KevinMD loves loves loves to talk about how universal health care will stifle innovation
, and while theoretically I see where he’s coming from, I just don’t see the overwhelming data to support the hypothesis. His most recent link is to
a Happy Hospitalist post about purchasing pens
and limits to innovation, but I don’t really see the connection. I’ve seen plenty of surgeons get to choose which devices they’d like to use being
paid by Medicare, the VA, or private insurance.
And because timing is everything, The New Republic’s Jonathan Cohn has a really fantastic piece on innovation in universal health care:
Creative Destruction: The best case against universal health care
. Just like he says in the article, I’ve yet to see an innovator in the academic sector (where much of innovation begins) be driven by profit. It’s driven
by wanting to alleviate suffering, to find answers to questions, to let curiosity and discovery flourish. If you didn’t know, the invention of the CT scanner is
shared between the US and UK. France was the first to discover the HIV virus.
The article’s a good 5-10 minute read, but well worth it. Key bits:
But it’s one thing to say that universal coverage could lead to less innovation or reduce the availability of high-tech care. It is quite another to say that
it will do those things, which is the claim that opponents frequently make. That argument requires several leaps of logic, many of them highly suspect. The forces
that produce innovation in medicine turn out to be a great deal more complicated than critics of universal coverage seem to grasp. Ultimately, whether innovation
would continue to thrive under universal health care depends entirely on what kind of system we create and how well we run it. In fact, it’s quite possible
that universal coverage could lead to better innovation.
Of course, the idea of involving the government in these decisions is anathema to many conservatives–since, they argue, the private sector is bound to make
better decisions than a bunch of bureaucrats in Washington. But, while that’s frequently true in economics, health care may be an exception. One feature of
the U.S. insurance system is its relentless focus on short-term good. Private insurers have little incentive to pay for interventions that don’t yield
immediate benefits, because they are gaining and losing members all the time. As a result, money invested on patient health may very well help a competitor’s
bottom line. What’s more, the for-profit insurance industry–like the pharmaceutical and device industries–responds to Wall Street, which cares
more about quarterly filings than long-term financial health. So there’s relatively little incentive to spend money on the kinds of innovations that yield
long-term, diffuse benefits–such as the creation of a better information infrastructure that would help both doctors and consumers judge what treatments are
necessary when.
The government, by contrast, has plenty of incentive to prioritize these sorts of investments. And, in more centralized systems, it can do just that. Several
European countries are way ahead of us when it comes to establishing electronic medical records. When fully implemented, these systems will allow any doctor, nurse,
or hospital seeing a patient for the first time to discover instantly what drugs that person has taken. It’s the single easiest way to prevent medication
errors–a true innovation. Thousands of Americans die because of such errors every year, yet the private sector has neither the will nor, really, the way to
fix this problem.
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