21 March 2006
Just one part of Will Wilkinson's vision of health-care reform, not approved by any think tanks at this time, and unlikely to win the support of the American Medical Associaion either:
You don't need a Ph.D. in mechanical engineering to change a muffler any more than you need a M.D. to set a broken arm. You just need to know how to change a muffler or how to set a broken arm.
There ought to be a guy, Manny, say, who does stitches. You cut your arm and you go to Manny's stitches joint, which flourishes because Manny is the best at stitches. Manny leaves no scar! Ever! Moreover, he's cheaper that some guy who spent years learning about the biochemistry of the human body. What does that have to do with stitches!? Why isn't there a Manny’s Stitches Joint! You should be able to get a degree from the University of Phoenix in knee replacements. Just knee replacements! Why can't you?! Because the AMA is evil. M.D.s are monopolists and welfare queens, and preventing a huge infusion of high-quality low-cost health care providers from coming to market. SHAME! If anyone attempts to say that our current system resembles a "free market," point out that in a free market you wouldn’t have to buy a massively expensive indulgence from the Church of Medicine in order to sell health services.
As for the uninsured, they fall into two groups: those who can afford to pay for their medical services up front and don't need it, and those who can't. For the latter, Wilkinson suggests:
What we do here is examine your case, examine the treatment options available to you on the roiling competitive market for healthcare services, or at your nearest [Health Rationing Service] facility, and offer you a voucher for an amount that will buy you the best treatment you can get relative to the Rationing Service's budget constraints and principles of prioritization. With the voucher you will be given a menu of qualified treatments. We will include on the menu some qualified treatments that cost more than the voucher. If you are able to raise funds from other sources (family, church bake sale, jar at the local McDonald's), then you should feel free to add those funds to your voucher to buy a pricier approved treatment. You will not get a voucher for the most expensive treatment. But because there is a real market, you also will not have to wait in line (unless you choose to use a HRS facility). And you can use Google Diagnostic Services yourself (which, to tell you the truth, is mostly what we do), and you will often be able to find excellent qualified treatment for less than your voucher. You are free to put the savings in your HSA.
Of course, this happens after all the other improvements are put into place. And this is why it works:
Our limited funds go a lot further. And you will not feel as bad not getting the very latest, most expensive treatments because the market will generate information that will make it quite clear just how little additional value you would get for the extra cost. You don't feel like a second-class citizen driving a ten-year-old Honda when it still looks pretty good and can get you from A to B just as well, and in almost as much comfort, as this year's Mercedes. We give you vouchers for the health equivalent of ten-year-old Hondas. But they work. The crazy thing about the old system is that you couldn't buy the health equivalent of a ten-year-old Honda even if you wanted to!
Migod, it might even be sustainable.
(Via Joanna at Fey Accompli.)Posted at 6:20 AM to Political Science Fiction