I’ve been reading Maggie Mahar’s Money-Driven Medicine and wow–if you need any more evidence that our health care system is a mess of perverse incentives and profit drive, Mahar will give it to you, plain and simple. The book makes a fantastic case from both economic as well as social justice and ethical viewpoints.

Several really important concepts that she nails, which may just have to become their own posts:

• We spend almost twice as much per person on healthcare in the US than in other countries, but we clearly aren’t getting a system that’s twice as good, if better at all.
• Economic theory demands that in order for a consumer to make a purchasing decision, he or she must have information about the good or service and its value. “This is what makes the purchase of health care so different from any other purchase: it is a transaction based on trust.” This speaks greatly to our duty and professionalism as physicians.
• “Insurance companies possess neither the expertise nor the standing to set the nation’s health care priorities.”
• Medical ethicist Daniel Callahan: “The market is far better at meeting immediate short term private interests than long-term collective needs.”
• Economic theory often doesn’t apply to the health care industry. Hospital mergers, one would expect, should reduce the cost of business through economies of scale. Instead, they often lead to duplication. Hospitals merge to improve their bargaining power with insurers, not to reduce costs or save money.
• More care is not necessarily better care.

Another concept I’ve materialized myself, as the saying goes:
If you’re a Democrat when you’re young, and a Republican once you get a mortgage, then you’re for private health insurance when you’re well, and you’re for health care reform when you’ve developed chronic disease.

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