Country Doctor

And since I've been posting when I shouldn't be, here's another.

Here's something you won't hear me say too often: David Brooks is pretty much right, and his point - that the existing structure for providing health services in America is based on a perverse incentivization of extra spending with little to no information, making the concept of a "free market" in health care almost impossible and ridiculous - is something that's been bothering me for a long time, and something which no existing plan really seeks to address. And David Goldhill's essay in this month's The Atlantic is excellent - I'm about half way though it and he nails the problems with the current American health care system on the head.

Yet where that has left me is mulling the idea that perhaps the best answer is not a guarantee of universal health care, in the broad sense of everyone being covered for everything, but instead only catastrophic care, to address only emergencies. That would restore a free market to standard health care - people would have to make health care choices based on the value of remedies and tests, to look at issues like quality and cost and incremental benefits.

Where, though, would the boundaries be for what is catastrophic and emergent and what is instead standard and, in effect, borne by individuals or supplemental policies? Where do children fit? Where does childbirth fit? And what is the impact on society for a system that doesn't deal with preventative care? How do individuals deal with the costs (societal, health, economic and otherwise) of disease, of possible pandemic like H1N1 swine flu, and other matters?

And so I end up back to where I started, that government-regulated and provided health care is probably the best of what are universally bad options.

UPDATE: Having finished Goldhill's essay, he's proposing much of what I discussed above - eliminating "universal" health care in favor of just a government guarantee of catastrophic care. His answer for the concerns that I raised? Creation of a mandatory Health Savings Account for all Americans, with the ability to borrow against future deposits where needs exceed existing funds. It's a creative solution, and I like it conceptually, but I'm not sure that it could work in reality. Would health care consumers behave rationally? It's a leap of faith, and I'm sad to say that I am not sure I have that faith in people's judgement. What percent of Americans put their trust in FOX News, or still believe that President Obama is not natural born American? Why should we expect them to make rational choices, then, in health care? Moreover, Goldhill's plan would also take a generation to implement fully, and we cannot wait that long for reform. The brakes on unrestrained health care spending need to be applied, and fast, along with an elimination of the dependence on employers for health security.

None of which is to say that I don't think Goldhill is fundamentally right in his diagnosis of the disease, and that his cure should work in a laboratory. But I'm not sure if America is capable of taking his medicine.