Monday, July 6, 2009

Health care reform

I was at a professional conference last week (part of the reason for my brief blogging hiatus) and listened to a speech by Julio Frenk. He described five features of any health care reform that is likely to be successful. First, he proposed that the agenda for health care reform cannot stand on its own--it should be noted that it is a part of a larger agenda for economic recovery. This makes economic sense. In a country like the United States in which one of every six dollars is spent on health care, it will affect the whole economy.

Second, he proposed that the budget be carefully considered. He noted that many health care systems are underfunded. In the United States, we can debate whether we are spending enough right now--although most people thing we are spending too much--but we certainly do not have enough public funds to meet the future commitments we have at the moment.

Third, he suggested that we consider capacity. As an economist, I would simply want to clarify--capacity for what? As importantly, who will decide what capacity is being developed? Will it be a centralized government decision or something left to the market or something in between?

Fourth, he commented that we need to focus on deliverables. If nothing else, as an economist I can't even begin to ponder a cost-benefit analysis in which we compare the costs with the benefits if I don't know what the deliverables are.

Finally, he suggested that we focus on evidence. I don't know anyone who would argue with that--in principle. Sometimes the debate gets stuck on whether there should be any room for physician judgment.

These principles seem reasonable to consider (and make good economic sense) no matter what type of health care reform we end up with. What we still need to determine is the best way to get the system to achieve the goals our society (and we as individuals) have.

Click here for an audio version.

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