PROGRESSIVE HEALTHCARE….Tyler Cowen provides some highlights from a new paper by Sherry Glied on international comparisons of healthcare systems:
The best parts of the paper concern equity. It is GPs which help the poor, not additional spending on technology or surgery; see p.18 for other comparisons along these lines. Furthermore, and this you should scream from the rooftops, consider this:
…patterns of health service utilization in developed countries suggest that the marginal dollar of health care spending — money used to purchase high tech equipment or specialist services — is less progressively spent than the average dollar.
In other words, egalitarians should not allocate marginal government spending to health care.
But that’s not quite right, is it? The point here isn’t that public healthcare spending per se is bad, but that (from a progressive viewpoint) it’s sometimes poorly distributed at the margins. The bulk of the spending is fine, and, as Glied points out later, distributed pretty progressively. Still, it’s well worth acknowledging the point that financing is only a part of the healthcare problem. Cost containment and efficiency are equally or more important. Thus, if we progressives advocate for a public financed healthcare system, we should also be advocating (for example) for relatively more public funding for GPs and less for the fanciest new high-tech equipment, which overwhelmingly gets installed in rich hospitals that serve rich communities. I’m down with that, and I think that most progressive healthcare analysts are too.
(Now, you may argue that this is utopian, that any publicly financed system will inevitably find itself under enormous political pressure to provide more goodies for its loudest constituencies — namely the rich, the middle class, and various interest groups. Maybe so. But that shouldn’t stop us from trying to do the right thing.)
As for all that high-tech equipment, some of it turns out to be useful and some of it turns out to be a fad. If rich people feel like paying to be guinea pigs for this stuff, I’m fine with that. But I’d certainly agree that a publicly financed system ought to be careful about making any of it part of a basic healthcare package until it’s well proven in the field. As progressives, our goal shouldn’t be to provide gold-plated care to every person in the country, nor should it be to restrict the ability of the rich to get better service if they want to pay for it. Our goal should be to provide decent care to everyone, with the market free to operate on top of that.