If you want a more precise description of why I’m saying the U.S. healthcare system, despite being the most expensive in the world, is far from the best, I suggest you look at this well-known paper from Barbara Starfield, the highlights of which are well-described here. The upshot is that, just as I suggested, unnecessary medical interventions are one of the leading causes (third leading cause) of death in the U.S. This would suggest that the problem is NOT just that many people don’t have access to healthcare.

Yea…..that’s not really the right way to read that article.

The article states that 225K people die each year from stuff that doctors do that’s unnecessary. It makes no comment on how many people die in other countries from things that doctors do that are unnecessary. I’ll grant that intuitively, our unnecessary-death count is probably higher than other countries, but it may not be substantially higher. There is no doubt that people in other nations are dying from all those things as well.

The problem is, as I said, that all the incentives are screwed up in our system. Doctors have every incentive to overdo it with procedures and drugs.

I think we’re agreeing that the incentives are mucked up.

If you’re arguing that a single-payer system is going to be more expensive, then my question is why OUR system is the most expensive per capita in the world?

Pretty sure I answered that already. One major issue is that we pay our professionals substantially more across the board, from the neurosurgeon all the way down to the Associates-Degree person who takes your blood. The second major area is handoffs; most of our doctors are small businessmen instead of employed by hospital systems, and this leads to higher labor costs as administrative people are replicated, and handoff costs as untrusted records moves from provider to provider. It;s a much more efficient distribution chain to just have 4K WalMart and Target stores rather than 40,000 mom and pops selling the same crap at higher markups. Also, the handoffs are one of the main causes of unnecessary testing. My brother in law is a cardiologist, and he frequently will get a new patient, order a test, and have the patient say “oh, I just had that two months ago at such and such hospital”. What does my BIL do? He re-does the test, because he has a patient to treat and he doesn’t have the time to wait around for a month for the other clinic or hospital to send him the previous results. Then, there’s smaller contributors, like tort, billing transparency, and a host of other things.

As far as why a libertarian system would not work here at this point, maybe you’re right, but I’m curious why you think that. You are suggesting that the way to fix healthcare is to tinker with our existing system, but I guess it’s hard to evaluate that without more meat on those bones. The tinkering we’ve been doing so far doesn’t seem to be helping.

My gut tells me that in the libertarian approach, prices don’t fall far enough or fast enough to avoid human tragedy.

Written by

Data Driven Econophile. Muslim, USA born. Been “woke” 2x: 1st, when I realized the world isn’t fair; 2nd, when I realized the “woke” people are full of shit.

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store