• Five (or six, or seven) health policy books

    Do you want to know what to read to become a true health policy wonk? Find out in my “Five Books” interview, now posted at The Browser.

    I would defy anybody to come up with [the US health system]. If you could go to a world where you are unaware of the American system and then design a system, there is no way you would come up with anything like what we have here. It’s just preposterous. It doesn’t make sense on so many levels. The risk pools are chopped up, there are many inefficiencies and strange subsidisations. Nobody would do it that way. One couldn’t even imagine that it would be possible. You can’t make this stuff up.

    I actually mention six books:

    There’s one more I’ll blog about later in the week. It differs from the other six in that it is fiction, but policy relevant fiction: 2030, by Albert Brooks.

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    • What American system? There is no health care system in America! Agree that no one could make up what’s happening, but as long as there is employer-subsidized health care for the well-employed and individual policies for the rest (by definition of individual policies being expensive and discriminating against pre-existing conditions as defined by insurers) there is no health care system!

    • I’d have thrown in the Victor Fuchs classic, “Who Shall Live?” (appropriate timing now given that the name is based on the Jewish high holiday prayers, about to be recited).

      Chapter one of this book is my favorite bit of writing in health policy. In short, Fuchs lays out the key trade offs that are unpleasant to contemplate but absolutely unavoidable in determining health policy. In doing so, he dismisses a wide array of myths about why the health system is failing.

      This book first came out in the 1970s, if I’m not mistaken, but the message is as true today as it was then. In order to gain traction in any rational health policies, one must confront very difficult questions. There are no magic bullets. If I had to name the most important obstacle to meaningful health reform, I would say it is the resistance by the public and politicians to understand that trade offs are unavoidable. Reforms will often entail trading off two things that people want to think of as fundamental and inalienable.

      Here’s my favorite line:

      “it is hardly news that we cannot all have everything that we would like to have, but it is worth emphasizing that this basic human condition is not to be attributed to ‘the system,’ or to some conspiracy, but to the parsimony of nature in providing mankind with the resources needed to satisfy human wants” (4)

      Imagine how much more progress we could make in health policy if more people understood this statement?