Re-Blog: NEJM’s Fundamentals of U.S. Health Policy, Part 7b: Dr. Chistensen’s Commentary on Creating a More Efficient Delivery System

2021.04.28 Chess_set_2014

I am happy to re-blog this post from fellow blogger Taylor Christensen MD, PhD. His basic point is well taken: The U.S. healthcare system could benefit from more competition. His corollary is that in at least a few cases, healthcare purchases should not be left to a competitive market.

Two points that I would add to his brief commentary:

  • A key policy challenge is to discern which cases should be left to the market and which should be treated like “public goods.” (See for example post)
  • In this post, Dr. Christensen somewhat trivializes the third-party insurance system as simply a sop to short-sighted employees who demand first-dollar coverage of low-benefit services. This claim aligns with the original premise of Fixing U.S. Healthcare blog (See post and post). However, I would invite Dr. Christensen to consider this blog’s subsequent more nuanced and darker claim that the healthcare insurance industry – and now the healthcare system itself — is a creature of government regulation, laws, and policies. In turn, government regulation and policies are a reflection of powerful corporate and political forces, influenced (some say controlled) by the very interests they regulate. This blog has come to the conclusion that this vicious cycle can only be broken by a popular movement, working through representative government. Only then could the healthcare system be freed from anti-competitive forces, a goal shared with Dr. Christensen. Only then can there also be a rebalancing between costs and benefits and between individual goods and public goods.

Enjoy this re-blogged post.

Image Credit

Title:  Chess set 2014

By:  Conal Gallagher


License:  CC BY 2.0 <;, via Wikimedia Commons

Clear Thinking on Healthcare

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In last week’s post, I summarized this article, which is the last in the Fundamentals of U.S. Health Policy series published by The New England Journal of Medicine. The article was written by Michael Chernew, Ph.D., and discusses the role of market forces (more specifically, competition) in improving our healthcare delivery system.

I’m heavily biased toward using competition inasmuch as it is possible (for good reason), but that doesn’t mean I’m blind to our failed attempts at improving competition in healthcare. And Dr. Chernew does a great job summarizing many of those failed attempts while remaining optimistic that competition still has a role in improving our healthcare delivery system.

I completely agree with his conclusion that where the market fails, we need government involvement. It’s a conclusion that is commonly agreed upon amongst researchers in this field.

But the difference between…

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The Pope & Healthcare Reform

This blog has taken the position that healthcare reform is compelled by practical considerations and by economic considerations. Although having health insurance extends and saves lives, this blog has not based its argument solely on that moral premise. I am reposting this report from the Catholic News Service to acknowledge that others in the discussion … Continue reading The Pope & Healthcare Reform

The Racial Argument Against Healthcare Reform

Perhaps the most potent argument today against healthcare reform is racial. Let’s look at the argument, and see how it stands up. The argument goes like this: Non-whites are inferior to whites, not worthy of sharing in the “common good” reserved for whites.Giving a societal benefit to non-whites subtracts an equal benefit from whites – … Continue reading The Racial Argument Against Healthcare Reform

Is the Texas Power Grid Failure a Metaphor for Blocked Healthcare Reform?

Here’s why the Texas power grid failed. This story sounds hauntingly similar to why healthcare reform has failed so far. It reminds us of what must be done to fix both. The system experienced rapid growth in the mid-20th-century. Investors used legal and political maneuvers to shield themselves from government oversight and to protect their … Continue reading Is the Texas Power Grid Failure a Metaphor for Blocked Healthcare Reform?

NEJM’s Fundamentals of U.S. Health Policy, Part 3: Do We Spend Too Much?

I admire Dr. Christensen’s posts, and thank him for featuring this series from New England Journal of Medicine! The NEJM authors claim — that some services have higher value than others — was the central thesis of Fixing U.S. Healthcare blog. My blog has highlighted the Oregon Health Plan of 1994, which used cost-benefit analysis to guide public policy in a tight-budget atmosphere. I will point out that Gov. John Kitzhaber (M.D.) began this plan as a purely economic project, but soon encountered the political reality that citizens assigned some values based on non-monetary (ethical, social) criteria! I invite you and your followers to check out “The Big Fix” and “The Problem of Diminishing Marginal Benefits in Healthcare.”

Clear Thinking on Healthcare

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This next part in The New England Journal of Medicine’s fundamentals of health policy series is written by my favorite health policy writing duo–Drs. Baicker and Chandra. They both do amazing research independently, but when they work together to write an article, it seems to be extra insightful and interesting.

Their task with this article is to help people think deeper than the simplistic sentiment, “The U.S. spends way more than every other country on healthcare; we need to cut back, and any increase in spending is wasteful!”

Key insight: Only looking at the aggregate number obscures many important facts about our healthcare spending; digging a little deeper totally changes the conversation.

Here are my favorite examples of this from their article:

  • As nations grow richer, they spend more on healthcare. So, based on that alone, the U.S. would be expected to spend more…

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