The Perils of Balance

Ezra Klein on health care system comparisons:

Washington, D.C.: I find your view of health care reform to be unjustifiably rosy. There are problems with European-style health care programs, and you should acknowledge them. Your views would be more credible if you weren’t so strident and partisan.

In any event, I want to know where all the health care providers are going to come from to treat all these newly insured folks. How can you add 46 million people to the system without expanding the supply side? My primary care physician doesn’t accept new Medicare patients, and she told me that she will drop Medicare if she has to accept new “public option” patients as part of Medicare. She says that she’s tired of losing money on Medicare patients or being forced to over-charge insured patients to make up her deficit. And you don’t want to hear what she has to say about the costs of converting her practice to electronic records.

So, I ask you, where are the health care providers going to come from to treat all these new patients, never mind the existing ones?

Ezra Klein: You know, I’ve actually over the years written a lot about the problems in European systems (Britain, in particular), but in part, I do that because there’s pressure to appear judicious on these thing. In all honesty, I think I’m too fair on this point.

People want to believe that this is more of an on-the-one-hand, on-the-other issue than it is. They want to believe that there are hidden, incalculable, unknown dangers to the systems that appear to work so much better. Maybe we’d lose all innovation (a weird critique: If it was really unprofitable for Pfizer to sell to France, they wouldn’t sell to France). Maybe we’d lose choice of doctors. Maybe…something. Anything.

But maybe not. Maybe our system looks worse because, well, it’s worse. We have a market model for a good that foils the incentives of the market. And that model has failed. And we see that in the data. Not some of the data. All of it. Every other single industrialized country has fewer uninsured than we do. Every single one pays substantially less — not 10 or 20 percent, but 30 or 40 or 50 percent — per capita. Every single one has health outcomes that are at least comparable. Sometimes, the correct answer is the simple one. And though people don’t always like it — and I, like everyone else, want to be seen as judicious and authoritative and fair-minded, and so sometimes obscure it — maybe, in this case, the obvious answer is the right answer.

As for your second question, that’s absolutely correct. We’re going to need, in particular, many more primary care docs (I think we should have fewer specialists overall, though there will be regional shortages worth worrying about). I’m a big fan of doing that through licensing nurse practitioners and physician’s assistants and so-forth. But people can disagree on how to accomplish that goal.

Man, that cat brings it. I’ve said this for a while, and I’ll say it again: if you want to learn about health care reform with a quickness, you can do a lot worse than Ezra Klein.


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