benefits of alternative treatments.
Those who favor universal government-provided health insurance also have
an obligation to describe how health-care decisions will be made. If we
cannot afford all the health-care services that everyone might want,
then we are going to need policies for rationing health care.
Beflained, thore electing to undergo surgery, we want the diagnosis expe alternatives described, the risks outlined and our responsibilities for contributing to a successful recovery made clear. By the same token, surgery on our health-care system requires a more thoughtful conversation than this country has had so far.
Beflained, thore electing to undergo surgery, we want the diagnosis expe alternatives described, the risks outlined and our responsibilities for contributing to a successful recovery made clear. By the same token, surgery on our health-care system requires a more thoughtful conversation than this country has had so far.