The waste constituency

As is typical of his work, Uwe Reinhardt’s latest paper (ungated pdf) is an enjoyable read, quite accessible, and illuminating.

[Patients] are both objects of human compassion and biological structures yielding cash flows. […] A strictly observed etiquette in public debates on health policy, however, is never to talk openly about the second goal of health care. Any proposal to enhance the second goal therefore must be styled to seem to further the first goal—e.g. ‘enhancing the quality of patient care’, ‘innovating to create value for patients’, ‘saving lives’, and so on. This essay will stray from that tradition.

Given that every dollar of health care spending is someone’s health care income, including fraud, waste, and abuse, there must exist a surreptitious political constituency that promotes [] waste, which many health-policy experts around the world now view as a major ingredient of health spending. The long-standing opposition to cost-effectiveness analysis in the US Congress, for example, can be viewed in part that waste constituency’s work.

Reinhardt summarized the paper in an Economix post on Friday.

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