tag:blogger.com,1999:blog-8573839334358190868.post3935113218980901521..comments2024-03-29T02:48:49.906-04:00Comments on The Apothecary: Health Care is DivisibleAvik Royhttp://www.blogger.com/profile/17800177830841080188noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-8573839334358190868.post-25196668046536181132021-01-05T03:53:00.150-05:002021-01-05T03:53:00.150-05:00In my opinion, the article above contains very use...In my opinion, the article above contains very useful content. The author is able to explain well.Lailahttps://uma.ac.id/noreply@blogger.comtag:blogger.com,1999:blog-8573839334358190868.post-53479854558586200612010-09-03T16:13:50.895-04:002010-09-03T16:13:50.895-04:00Hi Steve,
Not sure that you are completely unders...Hi Steve,<br /><br />Not sure that you are completely understanding the concepts -- which isn't your fault because I haven't directly articulated them. I was planning on doing so anyway in a future post, so stay tuned. <br /><br />Broadly speaking, in a free market, people buy things with the information they have. If they don't have enough information, consumers naturally gravitate to those sellers who provide the most information. Where necessary the government can help aid efforts at disclosure and transparency (the SEC is a good example of this).<br /><br />Stupidity is not sufficient reason to void the free market, nor is emotionalism. If I buy my daughter a puppy, purely for the reason that she is begging me for one, even though I know the puppy is going to be a big pain the butt to take care of, this may be an emotional decision, but the fact that it is emotional is not sufficient justification for a government takeover of the puppy market.Avik Royhttps://www.blogger.com/profile/17800177830841080188noreply@blogger.comtag:blogger.com,1999:blog-8573839334358190868.post-11240454930985872152010-09-03T14:51:12.736-04:002010-09-03T14:51:12.736-04:00". The fact that some decisions may have emot...". The fact that some decisions may have emotional components do not disqualify them from being functional in a free market.<br /><br />2. The fact that dumb (or unwise) people make bad decisions, also, is true in every field of human endeavor. Freedom means giving people both the freedom to be smart and stupid."<br /><br /> You are contending that even in a market where a large percentage of people, in my experience probably a majority, either do not understand what they are buying, or under sufficient emotional duress to affect decision making, will still be able to create an efficient market? I think if you start back with Smith, we see markets working very well as he observed, but then people did not buy things that were not understood. I believe that has changed. I also believe that we have many examples of emotional responses driving markets to irrational or exaggerated responses. However, I would be interested in other people's ideas. Would you mind if I asked this question of a few of the econ bloggers like Cowen or Kling?<br /><br />Stevestevehttps://www.blogger.com/profile/14470634215313696595noreply@blogger.comtag:blogger.com,1999:blog-8573839334358190868.post-32371155539719957222010-09-03T14:28:33.504-04:002010-09-03T14:28:33.504-04:00Hi guys,
1. The fact that some decisions may have...Hi guys,<br /><br />1. The fact that some decisions may have emotional components do not disqualify them from being functional in a free market.<br /><br />2. The fact that dumb (or unwise) people make bad decisions, also, is true in every field of human endeavor. Freedom means giving people both the freedom to be smart and stupid.<br /><br />3. Markets are an accurate pricing mechanism, and also the best way to drive prices as low as sustainably possible. Markets have many other salutary features -- most importantly, that they are driven by voluntary decisions.<br /><br />4. Brad -- you're right to ask the quantitative question. It's something worth exploring, once we have firmly established how to segregate the categories of spending. There are plenty of data sources one can use to make the required calculations, but first I want to spend more time on the philosophical question of what should be in which bucket (something that we are currently debating).Avik Royhttps://www.blogger.com/profile/17800177830841080188noreply@blogger.comtag:blogger.com,1999:blog-8573839334358190868.post-68589525879155319352010-09-01T21:10:36.339-04:002010-09-01T21:10:36.339-04:00"and those where high impact decision making ..."and those where high impact decision making may be moderated a bit for reasons related to sophistication, cognitive ability"<br /><br /> Add in emotional difficulties, acute and chronic. Some days it seems like all of my patients are taking anxiolytics and/or anti-depressants.<br /><br />Stevestevehttps://www.blogger.com/profile/14470634215313696595noreply@blogger.comtag:blogger.com,1999:blog-8573839334358190868.post-91609440615095005532010-09-01T20:15:53.404-04:002010-09-01T20:15:53.404-04:00Avik
To advance the discussion, can you get a bit ...Avik<br />To advance the discussion, can you get a bit more data driven.<br /><br />What percentage of health expenses could be categorized as discretionary versus non, ie, responsive to consumer directed decisions?<br /><br />Factor in EOL care, dual eligibles, low SES, folks with >5 chronic diseases (all not mutually exclusive), and those where high impact decision making may be moderated a bit for reasons related to sophistication, cognitive ability, etc. <br /><br />Contradictorily, what level of spending could potentially accrue to engagement in shared decision making, patient directed care, and ability to participate in delivery process?<br /><br />Opinions and conjecture wont advance discussion, not that I am putting any numbers on the table, but what data have you come across to parse out?<br /><br />Thanks<br />BradAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-8573839334358190868.post-12896498087300322002010-09-01T14:37:38.673-04:002010-09-01T14:37:38.673-04:001) Mortality for total hips is about 0.2%. How man...1) Mortality for total hips is about 0.2%. How many other things do we do with such a high mortality risk? Depending on how you define it, mortality for major surgeries runs around 0.5-2%. Of course, you do numbers for a living. I like numbers. When I tell a mother that her child has a 1 in 100,000 risk of dying when I take away her infant, what do you think she hears? I know what a lot of them hear since we regularly get complaints that we told someone there kid might die. <br /><br />2) There are concerns besides mortality. Paralysis (most young men in particular really fear this one), prolonged ventilation, loss of vision (big one now with all of the back surgeries), impotence and pain. I take care of lots of kids for MRIs. These moms are scared. The potential results scare them and having their kids anesthetized scares them. At least I assume that is why so many of them cry. (Actually, I often ask, so I am not just assuming.)<br /><br />"It would benefit those who believe that health care is incompatible with the free market to refine their arguments. A stronger liberal argument for socialized medicine would be: let’s let the free market reign in those areas of health care that are most like the rest of the market economy (i.e., non-catastrophic and elective care), and instead focus on socializing the aspects of the system that are most unlike the rest of the economy (i.e., catastrophic care)."<br /><br /> I strongly agree with the first part here. Outpatient (non-procedural) care and much chronic care could respond well here. I disagree with just the catastrophic part. I think that most major surgeries do not fit well. Many of the more expensive tests do not apply. Others seem like they could go either way, so I would prefer to run pilots to see.<br /><br /> BTW, we seem to have a fundamentally different view of markets. I view them as our best, most accurate pricing mechanism. You seem to view them as the way to the lowest price. Am I misrepresenting your belief?<br /><br />Stevestevehttps://www.blogger.com/profile/14470634215313696595noreply@blogger.com