Public health care policy

Imagine that you're interested in health care or public health. Or, perhaps, imagine you're a MD MPH PhD-candiate doctor working in an emergency room department in an urban hospital (though who would be that crazy?). In that case, you really should be reading Ezra Klein's blog. He has two really great blog posts today that I just must highlight. From the first:

Consumer-driven health care controls costs by pushing more spending onto the consumer so that they can afford less care. It rations by income. It's not even deceptive about this: That's literally what "skin in the game" means. When you're paying more for your care, your price sensitivity increases, which in turn makes you both less able and willing to pay for care, which in turn will make you more likely to purchase valuable care and discard bad care.

That, at least is what advocates hope will happen. Whether you believe them depends on whether you believe consumers can make smart care decisions, and whether you believe wasted care can be cut out by bluntly disincentivizing all care. But the cost controls here have nothing to do with innovation; they have everything to do with increasing financial exposure so we're less willing and capable to purchase medical services.

And from the second:

The LA Times reports that uninsured adults in Los Angeles are waiting more than a year for gallbladder and hernia surgeries. Indeed, the Harbor-UCLA medical center just told the county's clinics to simply stop referring non-emergency gallstone, hernia, orthopedic, or neurosurgery patients till the hospital worked through its year-long backlog.

The clinics, predictably, are responding by sending these patients to emergency rooms, further overwhelming ERs with patients in terrible pain, but not technically suffering from an emergency. Yet. So they're being turned away, though no doubt going into debt or having their wages garnished as they attempt to pay off the bills. Meanwhile, In the absence of the necessary surgeries, we're holding these folks together with belts and trusses -- literally

On the other hand, if you're the most powerful man in the world, here's your view on health care in this country:

People have access to health care in America. After all, just go an emergency room.

I feel healthier already. Don't you?