Wednesday, August 26, 2009

Goldhill: How American Health Care Killed My Father

The September 2009 Atlantic carried the following piece by David Goldhill, "How American Health Care Killed My Father".

He makes many excellent observations. Although I don't fully agree with all of his proposed solutions, his article is well worth reading. Here are a few excerpts:
...Like every grieving family member, I looked for someone to blame for my father's death. But my dad’s doctors weren't incompetent -- on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing -- without exception, his nurses were dedicated and compassionate. Nor from financial limitations -- he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.

Indeed, I suspect that our collective search for villains -- for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care -- from doctors to insurers to pharmaceutical companies -- work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create.
In particular, he describes in detail the following major points:
* Health Care Isn't Health (Or Happiness)
* Health Insurance Isn't Health Care
* The Moral-Hazard Economy
* There's No One Else to Pay the Bill
* The Government Is Not Good at Cost Reduction
* Our Favored Hospitals
* You Are Not the Customer
* The Strange Beast of Health-Care Technology
* The Limits of "Comprehensive" Health-care Reform
(Read the full text of "How American Health Care Killed My Father".)

Most of his proposed changes are free market reforms or would be happen naturally in a free market. (I disagree with some of his ideas, such as requiring everyone to own a Health Savings Account. But I agree with repealing legal obstacles to purchasing HSAs and catastrophic-only insurance plans.)

And most importantly, he's willing to challenge the idea that "reform" is synonymous with government-run "universal coverage", especially given that he identifies himself as a Democrat. More politicians need to hear this message.