This is not your grandfather’s health care

Sometimes someone just nails a point so precisely that all I can do is sit back and nod. Earlier today, referencing my post, Matt Yglesias did just that. Since I get a “500 server error” trying to click through (which may be resolved by now), here’s all of what Matt wrote. I’m only leaving out the chart I already posted this morning.*

The health care system in the United States has a lot of problems, but I think people are sometimes too pessimistic about it. This happens largely through slippage between the phrases “health care spending” and “health care costs.” Everyone knows, for example, that economy-wide spending on tablet computers has surged over the past three years. But nobody says “tablet costs are skyrocketing.” What happened is that iPads came on the market, followed by a bunch of lame competitors nobody liked, followed by the Kindle Fire which is cheap enough to open up a whole new market segment.

By the same token, it always bears noticing that the health care that’s so expensive in 2011 is qualitatively different from the cheaper health care of 1961. [The] chart, delivered to us by Austin Frakt, illustrating steady progress in fighting cardiovascular disease illustrates the point.

That’s not to let the health care status quo off the hook for its myriad flaws, but simply a reminder that “health care” is not a static target. A big part of the price problem is that so much of our innovative energy has been dedicated to better-and-more-expensive innovations rather than about-as-good-but-cheaper ones. That naturally pushes spending up. But it’s still a form of improvement.

OK, I can do slightly more than nod: Of course there are also technologies that don’t improve care or ones that do for some but are used for classes of patients for which they don’t. That’s true even in cardiovascular care. Misuse of angioplasty has been widely documented, including by Chandra and Skinner. Still, Matt’s point is well worth keeping in mind.

* I have not checked Slate’s rules on reuse because, well, I’m getting a “500 server error” and can’t. Happy to cut this down to an excerpt if someone tells me I need to.


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