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Saturday, January 15, 2011

Getting down to the messy details

I good friend of mine sent me this link from  the Washington Post today. The piece is titled:

Basic' gets tricky in the health-care law -

by N.C. Aizenman

It starts off with:

Should health insurers have to cover treatment of Lyme disease? What about speech therapy for autistic children? Or infertility treatments?
Can they limit the number of chemotherapy rounds allowed cancer patients? Or restrict the type of dialysis offered to people with kidney disease?  This week an independent advisory group convened by the Obama administration launched what is likely to be a long and emotional process to answer such questions.
And the piece ends with:
After hours of testimony, the panel's chairman, John Ball, seemed to find only one point on which everyone could agree: "We have an impossible job."

This should come as no surprise.  Richard Epstein clearly articulated this almost 15 years ago during the controversy surrounding ClintonCare. In his classic "Mortal Peril" (published in 1997), he describes the barriers to implementation of positive rights.
The creation of minimum standards is moreover, a far more daunting enterprise than its modest label might suggest. Someone must specific the minimum....Minimum standards quickly transform themselves into "decent minimums" precisely to avoid these Malthusian overtones. Once disconnected from elemental survival the standards creep towards even higher minimum standards... The vast expansion of the overall level welfare rights has been well documented...

He goes on to describe our present circumstances exactly.
The demand for a system of minimum rights also creates manifold difficulties for figuring out how to equate marginal benefits and marginal costs, and the problem is endemic to any system of positive rights to health care. Initially there are no accurate prices for measuring costs and no observable metric for measuring benefits, and none for rationing service.
The more things change the more they remain the same. Perhaps before we pass a law requiring minimum standards we should at least have a process which can define what we are mandating. Who will make these calls and upon what metrics? What is the wisdom of creating an entitlement which is based upon executing an impossible task as the first step in deployment.

1 comment:

  1. Everyone agrees to cut unnecessary and excessive care, except their own.