It’s Not Whether But What We Subsidize in Health Care

Paul Glastris posted a brief intro this morning to our Sneak Peek at a remarkable piece by Phillip Longman from the July/August issue about the connection between physician training, primary care shortages, and health care costs.

If you care anything about health care policy, fiscal policy, education policy, or poverty policy, this is an article you really should not miss. And if the specifics don’t grab you, here’s an angle that should: as Longman makes abundantly clear, the federal government is already subsidizing through multiple channels a system of physician training and compensation that encourages over-specialization, unnecessary medical procedures, excessive costs, and the atomization of health care providers. A big part of the reform movement that has produced the Affordable Care Act is to reverse the incentives to inefficiency and poor quality currently supported by federal policy and federal money.

So when you hear conservatives describe ACA and its affiliated policies as representing a “government takeover of health care,” one important response is to point out that the status quo ante was hardly a market paradise, and that the most basic thrust of health care reform is to “first do no harm.” Since physician training stands at the very center of the system, “teaching no harm” is critical to reform–and because health care reform is at the center of progressive governance for the foreseeable future, it’s critical to its future as well.

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Ed Kilgore

Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.