Congratulations to the Coyote whose blog has turned 9 years old on Sunday. For years I have been in the habit of amply stealing from Coyote's excellent offerings - mind you, always acknowledging the source. Today, I am celebrating the blog's birthday with another massive robbery:
Progressives are passing around this chart from Brookings as an indicator of "what is wrong" with the US healthcare system.

This is how Kevin Drum interprets the chart:
In other words, the supposed advantage of PRT—that it
targets cancers more precisely and has fewer toxic side effects—doesn't
seem to be true. It might be better in certain very specialized cases,
but not for garden variety prostate cancer.
And yet, new facilities are being constructed at a breakneck pace.
Why? Because if they build them, patients will come. "They're simply
done to generate profits," says health care advisor Ezekiel Emanuel.
Roger that.
This is an analysis that may be true, but let's take a moment to
consider how strange it is. Forget health care for a minute. Think
about any other industry. Here is what they are effectively saying:
- Industry competitors are making huge investments in a technology that has no consumer value
- The competitors in this industry are all making investments in this
technology so rapidly that the industry is exponentially over-saturating
with capacity.
And from these two facts they conclude that the profits of industry competitors will increase??
Let's for a moment say this is true -- an enormous investment that
has no customer utility and that is made by so many players that the
market is quickly over-saturated actually increases industry profits.
Let's take a moment to recognize that this is BIZARRE. We have to be
suspicious of some structural issue for something so bizarre to happen.
As is typical of progressives, their diagnosis seems to be that private
actors are somehow at fault for being bad people to make these
investments. But these same private actors, even if they wanted to,
could never make this work in any other industry, and besides there is
no evidence that hospital managers are any worse people than, say,
cookie company managers. The problem is that we have fashioned a
bizarre system through heavy government intervention that apparently
makes these pointless investments sensible to otherwise rational actors.
One problem is that in any normal industry, consumers would simply
refuse to buy, or at least refuse to pay a very high price, for services
that have little or no value. But in health care, we have completely
eliminated any consumer visibility to prices. Worse, we have eliminated
any incentive for them to care about prices or really even the utility
of a given procedure. This proton beam thingie might improve my
outcomes 1%? Why not, it's not costing me anything. Perhaps the
biggest problem in health care is that the consumer has no incentive to
shop. Obamacare does nothing to fix this issue, and in fact if anything
is taking us further away from consumer shopping and price transparency
by working to kill high deductible health insurance and HSA's.
There is only one other industry I can think of where capital
investment, even stupid capital investment, automatically translates to
more profits, and that is the regulated utility business. And that is
what hospitals have become -- regulated utilities that get nearly
automatic returns on investment.
In a truly free market, if these investments made no sense, one would
expect very soon a reckoning as those who made these nutty investments
go bankrupt. But they obviously don't expect this. They expect that
even if it turns out to be a bad investment, they will use their
political ties to get these costs built into their rate base
(essentially built into reimbursement rates). If any private or public
entity refuses to pay, you just run around screaming to the media that
they want to deny old people care and let sick people die. Further, the
government can't let large hospitals go bankrupt because it has already
artificially limited their supply through certificate of need processes
in most parts of the country.
The Left has proposed to fix this by creating the IPAB, a group so
divorced from accountability that it can theoretically make unpopular
care rationing decisions and survive the political fallout. But the
cost of this approach is enormous, as it essentially creates an
un-elected dictatorship for 1/7 of the economy. Which tends to be
awesome if your interests and preferences line up with those of the
dictator, but sucks for everyone else. Which category do you expect to
be in? (Oh, and let's not forget how many examples we have from history
of benevolent technocratic dictatorships - zero.)
The much more reasonable solution, of course, is to handle these
issues the same way we do in cookies and virtually every other product
-- let consumers make price-value tradeoffs with their own money.
The source.
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