Saturday, February 28, 2015

Medical Costs in the USA

(In which I discover what most health care economists knew all along.)

The basic reason we have a cost problem, as far as I can see, is insurance companies, which are financial companies whose whole business is maximizing profit, make a profit from providing care. There are therefore enormous incentives to overtreat and treat in the most expensive ways. This spreads through the whole system. All the health care providers: the doctors, the hospitals, the pharmaceutical companies, come to expect high returns from their work, and expensive practices drive out frugal.

I am haunted by this article: Why I Had to Close My Preventive Healthcare Clinic. There was a lot that went wrong for Dr. Charlap, but this concluding remark stands out: "It takes a very long time to get a thorough history and do a good exam and almost no time to prescribe a medication for a presumed illness. I chose the former. Insurance pays for the latter." And makes more money from it. Keeping people healthy does not pay as much as keeping them chronically ill.

All the cost control efforts I am aware of focus on getting doctors to accept less for treatment, and do nothing to resolve the perverse incentives in the rest of the system and, especially, the conflict between insurance company profits and cost-effective health care.

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