Do You Want The Government or the Market to Control Your Health Care?

1. The government is doing a fine job, documented in several studies of patient satisfaction and quality metrics, in running the Veterans Administration health care system.

2. There is no free market competition in health care in most parts of the country.

Discouraging utilization is a slippery slope as you will reach an inflection point in your projected 'plummeting costs' curve; making people pay for expensive screening tests (colonoscopy, mamography, CT calcium scoring, carotid and aortic ultrasound testing, routine bloodwork, psa screening, etc) will ultimately increase costs because categorically people "feel healthy" right up to the point that they have a catastrophic illness. As soon as enough people go without these tests (perhaps, who knows, we're in a recession, and there's not much disposable income to go around), total health care costs rise, not plummet. Charles Krauthammer argues that screening causes costs to go up--he makes assumptions that currently we are not yet to this inflection point, assumptions that may not be correct.

And, btw, Vladimir (above) is correct.

Re: Vladimir's comment:

Anyone who believe's the government is going "a fine job" should read "Healthy Competition," by Michael F. Cannon and Michael F. Tanner. It's a very well researched book that, among other things, demonstrates precisly how the government, a la Medicare, Medicaid, etc., has performed absolutely abysmally.

Patient satisfaction surveys are obviously not a good barometer for fiscal and clinical efficacy.

With respect to David's comments:

I read Krauthammer's editorial and he (et al) do make the case that preventive testing actually increase costs and to the extent that's true it should be included in the cost structure.

The bottom line is that the only reason that reform should include a government option is if you sincerely believe that market hegemony by the government will improve care and reduce costs--and, frankly, there's just no research that supports that contention.

Phil Mella
ClearCommentary.com