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.

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