Health care bias
January 14, 2008 – 5:41 pm by JohnIn this month’s edition of the Journal of Clinical Investigation, the book Who Killed Health Care?: America’s $2 trillion medical problem—and the consumer-driven cure by Regina Herzlinger is reviewed by an unsurprisingly biased public health researcher.
While the book doubtlessly has many flaws, its central premise is a valid and correct one: increasing consumer choice is the major solution to many problems with America’s health-care industry. This would necessarily entail a concomitant decrease in State direction of medical decisions, and this is unacceptable to many Americans and nearly all researchers in the scientific and medical fields.
The reviewer demonstrates a fair amount of knowledge of economics and an even greater bias in favor of State dismissal of the laws of economics.
Although consumer choice is central to consumer-driven health care, the author [Herzlinger] glosses over the fact that health care does not meet the conditions necessary for efficient consumer choice.
You gloss over the fact that corrupt politicians, disinterested bureaucrats, and in general every member of the professional criminal class is even less able to make informed or efficient decisions for consumers regarding any good, much less as complex a one as medical care. Socialism does not meet the conditions necessary for economic calculation or efficient allocation of resources.
Economic theory demonstrates that consumer choice enhances efficiency only if (a) individuals know with certainty the level of satisfaction they will obtain from a product or service, (b) they are rational, (c) they have sufficient information to make good choices (i.e., they know what choices are available and the opportunity costs of each choice); and (d) they are the best judges of their own welfare.
I don’t know whose “economic theory” she is referring to, but I’m betting his name started with a “K” and ended with “pure socialism.” Who do you suggest are the best judges of their own welfare? She only takes the sufficient-information point (point c) any further, but I can’t help but predict that she would think bureaucrats, “public health officials,” the patients’ own doctors, and various other State-approved authority figures are better judges of people’s welfare than the people themselves. Most of the time when a medical decision is involved, one’s doctor is, of course, the best judge of our welfare—and it is our responsibility to seek out, listen to, and follow through with their advice.
Secondly, when is anything other than consumer choice the most efficient way of allocating resources in an economy? As Mises, Hayek, and Rothbard clearly showed, any (coercive) interference with private decision-making must necessarily, in the long run, lead to inefficiency. It is a general truism that such inefficiencies tend to lead to more State interventions, which lead to more problems demanding State fixes, et cetera ad totalitarianism.
Health care is fraught with uncertainty. There are uncertainties about incidence of disease, efficacy of treatment, care outcomes, and other variables. Furthermore, health care decisions are often made under pain, fear, and serious time constraints. Health care consumers often do not have sufficient information, and when available it is often too complex for the consumer to decipher sufficiently to make the best choices. More information would not necessarily overcome uncertainty. It is dangerous to downplay the need for proper information in making health care choices because this can lead to worse health outcomes than those observed under the current system.
Everything is fraught with uncertainty. The astounding arrogance of Statists like her who think they can smooth out the vagaries and uncertainties of life with State coercion has led to more death, misery, and loss of freedom than any other idea in the history of our species, with the exception of the barbaric instinct to expand and wield violent power over others solely for power’s sake. I wrote about the insightful way in which Anthony de Jasay addressed this issue in his masterpiece The State a couple days ago—the idea that replacing the problems of freedom with problems of government will benefit people. Libertarians and Austrian economists insist that it won’t, due to the legal immunity enjoyed by the State, which Jasay addresses, and because of the inability of a socialist State to allocate resources efficiently.
Herzlinger presents the problems well, although this reader believes that doctors and American citizens should also be held responsible for tolerating the decline of health care. In a democracy, citizens should exercise their voting rights to protect and improve vital institutions such as health care.
Translation: The mob should empower the State to use coercion against the dissident minority, in order to take money from people who earned it and give it to people who didn’t.
In summary, this book review is a prime example of bias: you can tell the reviewer formed her opinions of the book and its thesis ahead of time and closed her mind to arguments that countered her preconceived notions of the State’s role in medical care. At least she courteously recommends the book to all of us concerned about the state of our health-care industry, probably because she wants more of her ilk to learn about the enemy and prepare their attacks on freedom of choice.
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