Megan McArdle at the Atlantic looks at the unforeseen consequences of "universal health care' in the state of Massachusetts. Believe it or not, expanding the public net of coverage has the effect of driving up health care costs. Imagine that. Coupled with the fact that there aren't nearly enough primary care doctors to provide care for the massive influx of new patients, a financial and public-relations disaster is brewing in the old Commonwealth.
So now a commission appointed by the governor is exploring the political feasibility of capitation as a solution. Capitation means that an arbitrary cap is placed on the amount of health care one can receive over the course of a year. Once you hit your limit, you're out of luck. It's an awful proposal, of course, representing the worst of human commodification and rationing.
I find it interesting that when we discuss the issue of cost in the health care debate, everything always boils down to the potential abuses of a fee-for-service system where proceduralists are incentivized to do more, inject more, excise more, radiate more. It is the greedy doctor's fault. And the solution is simply to cap the amount that can be spent on individual patients. Certainly you're going to deleteriously effect a proceduralists income by capitating, but you're also potentially compromising individual patients. What about the diabetic fifty year old who suffers from incapacitating biliary colic, needs her gallbladder removed, but has already exceeded her spending limit just from her expensive medications and other health care needs? Who's going to electively do her lap chole for free, with all the inherent risks?
Peter Orszag et al (along with articles on McAllen, Texas practices) have successfully demonized physicians as the source of the cost problem. But if something is expensive, why in health care do we attribute that cost simply to the utilizers (doctors/patients)? What about the producers who stand to gain the most profit from the current system? Where is the outrage against Big Pharma and the medical equipment industry (Stryker, Medtronic etc)? Why are caps set on the amount of (cheaper) prescription drugs that can be imported from foreign countries? Where is the populist rage about $3,500 MRI's? Could it be that political clout carries the day in contemporary American politics? That it's easier to go after the fractured, disunited physician lobby?