Jeff Goldsmith in this Health Affairs blog entry summarizes what we might look forward to in the New Year. I found his pointer to the McKinsey study useful since I’ve been uneasy for years in my support of PNHP’s view of the source of savings in single payer healthcare. Goldsmith’s three key ingredients for a health policy book by a Democrat seems on point:
1–Personal interest horror stories;
2–Debunking of Himmelstein/Woolhandler/PNHP assertion on 31% of health costs due to "administration". (See the McKinsey Global Institute’s 2007 “Accounting for the Cost of Healthcare in the United States” for a more rigorous analysis);
3–Mention of the WHO study ranking the USA 37th in the world in health care.
The piece goes on to discuss the Federal Health Board and why it might work and what political barriers to implementation it could face. I’ve been fascinated for years by the hesitancy to adopt a technocratic approach to the underlying issues of coverage and benefit–the diseases and technology to treat them are arcane. Perhaps at this moment the body politic suffers from sufficient fear of the complexity and of the financial abyss confronting employer paid healthcare so that rationalization whose goal might be improving upon "the failure of the intermediation system to provide sufficient incentives to patients and consumers to be value-conscious in their demand decisions, and establish the necessary incentives or mandates to promote rational supply by provider and other suppliers." (McKinsey Report cited above).
Ah, "incentives or mandates . . . ". Physician, heal thyself.