[Peter Suderman]
Typical libertarians, always projecting! Or so says Ezra, who goes on to argue that…
The liberal vision on health care, however, is not the libertarian's dream of a perfect market, checked by individual consumer preferences, but paid for by the government. Most liberals think that implausible. In the aggregate, the individual consumer will never have enough information or enough expertise to exert effective control over the medical industry. People don't comparison shop when they have a heart attack, they don't know how to effectively contrast chemotherapy providers when their doctor tells them they need to start treatment now. Confronting illness -- much less physical trauma -- is not like buying a television. You can't walk away from the deal, and you're in a terrific state of fear and urgency before you ever speak to a salesman.
Which is why liberal solutions don't try and force the individual into a governing role he or she is not equipped to assume. That's not to say we don't want to give them the maximum possible information and price transparency, but we don't believe that to be a sufficient answer to the health care crisis. An actual solution will require reforms far above the level of the individual. The incentives of providers will have to be reworked to prize wellness over profits, or at least to align profits with wellness, rather than simply with treatments. The government is going to have to step in with a lot of money for the sort of comparative effectiveness research the private sector has been stubbornly unwilling to carry out on any large scale.
First of all, I think Ezra overstates the prevalence of emergency care. Not every medical situation is a dire one; in most cases, in fact, you're not about to die if care isn't given as soon as possible. Usually, those seeking care do have some timeeven if only a few days or weeksto make informed choices of their own. But because they're so insulated from costs due to the current insurance regime, they have no incentive to do so.
Anyway, I think his response fails to address my original point, which was that, no matter what, some entity needs to record and make available various health care metrics in order to make decisions about care. But there's no guaranteeand in fact, I'd argue that there's actually less of a guaranteethat the government is or will be equipped or willing to reliably do so.
Let's think about this for a minute. He argues first that individuals are doomed to lack the sort of information necessary to make choices about their health care. And then he argues that the government needs to spend "a lot of money" on effectiveness research. Presumably, if the consumer is unable to make determinations for him or herself, that means the government will be doing so instead. So although he pays some lip service to giving individuals the "maximum possible information and price transparency," what Ezra essentially wants to do is leave health care decisions in the hands of bureaucrat-experts (presumably, in a largely or fully public system, the ratings and determinations of the government body are followed by the health providers). And as I pointed out before, the government isn't exactly a bastion of accuracy and honesty when it comes to self-assessment.
But even taking the label of health bureaucrats in a non-pejorative sense, I'm not comfortable with the notion of putting government in charge of health-care metrics. For one thing, I'm apprehensive about the idea that individuals shouldn't be trustedor at least given the optionto manage and determine as many of their own health decisions as possible. And for anotherand this was my original pointeven if your government-run comparative effectiveness research board consists of the most honest, decent, and committed public servants in the history of the nation, they're still going to be subject to a variety of outside incentives.
Those bureaucrats may not be elected themselves, but they'll be appointed by elected officials. And elected officials will, for example, care about rising health care costs. The CBO projects that medical spending will make up the bulk of the rise in entitlement costs over the coming decades. As it is, cost issues already result in what I would consider morally dubious ideas about who's required to cough up for health-care. And, as Michael Cannon noted recently, government-run health care doesn't always bring the sort of cost efficiencies its proponents expect. And you have the fact that concerns about costs also lead to regimes like the one in Britain, where the NHS has been known to make medical treatment conditional on patient behavior.
So even if individual knowledge about health care is never perfectand Ezra's probably right that it never will beI'd still prefer to leave those choices in the hands of individuals anyway, to open up health insurance markets rather than further regulate them, to find ways to give everyone more information on which to make their own decisions rather than simply assuming that it's hopeless and throwing bundles of taxpayer money at the problem.