February 2007 | Back to Table of Contents
Editor's Note
An Unreasonable System
Historian Thomas Carlyle once dubbed economics “the dismal science.” I know I certainly thought it was in college as I slogged through Paul Samuelson’s Economics 101 textbook. Tidy supply-and-demand curves and compact phrases such as “price elasticity” cloaked complex, almost mystical relationships that allegedly described how societies use money. But as I tried to tie those pat concepts to daily headlines about the U.S. economy, I found that they didn’t fit reality, and I harbored the suspicion that economic theory was all smoke and mirrors and that economists had built a pseudoscience with a lexicon of babble intended to bamboozle the uninitiated. The first President Bush labeled supply-side economics “voodoo economics”; but for some of us, all of economics has seemed as scientific as sticking pins in dolls.
Perhaps no segment of the economy is as dismal and incomprehensible as health care. In the United States, health care is like that gigantic boulder in the television commercial rolling down the streets of Manhattan, gobbling up cars and people, knocking down buildings. Health care is currently gobbling up 16 percent of our gross domestic product and shows no sign of being satiated. If its relentless expansion isn’t stemmed, it threatens to knock down other pillars of our economy. And no one seems to know how to slow, much less stop, it. Somehow, all the curves and theories have failed for decades to decipher the turmoil that is the health care economy.
Economists as well as politicians and consultants offer solutions du jour to derail the health care monolith. The pet idea this year is pay for performance, an attempt to measure and reward what physicians and hospitals do (see p. 30). Following Adam Smith’s rule that competition holds down costs, recent remedies also aim to reinsert competition into the health care equation. Yet many analysts say health care doesn’t follow the rules of the market with some believing competition has escalated, rather than controlled, costs (see p. 26). And the idea of the single-payer system is like the Energizer bunny, still going thanks to a dedicated band of believers who bang their drums but never really capture a sizeable following.
Many who labor in health care fields yearn for reason and simplicity. It is unreasonable that 46.6 million Americans have no health insurance, that seniors still spend a substantial proportion of their income on health care, and that Medicare and third-party payers continue to micromanage the care physicians deliver, implying that physicians are either ignorant, self-aggrandizing, or outright fraudulent. It is unreasonable that multibillion-dollar corporations have captured a huge chunk of the health care dollar as payment for basically transferring money from patient to provider and that health care corporate executives’ compensation is egregious if not criminal. Our health care system should be more reasonable and simpler.
Searching for simple solutions to intricate problems may be a quixotic quest, but I would suggest starting by talking to the players at the center of health care economics: patients and providers. What do patients want? Compassionate, quality care from providers they trust at a price that won’t bankrupt them. What do providers want? The freedom to use their knowledge and skills to care for their patients while making their own financial ends meet. Their simple needs are buried in a system of big players, conflicting interests, and inefficient processes that waits for some brilliant economist to turn the dismal into daylight.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at cmeyer1@fairview.org.