I got this from Matthew Yglassias who is talking about Shannon Brownlee:
Even better, the thesis is admirably clear: A system in which health care workers are paid for “providing health care” rather than for providing good health outcomes is a system that’s set-up to generate lots of wasteful and counterproductive spending.
The entire post is here
This may explain part of the reason that the current health care mess is not completely the fault of insurance companies, these companies are stuck with a system that is designed to generate revenue for health care workers, even in cases where those workers are not producing better outcomes for their patients. To fix the system people will have to take a rational look at what kinds of care offer real benefits and what kind of care do nothing more than provide a good living for doctors. The same can be said for drug companies. People should have access to drugs that improve their lives, but it is stupid to suggest that the government should help people pay for drugs like Vioxx that do nothing but cause heart problems and early death. Â
 The more I look at health care the more I think it is hard to find one villain, the insurance companies certainly are cold hearted and don’t seem to care about the people they insure, the drug companies seem to be more worried about how to market a drug, than whether or not it really works or is even safe. Doctors seem all to happy to prescribe drugs based on the reccomendation of their pharmacutical reps. It seems like all the people who should be looking out for the best interests of the patient are far more concerned with their own interests. Even the patient who insists on being given anti-biotics for a viral infection is not without blame. Â
 Everyone needs to look in the mirror and ask themselves why the US spends twice as much on health care as any other devoloped country without getting any better health outcomes. While at the same time almost 50 million people do not have access to health care.
John:
We don’t see this wastefulness with cars, discount brokers, cell phones, beer, internet retailers …
Maybe we need less market distortion rather than more?
50 million people can walk into an emergency room anywhere in the country, regardless of legal or financial status, and receive treatment. That’s not quite as bad as 70% of the rest of the world.
Maybe we should help the sub-Saharan Africans with AIDS, malaria, and clean water for $1/day/person along with the several dollars per day per person that you might be envisioning.
The emergency room as good as it sounds has a few problems, first you get a lot of people who don’t have life threatening problems in the ER, this distracts from people who are in real medical peril. In addition if you don’t have insurance you may get treatment at the ER but you will also get a bill that very possibly will lead to bancruptcy.
John: So you are AGAINST 1) open access, and 2) insurance?
Not so much against them as I think their are better ways to andle the uninsured.
The emergency room is not meant to handle kids with sniffles and it is and extemely inneficient way to treat non-critical situations. One of the reasons that US medicine is so innefient is the over-use of the emergency.
As for insurance at this point it seems like the best fix for the situation is to make sure everyone has access to affordable insurance that covers necessities. This is one place where I think Hillary is pretty good. If everyone had insurance it would reduce the stress on the emergency rooms and let the doctors and nurses in the ER focus on critical care patients .
One of the things that was interesting about the Krugman article was that he was critisizing Obama for not villanizing the insurance and drug companies. The reality is that the insurance companies and drug companies are playing the game the way the rules are written and maybe the solution is to change the rules. That starts with making some changes that would make medicine more efficient. One of the best ways to make medicine more efficient would be to get relatively healthy people out of the emergency room and in to doctors offices where they could recieve better treatment at a fraction of the cost.
It seems like everyone wants to find a bad guy in the health care debacle that is the US system. In reality it is just a bunch of people acting in their own best interests to the detriment of the patients. Part of the reason for this is that most people do not have the training to judge what is the best course of treatment for various ailments. The trusted advisor is the doctor who has taken an oath to do no harm, however this oath seems to crumple when extra payments from drug companies or a chance to do an expensive surgery is involved. In other words the system is pretty messed up and their is not one easy fix.