Tuesday, November 3, 2009

Uwe Reinhardt Highlights

NPR interviewed Princeton health economist Uwe Reinhardt. Reinhardt does a good job clearly and concisely explaining concepts. There is a lot more than gets covered in the interview, but this is good. Here is a summary:

* People are generally individually selfish, and need active leadership to coordinate for the good of the group.

* The current health system hides too much information (costs and quality), so we can't make good decisions about what care to get or how much to pay for it, which leads to high prices for mediocre outcomes.

* Prices are different for people based on what can be negotiated, not costs or benefit.

* Government-imposed standardized prices work well in Maryland and Europe.

* Care providers are paid way too much for giving treatment and tests. This is a huge incentive to perform unnecessary procedures and prescribe unnecessary drugs. They are generally not paid based on outcomes (hidden from consumers).

* A public health insurance option would be able to negotiate good prices.

* The free market screws over poor people by relocating care providers (in addition to pricing out insurance for those who don't qualify for Medicaid).

* The private insurance system requires a ridiculous amount of nonstandardized paperwork that raises costs and takes resources away from treating patients.

So, what are some ways we can use this information to make our system better? I think it's clear that we need a way to track outcomes by doctor and clinic, and make costs transparent. Outcomes can easily be tracked if we had a unified system (single payer), which would lead to paying providers for outcomes instead of for giving unnecessary treatments. A single payer would also negotiate good prices that make the system more sustainable, and vastly reduce costs and wasted time due to paperwork. Government intervention is necessary in order to make care accessible to the poor, since the free market only provides incentives to abandon them. Unselfish, compassionate changes that are good for the whole country will have to be made by the government because individual actors are selfish.

No comments:

Post a Comment