A good documentary on health care: “Money-Driven Medicine”

I just watched Money-Driven Medicine this evening.  It’s a documentary about our profit-driven health care system that shows how money-making infuses and corrupts our system.  My fiancee, who works as a nurse at both a hospital and a doctor’s office, says that the film portrayed the system very fairly.  Here are a couple of things that stood out to me:

  • For the market enthusiasts: Repeating “we have the best health care system in the world” is not enough.  Idealizing free-market competition in the health care system doesn’t make sense to me.  One central point of the documentary is that the health care industry is based on paying for services.  This incentivizes all sorts of unnecessary tests and often turns doctors into dispensers of procedures rather than counselors who can help you improve your health and live a healthy lifestyle.  The most extreme example in the film was that Dr. Donald Berwick, who researches the health care system, called a hospital in Texas that advertised a great procedure.  He asked for information about it to share with other hospitals, but the hospital refused to share it because sole possession of the procedure gave them a competitive edge in their market.
  • For those who want to increase the role of government: It appears that the documentary was based on Maggie Mahar’s book of the same name.  Mahar said in the movie that you can trace the rise of medicine as an industry to the creation of Medicare in 1965.  This meant that medicine was big business, and businesses that built lots and lots of hospitals with lots and lots of technology and placed businessmen in charge of health care companies became the norm.  So that’s a serious challenge to the Democrats’ plans for more government involvement and money in the system.  Wouldn’t that suggest that companies will line up to get lots of money from the government as the government spends more?  It seems like the Obama plan will entrench the medical industry that much more, as some critics are saying.

I’d encourage you to watch the movie if you’re interested in this topic.  For now, it looks like it’s only free until the end of November, but maybe they’ll extend the free period.

Finally, an interesting way to look at the economy from Doug Wilson.  It’s an old post that I was reminded of when thinking about this:

We still have more capitalist traces and remnants than (say) Europe, but ours is a managed and manipulated economy, not a free economy. This means, in the long run, we have a system where subsidized and regulated business and officious government put their heads together and decide the best way to screw the little guy. In response, the little guy howls and, not having read basic economics, calls for the government to “do something.” The government is happy to pretend to do so because this bestows more power on them, and the government will then have more resources to work with the next group of lobbyists for this interest or that one. Free market?


One comment

  1. Sadly, it’s December and the video is no longer free. Sole possession gives them a competitive edge in their market! Darn that profit motive! 🙂 I have my own issues with the extent of copyright and patents, but it’s a bit ironic if that’s one of their beefs with the health care industry.

    I think people’s solutions to this issue derive from how they frame the core problem. If excessive profits are the problem, then profit/wage/price caps are the implied solutions. Perhaps likewise for “paying for services” but that seems like a vast over-generalization of the cause of unnecessary tests.

    IMHO, it is better to look further up the chain: why are we purchasing unnecessary or (relatively) poor or overpriced products? If lower cost alternatives with better care exists, why aren’t they being purchased? If they could exist, why don’t they?

    Framing the problem this way leads us to look for solutions which increase informed individual choice, transparency, and competition. Maybe that makes me a “market enthusiast”. I just don’t think we can escape market economics — products and innovation have (an often subjective) value regardless of whether we try to hide it behind government.

    Being not-for-profit is not unique to government (there are many non-profits), rather government’s unique power is that of coercion and the enormous black box of funds derived from that power that is often used to warp our perceptions of value.

    I agree with your Doug Wilson quote. Whether or not we have the best health care system in the world, I think our current health care system is a poor example of the free market. e.g. due to laws which limit competition and lead people to ignorance over the cost and value of services they “purchase” because they generally aren’t the ones actually purchasing it, and when they are, it is a bloated price, discovered after the fact.

    Payment and product should be in a tighter, more transparent loop, allowing well-informed individuals to decide what is best for them. The negative is that individuals are then responsible for their decisions. As a result, some cases will end sadly. It will also force us to distinguish health care, insurance, and charity, which, in the end, is probably a good thing.

    Mahar’s book seems to praise the VA system which does sound good for its technological advancements. Of course, we can’t just look at its current efficiencies in isolation; we must also include the full cost of conversion to a more efficient system.

    But at this point, if it is better, why not open it up to everyone? I think it could be done, but the government would have to restrict itself to only subsidizing the vets and not the entire hospital system, even as it remains not-for-profit.

    Here are a few more ideas I’ve been thinking about:

    (1) If software or hardware was designed for the VA, why not open-source it? It should be a condition of government funding that any source code and designs (and research?) be provided as public domain (or some other free license, at least for citizens). Other businesses own the designs they commission, why not We The People? Plus, this would lower the bar of entry for all other providers. It should be the role of government to encourage and integrate such standards and transparency, if not fund them.

    (2) A central best practices website, including an Expert System on the rules of diagnosis and treatments (linked to research) as a resource to help patients and doctors make good decisions. Its use should not be mandated, but the government might be able to use it to limit liability in some cases.

    (3) A central website tracking medical providers with patient and doctor comments and giving treatment rates for comparison. I think the government can have a valid role in informing people how to improve their health and at the same time increasing effective competition, again without relying upon mandate.

    (4) Maybe I need it explained to me, but why not open source the medical coding and other resources that are required to be used by law? More generally, the government should not create artificial markets.

    Argh. I fear I’ve lost the gift of concisionessitocity. As Pascal once wrote, “I have made this letter longer than usual because I lack the time to make it shorter.” Sorry about that. 🙂

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