As a new wave of politicians head to Washington, including several doctors, the question arises what, if any, changes will we see to health care?
According to many of the new arrivals ‘Medicare for All’ is the solution to our problems. Is it?
Here, let me list some of the problems in health care, and what solutions might or might not work in the years to come.
People have difficulty accessing a doctor or there is a long delay. Many people have health questions and concerns and it is a challenge— even for those of us with insurance— to get the advise of a professional. The solution here is likely to be private markets and AI driven. These tools dramatically lower the barrier to ask medical questions, and the quality of the information surpasses most doctors. Technology and not government is best poised to address this. The potential to disrupt health care jobs and workflow and billing is massive— an existential threat to the status quo. Government is likely only to get in the way of this progress, rather than facilitate it.
Many novel drugs, devices and procedures debuted don’t work/ have harms exceeding benefits. The ACA has only exacerbated this problem by allowing lobbyists to add more and more unproven remedies, tactics, strategies and products to the public tab. The ACA caps insurance profits, discouraging them from year-over-year push back, and incentivizing them to grow health care spending. Given that it requires inordinate technical expertise to separate the wheat from the chaff, and given how easy it is to fool even folks with substantial experience in the space, this problem— a core problem in American medicine— is unlikely to be addressed in the near term. We will have more innovative and garbage products than ever before, and we will be unable to tell them apart.
Products and health care writ large costs too much. Government regulation or participation in insurance markets is undoubtedly the lever for the high and unsustainable price in health care. I have little confidence it will be value driven. In other words, I doubt that government will reduce spending on marginal goods and service and incentivize innovation and valuable services. Instead, very likely it will be done haphazardly and indiscriminately resulting in disincentives to make transformative products and marginal products alike. Medicare for all is one level, but I suspect the reality will be a broader mixed market solution (ala the ACA).
People have difficulty getting the latest and greatest therapies. Again, because we are unable to differentiate good vs marginal products, cost control will rely on tiered structures, arbitrary delays, etc. This will likely result in further frustration from the American consumer.
No matter all the health care in the world, people still die. Better diet and exercise are keys to living longer and better— the MAHA principles— and not health care itself. Additionally, better doctors don’t generate better outcomes— only better technology does. Patient disappointment may swell if government moves in the direction of a single payer.
Access, cost, and value are the core problems in medicine— the next decade may address some, but likely not all these concerns.
Thanks for this, Vinay. As you may know one of the Drs coming to DC is Richard Pan, the former CA state politician who championed one of your favorite policies, “Toddler Masking”, at daycares during the COVID times. He is a mandate lover through and through, and is one who thinks that “ experts “ , himself included of course, know what’s better for children than any parent does. He’s a real winner! Yippee! ( Insert a huge amount of sarcasm here!)
Government involvement beyond a moderate level, especially when funding endeavors, is almost always bad. Everything thing costs more than it otherwise would.