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Spheres of Reform

August 12, 2009

Dr. Weil has recently begun blogging for the Huffington Post. While much of the recent health care debate has focused on affordability, Weil argues in his first post that politicians on both sides have wrongly diagnosed the problem with American health care:

But what’s missing [from the debate], tragically, is a diagnosis of the real, far more fundamental problem, which is that what’s even worse than its stratospheric cost is the fact that American health care doesn’t fulfill its prime directive — it does not help people become or stay healthy. It’s not a health care system at all; it’s a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction more broadly.

It’s impossible to make our drug-intensive, technology-centric, and corrupt system affordable. Consider that Americans spent $8.4 billion on medicine in 1950, vs. an astonishing 2.3 trillion in 2007. That’s $30,000 annually for a family of four. The bloated structure of endless, marginal-return tests; patent-protected drugs and “heroic” surgical interventions for virtually every health problem simply can’t be made much cheaper due to its very nature. Costs can only be shifted in various unpalatable ways.

I am highly sympathetic to Weil’s critique and wish that more physicians practiced his brand of integrative medicine. Still, whatever the limitations of Western medicine, I am not sure that Washington is the best place for this type of reform. However urgently needed, reform along the lines Weil urges seems to me a job for health care professionals rather than politicians.

Which isn’t to suggest that Washington take a hands-off approach. Rather, the salient political question here, as elsewhere, is: “who gets what?” It is for the medical profession to decide what type of care patients will receive, and for the politicians (and possibly markets) to decide who will receive care, and how to pay for it. Similarly, the political question with respect to education is how much funding a particular university ought to receive, rather than whether or not that university ought to continue offering courses in the Finnish language.

Obviously, the advice of economists will play a role in addressing “who gets what?” questions. In this respect, even the most purely political decisions depend on outside knowledge. At the same time, economics alone cannot answer the question as to how resources ought to be distributed, only point out likely outcomes to specific policy proposals. “Who gets what?” is, in other words, as much a philosophical as it is an economic question.

Ultimately, what we need is cooperation between knowledgeable professionals and philosopher kings.

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