Holman Jenkins: Why Obama Bombed on Health Care – WSJ.com

Holman Jenkins: Why Obama Bombed on Health Care – WSJ.com
Someday this country will have a health-care debate that’s not abject in its idiocy.

It will involve a term used by Congressional Budge Office chief Doug Elmendorf, who has become a notoriety for harping on the word “incentives.” The same word was used the other day by Warren Buffett, about what’s missing from the health-care plan on Capitol Hill.

We actually prefer the formulation of Duke University’s Clark Havighurst, who speaks of restoring the “price tags” to health care.

Now that’s a concept that the public could actually make sense of

Amen.  The lack of pricetags, and ‘skin in the game’ is directly responsible for a lot of the healthcare spending explosion.  Market, please.


Comments

  1. Yes, incentives rock.

    One thing that boggles my mind is that insurance companies are not nearly as effective at honing down on truly effective treatment as one might think. It is supposed to be in their interest…

  2. “Market, please”?

    Really? Do you really think there is any chance of physicians, much less the public, embracing the market and relying on it like every other professional does?

    Like architects or engineers, for example, having to compete on the quality of their services? Do you think physicians are going to want to do that? Do you think even 1/4 of them have a clue how to market their services to the public, or have any confidence they could make the same amount of money they do now with the government paying 50% of all healthcare costs?

    Do you think they’re really ready to have to go out and collect from individuals who don’t pay timely? Or to determine the actual value of their services on a scale not set by CMS? Or compete with other physicians on price?

    Frankly, I don’t see it. Too many have been on the third party payor teat too long. They know no other way. And frankly, given the salaries, the existing system has been good to them in terms of pay. Unfortunately, it’s unsustainable.

  3. “Market, please”?

    Really? Do you really think there is any chance of physicians, much less the public, embracing the market and relying on it like every other professional does?

    Like architects or engineers, for example, having to compete on the quality of their services? Do you think physicians are going to want to do that? Do you think even 1/4 of them have a clue how to market their services to the public, or have any confidence they could make the same amount of money they do now with the government paying 50% of all healthcare costs?

    Do you think they’re really ready to have to go out and collect from individuals who don’t pay timely? Or to determine the actual value of their services on a scale not set by CMS? Or compete with other physicians on price?

    Frankly, I don’t see it. Too many have been on the third party payor teat too long. They know no other way. And frankly, given the salaries, the existing system has been good to them in terms of pay. Unfortunately, it’s unsustainable.
    OH! You’re my new favorite blogger fyi

  4. Matt;
    I think that if people were to start seeing what treatments cost them, and had to start paying up front, then they wouldl probably start allocating money for that.
    So, yes, I do.

  5. Matt… In response to your latest comments about the market not working for healthcare I must disagree. Of course, I am a practicing Emergency Medicine Physician and disagree with much of what you say here but I can tell you from personal experience that when one has ‘skin in the game’ the discussion is based upon risk/benefit and not demands from the patient. When the patient is paying for their healthcare, as some of my patients still do, they are very involved in what I order or do not order and we have several risk/benefit discussions and I am able to practice medicine instead of acting as a waiter checking boxes for tests the patient has decided the insurance company or government owes them for their minor illness or injury. Our society loves ‘tests’ and they feel much better when I say a test is normal and when they aren’t paying for the tests they love to demand tests. The costs of healthcare would go down very quickly if everyone had to pay something for healthcare every time.

    For example… Let’s pretend that instead of healthcare we decided that since people die for lack of food or poor nutrition then “food” should be a right and since it is a right the Govt should provide it. Therefore, we need a govt mandated food insurance. The grocery stores may not turn away any customer for lack of ability to pay. If I could go to the grocery store with my government mandated food insurance and I know that with my insurance I’m only paying ten dollars regardless of what I put in my cart you better believe I would fill the carts up. Why not? And why stay with healthy foods? Who cares about the price – It’s paid for. “I got the good insurance now” They owe it to me. It’s my right!

    Do you see how the grocery bills would rapidly rise if we didn’t each have to pay for our choices. I think the same thing happens in healthcare. Patients and families want the “best” and define the “best” as “do the most” The best thing for many patients may actually be “less” If we were footing the bill we may actually consider our decisions just a little more and listen to the physicians discussion of the risks and benefits.

    Okay, I’ll end my rant now. I’m certain you will completely disagree. Good day!

  6. TheNewGuy says:

    You cannot hide the costs of things from the patient, and insulate them from bearing some or all of that cost burden, and expect them to make rational, cost-conscious choices about what they really need.

    Can’t. Be. Done.

  7. I think understanding the price tag and efficacy of a treatment up front are important. Few other industries can get away with such hidden, arbitrary, and capricious pricing.

    But buying health care isn’t like buying dog food or flat-screen TVs. Should health care be priced to what the market will bear, because that’s how we assume goods and services are priced otherwise? Do you want to keep rationing care based on cost vs need? How moral is it to take profit off health care – can you justify paying investors rather than using profit to improve care or provide more care? Or adjusting your business model to maximize profits rather than care?

    Let the racist obstructionists call me a socialist – I don’t care. I’ll probably be paying more under a private option system and to tell you the truth, the money doesn’t matter as much to me as divorcing health care from employment status. That gives me more economic opportunity than tax cuts ever will.

    The system we have now is morally and economically indefensible and to suggest that the nation that put a man on the moon and built the atomic bomb can’t sort out how to make it work reeks of self-serving defeatism. It’s yet another aspect of Obama Derangement Syndrome – he must be made to fail at all costs, even at the cost of destroying the nation, just to let the tattered remnants of the GOP say “I told you so.” To hell with them.

  8. Brian – please send me more information about your strawman argument.

    Seriously – look at Texas for disparities in ordering needless tests. I may well have read it here, but it is more likely risk-averse and grifting facilities that are more likely to load up the cart with high-cost low-value tests, not patients. Why? Because the facilities get compensated in hard cash; patients don’t. Nice repurpose of the ‘welfare queen’ meme; it’s still a load of bullshit.

    Pay for minders to keep the ‘frequent flyers’ at bay, reform drug policy to reduce the volume of drug seekers, pay for universal preventative & early treatment to avoid preventable “emergencies”, and fix Medicaid compensation rates and EMTALA to encourage facilities to heal people instead of gaming the system to weasel out of treating loss-leader patients.

    Yeah, it’s a hard problem but nothing the country that invented the Internet and the M1911A can’t solve.

  9. TheNewGuy says:

    “Racist obstructionsists?”

    f*ck you, pal.

  10. Yes, racist obstructionists.

    Do you have a more reasonable explanation for Obama Derangement Syndrome, re: the ‘birthers, argumentum ad Nazism, accusations of being a Socialist, guns at the Town Hall meetings, and the constant desire for Obama to fail regardless of how many Americans it hurts, etc.?

    I’m not accusing everyone who’s opposed to the insurance reform plan du jour of being a racist but I am saying there’s a significant element of racist obstructionism rearing its ugly head in this ‘debate’ and many others.

    The market has failed to provide maximum care per dollar, and clearly labeling treatment with its price is necessary but not sufficient. Plenty of countries allocate health care better than the US, and for less.

  11. I have to say that calling people racists isn’t going to get you anywhere in encouraging people to your side. There are plenty of reasons to be against the current proposals, and your projection of racial bias onto those in opposition says a lot more about you than them.

    And it’s not good.

    BTW, the most famous episode of a gun at a town hall meeting was a black man carrying an AR-15. Racist? Stop regurgitating talking point slurs here, or you’ll be off.

  12. Brian, I actually agree with you wholeheartedly. I just do not believe that is a realistic option so long as the primary providers of healthcare, physicians, continue to embrace the third party payor system. Based on their actions, physicians are quite comfortable with the status quo. Problem is that the status quo is pushing us closer and closer to single payer, not the smarter direction you propose.