Priceless: Chapter (1)


by Austin Frakt

Source: The Incidental Economist

I assume you know by now that I’m blogging my way through Priceless: Curing the Healthcare Crisis, by John Goodman. I also assume you’ve read prior posts (found under the Priceless tag). This post pertains to Chapter 1, which begins, “Forget everything you know about healthcare for a moment.”

That’s what John wants. But I want you to do something different. I want you to not forget anything you know about evidence. In particular, I want you to insist that claims be supported by some and not take an anecdote or two as a sufficient basis for decision-making.

My read of Chapter 1 is that it is full of unsupported claims and sprinkled with anecdotes. It being a book intended for the masses, I forgive John for that. Many other books for non-experts and with aspirations of policy import do the same, left, right and center. But we don’t have to be satisfied by it. John has no right to expect that we be. He also has the rest of the book to convince us. This is just Chapter 1, after all.

With that as set-up, you’d expect me to deliver a thorough take-down of the chapter. I’m not going to do that. Instead, I ask that as you read it, keep an eye on what has a citation (and check the references if so motivated). Notice when you’re being encouraged to think a particular way by an anecdote. Stories sell. Buyer beware. Just saying.

The point of the chapter is that the government (mostly) and health insurers (a little) — third party payers, basically — are ruining what would otherwise be a more efficient health care market. Maybe! Note that I wrote “efficient,” not equitable. There is a difference. Neither is the whole ballgame. Let’s keep that in mind too.

But, back to John’s point. He claims that if third-party payers and all their regulations would just get out of the way, the market would be free to innovate, and we’d be better off for it. Maybe! Here’s one of his anecdotes about how private enterprise excels,

Did you know that eHealth already has an electronic exchange, and more than 1 million people have health insurance purchased online through its system?

I did know that, actually. Another thing I know is that Medicare has an electronic exchange too. It’s at Medicare.gov. There, every one of the nearly 50 million Medicare beneficiaries or trusted family members or friends on their behalf can compare health plans across dozens of dimensions, enter in their drugs to find the best deal for Part D coverage, change plans, and much more. You can navigate it to see for yourself, even if you’re not a beneficiary. I don’t know how this site compares to eHealth. My point is only that private enterprise is not the only entity that can produce an online exchange.

Here’s another anecdote:

[D]id you know that eHealth already offers many of its customers an electronic medical record (including a record of doctor visits, prescriptions taken, etc.), based on insurance payment records?

That I did not know. But I did know that the Veterans Health Administration had one of the (or maybe just the) first electronic medical records, first developed in the 1970s by government employees and since then upgraded considerably. (See Phil Longman’s Best Care Anywhere for the history.) It’s open source and free to other organizations. I don’t know how it compares to eHealth, but at least one hospital CEO voted with his organization’s wallet for it. I also bet it existed well before eHealth. My point is that government was way ahead of most (or all) of the industry on this one.

A point I am not intending to make is that government is better. Yet, see how anecdotes work? I could probably make that case with anecdotal examples like those above and convince many with it. (Again, see Phil Longman’s Best Care Anywhere.) That is not my ambition.

I could respond to more parts of Chapter 1, but I’m sure some of the aspects that caught my eye will come up again. I’ll cover Chapter 2 on Wednesday.