What this country needs is more lobbyists, representing more interests groups. This is what Nicholas Lemann, Dean of the Columbia School of Journalism, all but declares in a contrarian piece published in a recent New Yorker. Basing his argument on The Process of Government: A Study of Social Pressure, a classic written by Arthur Fisher Bentley in 1908, Lemann declares that in the end, politics is all “about interest groups struggling against other groups and finally making deals, through politicians and agencies and courts.” And this, he implies, is the way it should be.
Under Bentley’s rules there is no such thing as “the public,” Lemann explains. “There are only groups.” And “the public interest” is a “useless concept,” because there is “nothing which is best literally for the whole people.” Bentley dismisses any idea of what I might call “the public good.” We live in a society divided against itself, in groups with very discreet, often warring interests. So much for making common cause for the common good.
As I read Lemann’s piece, I could not help but wonder: what does this mean for national healthcare reform? And I realized that there are some reformers who endorse something uncomfortably close to the process that Lemann describes.
Like Lemann, they believe that reform can be accomplished only by letting the interest groups duke it out. Big Pharma, the device-makers, hospitals and insurers all should take their rightful places at the negotiating table (after all, they paid our legislators for those seats), alongside primary care docs and RNs, surgeons and radiologists, hospital workers and hospital administrators, each group defending its turf. Then there’s the AARP, the AMA and the AHA, the libertarians who oppose mandates, the progressives who want mandates…But wait, didn’t I leave someone out?
Oh, right, the patients. When elephants fight, says a Swahili proverb, the grass suffers.
But Lemann insists that, in truth “the only way to defeat one set of
interests is with another set of interests.” By this logic, I suppose,
patients should climb out of their beds, rally, and form a lobby.
Alternatively, I would suggest that we are all patients—if not today, then tomorrow. And when it comes to healthcare, this is the only interest group that matters.
Lemann’s Argument
Nevertheless, let me give Lemann’s argument its due. He is after all, advocating “pluralism,”
a long-held theory that, in our democratic society, policy emerges as a
compromise between and among different factions. Ultimately, democracy
is viewed as a competitive marketplace where various perspectives,
represented by different groups, vie for influence over policy.
“Bentley’s influence soared after World War II,” Lemann explains. “In
the wake of Hitler and Stalin, big ideas about ‘the collective good’
had come to seem scary—the prelude to mass murder.” So while
Progressives were “appalled” by Bentley’s “presentation of politics as
a never-ending” and somewhat petty “small bore struggle for advantage
among constantly shifting coalitions of interest groups,” in the 1950s,
his ideas found a warm reception in many quarters.
Lemann acknowledges that there were always arguments against Bentley’s pluralism: “The standard objection is that pluralism gives too little weight to the power of ideas and of social and economic forces, and that it leaves no room for morality. . . .What if there actually is such a thing as a policy that’s right on the merits? Shouldn’t we find a way to make sure that it is enacted instead of having to trust in the messy workings of the political marketplace?”
Nevertheless, Lemann insists that “you can’t talk about morality as a
force in politics, because such talk is almost always a cover for
somebody’s interest.” Pluralism, he writes, teaches us to recognize
that our own “political passions…represent something other than the
promptings of pure justice… One has to get over the habit of assuming
that ‘interests’ and worse, lobbying and corruption, are the province
only of one’s political opponents and not one’s allies.”
Lemann recognizes that pluralism is no longer in fashion. He even
acknowledges that “to an unusual extent, our Presidential candidates
this year got where they are by presenting themselves as reformers, as
champions of the transcendent public interest—as the enemies of
Washington deal-making as usual.”
Indeed, Leeman points out, these days, “it is permissible to use the
word ‘interests’ in a positive way…only in the realm of foreign
policy”, and then they must be vital national interests.” (As in the
vital interests that led us into Iraq.) In domestic policy, interest
groups (and particularly those in that ill-defined but malign category
known as special interest groups) are always the bad guys. So are their
representatives in Congress—the lobbyists. “We’re inclined to think that the wheedling of interest groups distorts politics,” Lemann observes, “For Bentley, the working of interest groups—in interaction with one another—constitutes politics."
The Flaw in the Pluralist Heaven
Pluralism, in its purest form, assumes that all interest groups possess
equal wealth and power—and that Washington has no favorites. In truth,
as Elmer Eric Schattschneider wrote in his 1960 book The Semi-Sovereign
People, "The flaw in the pluralist heaven is that the heavenly chorus
sings with a strong upper-class accent."
Lemann notes that 1960 also marked the beginning of a decade when Bentley’s views would fall out of favor. In the Sixties, many Americans believed that they could find common cause in a struggle for the public good. The Civil Rights Movement
stands out as an example of diverse groups coming together in the fight
against racism. But the War on Poverty, the anti-war movement and the
fight for women’s rights also brought Americans of different ages,
races, classes and religious beliefs together, united in a battle for
what they saw as an over-riding good. What Lemann doesn’t point out is
that at some point in the 1970s, “identity politics”—the idea that only
those experiencing a particular form of oppression can either define it
or fight against it—began to splinter the reformers.
By 1980 America “had compassion fatigue,” observes James K.
Galbraith in The Predator State. The whole notion of pursuing “the
collective good” seemed as unappealing as it had in 1950, though for
different reasons. Meanwhile, it was becoming clear that, as
Schattschneider had suggested, the richest interest groups were
securing a disproportionate amount of political power.
In The Business of Business is Lobbying: The Growth of Corporate Lobbying in American Politics, 1981-2004, Lee Drutman notes
that today, “the lobbyists with the greatest power represent
corporations, followed by trade groups, and then professional groups.
Voluntary ‘citizen’ groups, who attract the bulk[of attention] from
political science scholars . . . amount to only a small sliver of the
activity.”
So while academics find grass-roots organizing fascinating (and indeed,
the Internet is giving it new life), it seems that corporations still
hold most of the chips at those bargaining tables where we hash out
public policy. Moreover, over the last fifty years, corporate power
has grown enormously. “If all organizations having representation in
Washington are considered, the proportion representing the interests of
business rose from 57 percent in 1960 to 72 percent in 1986” Drutman
observes.
The trend continued into the 21st century. Below, Drutman offers a list of “Top Spenders on Federal Lobbying, 1998-2005."
US Chamber of Commerce
$267,944,680
American Medical Assn
$145,535,500
General Electric
$129,085,000
American Hospital Assn
$119,632,808
Edison Electric Institute
$95,722,628
Pharmaceutical Research & Mfrs of America
$95,462,000
AARP
$94,292,064
Business Roundtable
$91,740,000
Northrop Grumman
$87,848,009
National Assn of Realtors
$80,820,380
Blue Cross/Blue Shield
$79,292,355
Freddie Mac
$75,940,000
Philip Morris
$75,500,000
Lockheed Martin
$74,864,165
Boeing Co
$72,778,310
Source: Senate Office of Public Records, via Center for Public Integrity
Why Pluralism is Not the Answer to Health Care Reform
Health Care Reform is too important to be left to what Lemann rightly
describes as “the messy workings of the political marketplace” where
“deals” are made. We don’t want to bring the lobbyists representing
drug-makers, device-makers, for-profit insurers and for-profit
hospitals to the table where we design national health reform because
they already have too much power. To invite them to sit down is to insure that the public interest will be trumped.
This is not to say that they shouldn’t be consulted. Policy-makers need
to hear and understand their views. They may even bring inventive ideas
to the discussion. But the lobbyists representing our for-profit health
care industry should not have a vote because their over-riding interest
is not our over-riding interest. Their first obligation is to grow
earnings for their shareholders. Health care reformers, by contrast,
have a different goal: high quality, affordable, sustainable health
care for all Americans. To do that, we have to contain spending. By
contrast, the for-profit industry wants to see healthcare spending grow.
Moreover, I would argue that health care reform is not something that
should be “negotiated” by competing interests, each motivated primarily
by self-interest. This should be a collaborative effort, and the
players should keep their eye on the larger public interest. For
the goal of health care reform is “a transcendent public good”—the very
thing that Bentley says does not exist. Supposedly, there is “nothing
which is best literally for the whole people.”
But I submit that high quality healthcare for all is in everyone’s interest, because virtually all of us will, at some point in time, be patients. Even worse, our loved ones will be patients—our spouses, our parents, even, if we are very unlucky, our children.
None of us knows whether we will be among those who are gravely ill for
many years. But we do know that, no matter how well we care for
ourselves, eventually we will die. And the longer we live, the more
likely it is that we will fall victim to one or more chronic illnesses—
diseases that may not kill us, but cannot be cured.
We also cannot know who will find herself the parent of a child
diagnosed with cancer at age 3—a child who lives for perhaps another
eight years, in need of the most compassionate, most competent care a
mother can possibly find.
Since we don’t know what the future holds for us as individuals, we must think collectively: it is in everyone’s interest to have the best health care system possible, and to make
that system affordable, so that even if a long and devastating illness
generates $3 million or $4 million or $5 million in medical bills, you do not have to worry about money—even though you are not Bill Gates.
Thus it is in the public interest to pool the unknowable risks that each of us faces, fairly and equitably,
asking everyone to contribute to the pool according to their ability to
pay (just as we contribute to Medicare) and then guaranteeing the same
comprehensive benefits for everyone, insuring that “everyone” receives
the safe, effective care that you and I would want for our own families.
This is a public good—a policy that, to quote Lemann “is right on the
merits.” But as a society, we cannot afford this public good if we
allow the health care industry to continue to gouge us, while peddling
unproven, ineffective, overpriced products and procedures. We have
nearly three decades of research from Dartmouth showing that one out of
three of our healthcare dollars are wasted on treatments that provide
little or no benefit. (See www.dartmouthatlas.org). We even know what
many of those treatments are. HealthBeat has written about some of them
here, here, here, and here.
If we say “no” to the lobbyists who would divide us, by appealing to
our fears, our cynicism, and our most selfish interests, we can achieve
common cause.
http://www.merriam-webster.com/dictionary/tautology
“But as a society, we cannot afford this public good if we allow the health care industry to continue to gouge us, while peddling unproven, ineffective, overpriced products and procedures.”
I guess it is only natural that people and groups will pursue their self interests. What would be interesting is to hear from special interest groups why their interests may benefit the common good.
Some groups will have more sound ideas than others, knowing, of course, they are consciously or even unconsciously, suggesting ideas that benefit them, either materially, or even emotionally or psychologically.
Most of the people will have some portions of their suggestions that will benefit the common good.
The secret is piecing those portions together to form workable solutions.
Now that would be a type of compromise I could support.
Don Levit
What America and Americans deserve in terms health care is the same coverage that Congress (that is the Senate and the House of Representatives) has provided themselves as public servants. If their benefits are good enough for them on our dime, why then do these esteemed 535 members of the Capital Hill fraternity not have the integrity to see that the very people that they represent get the same benefits they have?
The reality is that integrity at that level of government does not exist. Is there anyone in Congress today that does not have the medical lobby, the insurance lobby, the trial lawyers lobby, the medical education lobby, etc., in their hip pocket? Congress is bought and sold like cheap prostitutes by corporate pimps. Those that loose in the process is the health consumer. Congress should be appalled at the state of health care in America. Unfortunately, they do not see that there is an appalling problem because they have provided themselves the best health care that your tax dollar can buy.
If there is truly to be health care reform in America that provides for the least of Americans as well that those with the greatest resources, we must first reform the mindset of our Legislators. Therefore, as a form of raising the bar of understanding to reform is to educate Congress that one-in-six Americans have no health care coverage, that one-in-three have substandard coverage that will wipe them out financially if there were a major illness or accident, that one-in-four Americans have not seen a dentist in the last five years because they cannot afford the expense, that America currently ranks about fortieth in the world in terms of heath care coverage. To truly effect reform in health care will be to continually ask Congressional Members (at large and in your district) to afford all Americans the same health care benefits that they have given to themselves.
In real figures, America spends far more on those without coverage then if it were a provided benefit. One would assume that Congress would see that pandering to corporate interests is an expensive proposition to America. America has a huge shortage of medical professionals, especially physicians. This is not because we do not have qualified applicants. This is a result of physicians that want to create an artificial shortage to prop up the rates, thus, excluding many for the health care process. Insurance companies have become so consumed with profits that they have established barriers to many from seeking health care coverage and health care benefits. Congress have been rewarded for providing privileged legislation to establish and keep barriers in place for each of us to have reasonable equitable health care opportunities.
Ask you Congressional Representatives to step up to the plate. Ask them to stop prostituting themselves for the sake of corporate greed. Ask them to provide you and you neighbor the same medical coverage that they give themselves. Ask them to have integrity. Please tell them that this is no longer an issue of self interest, that this is an issue of national welfare.
If any one would like to send a copy of this to their respective Congressional Member’s, please feel free to do so. The only request that is asked is that no changes be made. Thank you. BW Sharp
The obvious analogy is public education, which wasn’t left to the marketplace, but was written into every state constitution. The “clash of special interests” before the Civil War precluded a national policy on education, but even after the slaveholders (just another special interest, I presume, in Lemann’s view) who were violently opposed to universal education were violently swept from power, the government still left it to the states to make universal public education a reality.
Now turn to health care. Not a single state has passed an amendment to its constitution requiring the state to provide for the health of the people, which would make health care a universal good. While you can complain all you want about the clash of special interests, the fact remains that health care is a service that is not guaranteed to anyone in this society, other than the old and the poor through Medicare and Medicaid. That leaves policy in the hands of special interests to clash over how the regulated (or unregulated in all too many cases) health care marketplace will provide that service to everyone else.
I’m just thinking out loud here, but if universal health care suffers a big defeat this or next year, perhaps reformers should strategically mobilize in states where it is possible to pass constitutional amendments requiring universal access to health care. Then it will be up to state legislatures to provide for that common good. And while that may not end the clash of special interests, it will change the topic under discussion from “if” to “how.”
I believe .. patient power can heal a sick healthcare system
The Indian healthcare system has become sick. In the private sector, doctors are no longer held in high regard; the doctor-patient relationship has deteriorated; and patients believe that the medical profession has become commercialized. The dismal state of the government’s healthcare services for the poor and the middle-class has also been extensively documented. The knee-jerk reflex has been to train more doctors ; set up more hospitals; and force corporate hospitals and doctors to provide subsidised medical care. This is simply a form of ” band-aid medicine”. The only effective solution will be to rely on the one resource which is almost inexhaustible—the people themselves. The principle is simple – educate them so they can manage their own health problems.
The reason that India is shining today is that we are in a demographic “sweet spot.” India’s major strength is its middle-class, with its millions of educated young adults , and protecting their health should be a high priority. Unfortunately , healthcare remains a neglected area , because of which millions of working years ( and billions of rupees ) are wasted on preventable illnesses . Medical absenteeism exacts a huge toll , but because it is hidden from public view, we have not addressed this problem effectively.
This is a daunting task, and the challenges are enormous. However, the biggest mistake we make is to assume that people are incapable of tackling their own medical problems; and that we need to look to doctors for solutions. We need to change our focus. Instead of trying to provide sophisticated healthcare services ( blindly imported from the West) , which need expensive technology, fancy machines and highly trained specialists, we need to tap the people themselves. People are smart and motivated , and are capable of remaining healthy, if we give them the right tools and teach them how to use them.
Doctors are illness experts – and not healthcare experts. Healthcare needs to learn from the revolution which has occurred in microfinancing. When given money and the freedom to use it as they see fit , even very poor people have come up with remarkably innovative ideas which could never have been planned, designed or anticipated by the traditional experts – bankers!
Information Therapy – the right information at the right time for the right person – can be powerful medicine ! Ideally, every clinic , hospital, pharmacy and diagnostic center should have a patient education resource center, where people can find information on their health problem .
The key is to develop patient-friendly materials which people will want to watch and can learn from. Most of us are visual learners, so this should be in graphic format. Modern technology has made creating and sharing visuals easy, so each community can build its own customised health video libraries with ease ! A simple example would be to find an articulate doctor with excellent communication skills, and to record a doctor-patient consultation with her about the top ten common clinical problems. A library of such videos could then be published online as “open source content” ; and patients and doctors could download and dub these in local languages . This version can again be uploaded to the web and shared with other patients from all over the country. Web 2.0 technology empowers patients to form support groups and communities where expert patients can help others. As the technology improves, it will soon be possible to deliver this graphic educational content on the third screen which is quickly becoming universal – the cellphone. Patients will find these videos much easier to relate to, since the videos are in their own language; deal with their immediate personal concerns; use local characters they can identify with; and provide local solutions which they are familiar with .
Information Therapy enhances patient autonomy by putting patients first; promotes patient-centered healthcare; respects the fact that the patient is the expert on himself; emphasizes personal responsibility for health; reduces the risks of medical errors; improves patient compliance with therapy; reduces the risk of litigation, because the patient has realistic expectations of the treatment; empowers patients to make their own decisions; and allows the intelligent use of integrative medicine, ( such as yoga , homeopathy and ayurveda) , so people can explore what works best for them. It creates expert patients and allows patients and doctors to form a healthy partnership, by improving doctor-patient communication. Finally, it saves money on medical care , both by promoting self-care (thus encouraging patients to do as much for themselves as they can, and not become dependent on doctors) ; and helping them with veto power, so they can refuse medical care they don’t need, thus preventing overtesting and unnecessary surgery .
Is educating people about their health and medical issues too expensive ? In fact, it’s too expensive not to do it ! Human capital is India’s most precious resource and we cannot afford to squander it. Information Therapy is free ; has no side effects ; and provides a terrific return on investment. We should insist that doctors dispense information therapy every time they do a consultation; advise a lab test; or prescribe medicines. In fact, both the government and insurance companies can make prescribing information compulsory . Information Therapy can be Powerful Medicine – let’s make the most of it !
Dr Aniruddha Malpani, MD
Medical Director
HELP – Health Education Library for People
Excelsior Business Center,
National Insurance Building,
Ground Floor, Near Excelsior Cinema,
206, Dr.D.N Road, Mumbai 400001
Tel. No.:65952393/65952394
helplib@vsnl.com
http://www.healthlibrary.com
“The flaw in the pluralist heaven is that the heavenly chorus sings with a strong upper-class accent.”
Bravo Maggie! Another excellent contribution to the health reform chorus.
AMA PACs dwarfing spending by PhRMA, who would thunk that was possible?
Gregg, Merrill, Aniruddha,
BW, Don, NG,
When people are writing such thoughtful comments toward the end of August, I’m impressed. Thank you very much.
Gregg–
Thanks.
And yes, it is surprising that AMA outspends Pharma. . .
But the AMA does have a huge amount of money.
Merrill– Very good to hear from you.
The slaveholders were, indeed, a “special interest group.”
The parallel to education is interesting. And you’re right–while the states have declared the right to education for everyone, they haven’t done the same for healthcare, except for seniors and, begrudgingly, the poor. (Southern states only agreed to Medicaid for the poor if Medicaid doctors wouldn’t be paid as much as doctors who took Medicare.)
But . . .I hate to see us reduced to letting states legislate healthcare for all.
Though, there is certainly an argument to be made that this would be better than the current situation.
And I definitely agree that universal coverage, at a federal leve, is very far from a slam-dunk in the next two or three years.
On the other hand, when I look at the public education that states offer, it varies so widely.
And the same is true of state-administered health care– Medicaid and Schip
Some states are just too poor to proivde really good public education or Medicaid. Others just don’t care. I’ll always remember a doctor in Texas saying “This state never has, and never will, take care of its poor.” The same is said of Florida.
So while I think you are right to think that we won’t get national health reform in the next few years, I’d rather hold out and keeping fighting, rather than turning it over to the states.
In the meantime, I’m focusing on Medicare reform, and would fight very ,very hard to have Medicaid and Schip folded into Medicare (as a federal program, with the states contributing what they contribute now).
That way, we could do our best to save our poorest and youngest citizens now, while waiting for universal coverage to be done right.
I’m afraid I have to stop now–but I’ll come back to respond to other comments later this evening or tomorrow . .
Thanks for the focus on the Lemann piece which raises an interesting and provocative point — one I’m closer to agreeing with than you are.
Who speaks for the patients? Well, a lot of folks claim to do so, ranging from the drug firms and insurers to the single payor advocates. Fact is the patients didn’t annoint any of them, tho they (not the contributors you list), did select folks to represent them in Congress. if they feel they aren’t well served, they can unelect them and find others to do a better job. the fact that they don’t do so suggests a general level of satisfaction.
as a small d democrat(large D also), I find the construct “x is too important to be left to politics” more than a little troubling. what isn’t? cleaning up the environment? ending the war in Iraq? Either you think that health is unique as a political issue, which is a broad and unsubstantiated assertion, or it is merely one of many complex issues too important to be trusted to our messy political system.
the reality is that this year’s election, which is about the economy mostly and the war secondarily, won’t result in any significant healthcare reform because the voters have made it clear that it isn’t a top priority of theirs. and if it isn’t a top priority for them, it won’t be for the candidates either.
finally, there’s a question of allocating resources, which the political system does in its messy way. if we accept your construct, who makes the decision about where the extra dollars the health system needs will come from?
Jim, BW, Don, NG, Alex,
Thank you all.
Jim: You write if people “feel they aren’t well served [by their Congressmen] they can unelect them and find others to do a better job. the fact that they don’t do so suggests a general level of satisfaction.”
Do you really think there is a “general
level of satisfaction” with your Congresspeople?
This from Gallup: “Approval of Congress has dipped below 20% for only the fourth time in the 34 years Gallup has asked Americans to rate the job Congress is doing. Today’s 18% score, based on a May 8-11, 2008 Gallup Poll, matches the record lows Gallup recorded in August 2007 and March 1992.”
The question was: “Do you approve or disapprove of the way Congress is handling the job.”
In theory,of course,you are right. Our Congressmen are our elected reps and they should, as a group, represent the “public good”–even if as individuals they have different ideas of what the public good is.
But something has gone badly awry in our electoral process. Many Americans believe that any one who runs for Congress is probably a crook–which is why so many don’t bother to vote.
They believe that politicians represent themselves, their own interests and the special interests that contribute so handsomely to their campaigns.
And I’m afraid that, in many (but far from all) cases they are right.
Campaign reform is another one of those complex issues this is, I’m afraid, too important to be left to Congress. But we need someone to appoint a non-partisan commission (like the 12 person commission that decided base closings, or MedPac, or the group up in Norwalk, CT.that oversees accounting rules) to address campaign reform. Maybe the
Comptroller General could do it since it is, in the end, a financial issue (He appoints the members of MedPac and has done an excellent job), or maybe the Attorney General insofar as it is an issue of corruption.
What we need, I believe, is much, much shorter campaigns (limited by law to a certain number of months) and a ban on television advertising (since those quick spots provide very little information and are too often used merely to smear someone with misinformatioin.)
Televised debates would be encouraged, with either the network donating the time, or the government paying for it.
We could look to other countires, like the UK, where campaigns are far shroter and much less costly for ideas.
If campaigns were much shorter, and there were no TV ads, they would be far less expensive. IF the need for campaign contributiions were less, lobbyists would have much less power.
I’m afraid that Congress has failed to pass legislation representing the public good for years:
the fact that it allowed the executive branch to lie its way into Iraq is just one example; poverty rates are up; children are the poorest group in this nation; we are the only developed country in the world without universal heatlh care; we have ignored global warming; our inner city public schools and schools in poor rural areas are a disagrace; many of our suburban schools are not much better in terms of what they teach. (Consider the writing ability of the average senior graduating from a public school in, say, Westchester County.)
BW Sharp–
Thanks–I agree with much of what you say. I disagree, however, as too whether we need more doctors.
We need a better distribution of physicians nationwide, and we need more primary care docs and fewer specialists.
We have more than two decades of reserach showing that too many specialists in certain areas drive overtreatment–which is not only costly, but hazardous to our health.
Clearly you are very intersted in health care and well-informed. See
http://dartmed.dartmouth.edu/spring07/html/atlas.php.
and
http://dartmed.dartmouth.edu/winter07/html/braveheart.php.
I think you’d find them interesting.
Don — the problem is that, by law, American corporations are supposed to put the intersts of their shareholders first, and that means growing earnings.
The economist Milton Friedman famously wrote:
” . . there is one and only one social responsibility of business- to use its resources and engage in activities designed to increase its profits so long as it stays within the rules of the game, which is to say, engages in open and free competition, without deception or fraud.”
Now I don’t happen to agree wiith him, but many people do–and that is the capitalist system we live in.
NG– The people who run corporations believe that when they or their families become sick, they have enough wealth and enough power that they will be able to get the best care available.
And in many cases they will be right. Though the “best care available” may not be as good as they think. They too can fall victiim to medication-mix-ups, hospital-acquired infections, etc., even at our most expensive medical centers.
But they don’t realize this. These tend to be the people who insist that America has the best health care in the world.
Alex– I take it you are saying that this post didn’t need to be written–that it has been said before.
That may be the case, but we, as a society, haven’t yet absorbed the message. I’m afraid someone needs to continue to repeat it.
I NEED YOUR HELP!
I have been invited to give a talk this October in the United Kingdom to physicians of their NHS (National Health Service).
IS THERE ANYTHING ABOUT THE US HEALTH CARE SYSTEM WHICH YOU WOULD RECOMMEND THAT THEY ADOPT FOR THE NHS??
There are people in the UK who think the NHS should be adopting more of a market based approach and think there are parts of the US health care system which they should be incorporating into their system.
Dave Hibbard, MD drdave@indra.com
Dr. Dave–
I would be very interested in knowing who is inviting you and sponsoring the talk.
Do they have anything to gain (financially) by the UK switching to a more market-based approach?
There are things about U.S. healthcare that are good–and better than in the U.K. But they don’t have to do with our “market-based approach.”
I can’t readily think of any way that the market makes the difference.
What does make a difference is that we spend so much more (2.4 times more, per person, than the average developed country.)
If the U.K. spent more, they would have shorter waiting times, etc. I know they have been putting more money into health care recently and that as a result, things have been improving.
But they have to make sure they spend it wisely. NICE
–the group that compares the effectiveness of products and services before deciding what to cover– has, by all accounts, been doing a good job.
If they incorporated more of a market-based system, there is no question but what some people could make more money. But that doesn’t translate into better care. . .