Thursday, January 19, 2017

Is David Brooks’s NYT Column on Market Forces and Health Care the Worst Conservative Column Ever on That Subject?

Hard to Tell, There’s A Lot of Competition

How Does Someone This Ignorant Get a Column in the Weekly Shopper, Much Less the NYT?

Conservatives charge that progressives are elite ignorant condescending ignoramuses but no one tops David Brooks, the pseudo intellectual who pontificates on the opinion pages of the NYT.  A recent Brooks column praising Republican’s market approach to health care has these gems.

Brooks admits market forces do not work in the specialized area of health care, but then admits it does. (confused, yeah so are we).

 “People’s needs for health care are unpredictable, unlike food and clothing. The doctor-patient relationship is unique and demands a high level of trust, empathy and care. Providers know much more about medicine than patients do, so the information is hopelessly asymmetric. Patients on a gurney can’t really make normal choices, and payment comes after care, not before.

These are all solid points, especially the doctor-patient one. But health care has become less exceptional over time. The internet and other mechanisms help customers acquire a lot more information. Sophisticated modeling helps with unpredictability in a bunch of fields.

Yeah, everyone Brooks knows has access to the internet, understand sophisticated modeling and has plenty of time to research health care and the technical background to understand it.  So of course his analysis is correct, for about 10% of the population.

And then there’s this.

“The most fair-minded review of the evidence I’ve read comes from a McKinsey report written by Penelope Dash and David Meredith. They noted that sometimes market forces lead to worse outcomes, but “we have been most struck by health systems in which provider competition, managed effectively, has improved outcomes and patient choice significantly, while at the same time reducing system costs.”

Wow, anybody in the real world think system costs are being reduced.  And of course there is the old favorite, anecdotal evidence.

“Laser eye surgery produces more patient satisfaction than any other surgery. But it’s generally not covered by insurance, so it’s a free market. Twenty years ago it cost about $2,200 per eye. Now I see ads starting at $250 an eye.

There’s a big chunk of evidence that market incentives would work in health care, especially in non-acute care. “

Uh David, you do know that almost all of the costs are in acute care.  We imagine David lives in a world where a person needs an ambulance, but stops to take the time to call around to see which service is cheapest, and which emergency room has a special, like stay 6 days at full price, get a 7th day free!!

And finally there is this howler.

“There are plenty of examples where market competition has improved health care delivery. The Medicare Part D program, passed under President George W. Bush, created competition around drug benefits. The program has provided coverage for millions while coming in at 57 percent under the cost of what the Congressional Budget Office initially projected. A study of Indiana’s health savings accounts found the state’s expenses were reduced by 11 percent.

Really, anyone who believes that competition has brought drug prices under control is so out of it that he needs medical care.  But we hope he takes the least cost instead of the Cadillac coverage a writer for the NYT probably has.

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