tag:blogger.com,1999:blog-4613208088679850968.post1202191869506621791..comments2010-06-18T10:20:30.235-07:00Comments on Dynamic Equilibrium: What is the "crisis" mean in the phrase "Healthcare Crisis"?misskathylinhttp://www.blogger.com/profile/10905964267127834096noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-4613208088679850968.post-73310640969457089492009-06-19T06:04:34.708-07:002009-06-19T06:04:34.708-07:00As much as it's a cliche, I think the answer t...As much as it's a cliche, I think the answer to your last question has to be... Comparatively! One of the article's great strengths was the shadow comparison to a closely matched community (same state, same demographic profile, radically different healthcare costs). I think similar tricks could be used at other levels of analysis, and could aid in constructing policy as well as analyzing where things are going wrong. For example, Canada and Europe are both aging as well, and Europe faster than we are (right?). And their costs are rising (I think), but they aren't spending as much as we are...<br /><br />On the other hand, there are some arguments (and I don't have a clue how valid they are - maybe you do?) that the US's extravagant health care spending, in part, subsidizes the rest of the world. Drug companies sell lots of expensive drugs here, letting them do enough R&D to make new drugs, surgeons test new procedures, etc. I don't imagine that these costs actually account for most of the gap (as compared to the sorts of things discussed in the article, e.g. overly expensive and overly aggressive treatment based on the logic of profits not best practices). <br /><br />More broadly though, what's interesting about this whole set of questions to me is that they get at the core of the paradox of liberal (in the old sense), enlightenment thinking: we want to make decisions for ourself, and imagine that's possible and good. And yet, as Polanyi so nicely puts it, we live in a "complex society" filled with interdependence and we have to make decisions relying on the expert knowledge of others. For this reason, Polanyi rejects both communism and the free market as utopic - both imagine a world without power, where individuals make freely unconstrained decisions. Instead, P argues that we have to ask ourselves, what does freedom mean in a complex society? <br /><br />Or as one blogger put it (approx): we have a choice between rationing care poorly and rationing care well. There's no choice that doesn't involve some kind of rationing. Our current system pretends as if no one has to make allocative decisions except individual doctors and patients, but that can't hold. Just asking these questions, and forcing actors at each level to think about them, is an important start.Danhttps://www.blogger.com/profile/07507086207394551238noreply@blogger.com