• *Catastrophic Care*: Chapter 8

    My favorite passage in chapter 8 of Goldhill’s Catastrophic Care:

    Whatever their own mistakes, our experts are required to try to make health care work without shattering our illusions. It is a job that forces them to create an ever more complicated, ever less comprehensible, ever less functioning system. We can blame them for the system’s addiction to complexity, but it’s the inevitable cost of our own denial.

    My least favorite:

    [N]o study has ever demonstrated a real link between lack of insurance and poor health results. […] And not for lack of trying.

    This passage takes us to an endnote that reads, in part,

    But as Megan McArdle argued in The Atlantic, the original studies on which all later estimates were based have a fundamental problem: they didn’t properly control for other factors that significantly affect the death rate with or without insurance (“Myth Diagnosis,” March 2010).

    Oh no! There is much more to this than Goldhill or McArdle told readers. Follow the link. I stopped subscribing to The Atlantic over this. Should I stop reading Goldhill’s book too? I admit, I am tempted. Notwithstanding some of the good points he has made, this is very disappointing.

    Other posts in this series are under the Catastrophic Care tag.

    @afrakt

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    • So many writers seem to fall into Aaron’s “Change the facts to fit your world view” category.

      Is it any wonder it’s so easy to bamboozle the public, for political or other reasons?

    • Apples and oranges. Goldhill opposes private health insurance as the way to deliver health care. He doesn’t oppose universal health care; he opposes universal health insurance. Frakt doesn’t make the distinction, and hasn’t since he and Goldhill started writing love letters to one another. Of course, the health care reform we got is for universal health insurance, so those invested in what we got spend lots of time defending it. As for McArdle, taking a few MBA economics courses does not make an economist. Why she is given such a large platform to spread non-sense is a mystery to me.

      • “Apples and oranges. Goldhill opposes private health insurance as the way to deliver health care. He doesn’t oppose universal health care; he opposes universal health insurance. Frakt doesn’t make the distinction, and hasn’t since he and Goldhill started writing love letters to one another. Of course, the health care reform we got is for universal health insurance, so those invested in what we got spend lots of time defending it.”

        I don’t understand what you’re responding to. Please make your comments relevant to the post.

        • I should not have referred to love letters. Your comments to Goldhill’s book/articles were critical but substantive and not at all personal. Goldhill’s replies were defensive and personal. Goldhill believes private health insurance (except for catastrophic coverage) is a flaw in our system and would ditch the current system and substitute a very different system. A system that includes an individual “health account” for everybody that is “funded” from a variety of sources (including public), future funding of the account can be used as collateral to borrow for unexpected current health care expenses, and eventually the account can be accessed for other purposes (such as buying a new car) if there are excess “funds” in the account as the result of lower lifetime health care expenses (because, for example, of lower than average health care expenses attributable to better lifestyle choices by the individual or being a better consumer of health care) together with a very high deductible (i.e., above the expected lifetime “contributions” to the health account) catastrophic insurance in case the individual has extraordinary health care expenses. I have two reactions to Goldhill’s hypothetical system. One, how can one comment on a hypothetical system. Two, why would anybody care to comment on a hypothetical system – the horse has already left the barn (i.e., we’ve done health care reform and Goldhill’s system wasn’t picked). I suppose Goldhill’s system appeals to a libertarian (McArdle) because it puts the individual at the center of his or her health care and the funding of it. But if our current system of health insurance is flawed, so is Goldhill’s system of individual accounts: what if the individual is overweight and sedentary, smokes, insists on every available diagnostic screening for illness, and has health care expenses above and beyond the total lifetime “contributions” to her health account and catastrophic insurance benefits. Tough luck? Or charity care the cost for which is shifted to others? Anyway, no more comments from me about hypothetical health care systems.

    • I think the observation (which I no longer remember the source, but it might well be this blog) that best fits the facts is that opponents of expanding health insurance don’t want a trade-off. They want a way to say money that has no costs associated with it. If Medicaid doesn’t improve health outcomes, then it is cost-free to eliminate it.

      It is often the case that there is some cost (however small) to reducing the level of resources put towards something. Usually the real question is have we hit the level where the costs outweigh the benefits.

    • Joseph is on the rightt track when he mentions ‘outcomes.’

      Many of our health care debates are murky because not enough different outcomes are discusseed………….

      for example:

      Medicaid may have little iimpact on death rates or illness rates.

      But it keeps some poor people out of medical debt, which is a huge outcome that wealthy persons like Goldhill mightr not recognize.

      And it probably allows some poor people to lead lives with less pain from fibromyalgia, MS, or whatever Medicaid can treat. That is another huge outcome.

      Medicare allows seniors to go to the doctor withiout fear of the bills.
      Having known older persons in the 1950’s who stayed home in pain from fear of meidcal bills, that is a huge outcome.

      The above is not a defense of all forms of medical spending. Personally I believe that spending $400,000 on a transplant for one person is a pretty trivial outcome for the dollars. I would rather see
      2000 shut seniors get a year of home visits and let the transplant person die. Kind of the British in me.

      Anyways, there is more than one kind of outcome.