Consciousness and how it got to be that way

Friday, February 15, 2019

An Obvious Healthcare Cost-Savings Proposal, That Doctors and Patients Will Obviously Resist

Arnold Kling draws attention to a proposal by Karl Denninger, which includes the following:
No government funded program or government billed invoice will be paid for medical treatment where a lifestyle change will provide a substantially equivalent or superior benefit that the customer refuses to implement. The poster child for this is Type II diabetes, where cessation of eating carbohydrates and PUFA oils, with the exception of moderate amounts of whole green vegetables (such as broccoli) will immediately, in nearly all sufferers, return their blood sugar to near normal or normal levels...This one change alone will cut somewhere between $350 and $400 billion a year out of Federal Spending and, if implemented by private health plans as well, likely at least as much in the private sector.
The tone gets even more pointed, and more accurate, further on.

Denninger further points out the core values-disconnect that makes talking about healthcare so difficult. That disconnect is that we are trading dollars and human suffering back and forth, and there's no way around this brute fact, ever, except to hide it from both buyers and sellers. This makes the system nauseatingly inefficient, whether we're talking about centralized planning or a free market.
Americans, and especially health care providers, do not want to think of health care as a commodity. The providers want to be paid, but they do not want to think of themselves as selling their services, so the payment comes from third parties and the price is hidden to consumers...All surgical providers of any sort must publish de-identified procedure counts and account for all complications and outcomes, updated no less often than monthly. Consumers must be able to shop not only on price, but also on outcomes.
This will be unpopular as both patients and doctors want to avoid responsibility for bad choices - but now that we're all paying for people to keep eating McDonald's and performing poorly-evidence-supported surgeries so they can buy a vacation home - we will have to make some hard choices.

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