Monday, September 8, 2008

A Different Shade of Gladwell

So I decided since the last article I posted was 8 years old that I would see if Malcolm Gladwell has written more recently in regards to health care. He has and he's flip-flopped! He decided that his previous arguments made with Adam Gopnik were based on the money put into the health care system, i.e. funding problems rather than systemic problems. I really respect Malcolm Gladwell's opinion because his book The Tipping Point really changed the way I think. I want to post a link to his blog stating his current (still 3 years old) opinion on this issue. He says our government blocks any attempt to socialize our health care system (there have been about 6 attempts so far) because of what is called "moral hazard." The idea here is that if people have insurance for something they tend to use it more frivolously thereby adding inefficiency and waste to the current system. He disputes moral hazard using logic, case studies, and statistics. Here is a link to the post: The Moral Hazard Myth

Also, in response to my first post on SiCKO, my cousin Brad proposed the possibility of using an actuarial system analogous to car insurance to help move past our current dilemma. I thought that was a very novel idea. Gladwell addresses this idea. I thought what he said was interesting so I'll cut and paste it here:

"There is another way to organize insurance, however, and that is to make it actuarial. Car insurance, for instance, is actuarial. How much you pay is in large part a function of your individual situation and history: someone who drives a sports car and has received twenty speeding tickets in the past two years pays a much higher annual premium than a soccer mom with a minivan. In recent years, the private insurance industry in the United States has been moving toward the actuarial model, with profound consequences. The triumph of the actuarial model over the social-insurance model is the reason that companies unlucky enough to employ older, high-cost employees—like United Airlines—have run into such financial difficulty. It's the reason that automakers are increasingly moving their operations to Canada. It's the reason that small businesses that have one or two employees with serious illnesses suddenly face unmanageably high health-insurance premiums, and it's the reason that, in many states, people suffering from a potentially high-cost medical condition can't get anyone to insure them at all.

Health Savings Accounts represent the final, irrevocable step in the actuarial direction. If you are preoccupied with moral hazard, then you want people to pay for care with their own money, and, when you do that, the sick inevitably end up paying more than the healthy. And when you make people choose an insurance plan that fits their individual needs, those with significant medical problems will choose expensive health plans that cover lots of things, while those with few health problems will choose cheaper, bare-bones plans. The more expensive the comprehensive plans become, and the less expensive the bare-bones plans become, the more the very sick will cluster together at one end of the insurance spectrum, and the more the well will cluster together at the low-cost end. The days when the healthy twenty-five-year-old subsidizes the sixty-year-old with heart disease or diabetes are coming to an end. "The main effect of putting more of it on the consumer is to reduce the social redistributive element of insurance," the Stanford economist Victor Fuchs says. Health Savings Accounts are not a variant of universal health care. In their governing assumptions, they are the antithesis of universal health care.

The issue about what to do with the health-care system is sometimes presented as a technical argument about the merits of one kind of coverage over another or as an ideological argument about socialized versus private medicine. It is, instead, about a few very simple questions. Do you think that this kind of redistribution of risk is a good idea? Do you think that people whose genes predispose them to depression or cancer, or whose poverty complicates asthma or diabetes, or who get hit by a drunk driver, or who have to keep their mouths closed because their teeth are rotting ought to bear a greater share of the costs of their health care than those of us who are lucky enough to escape such misfortunes? In the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be. The reason the United States has forty-five million people without coverage is that its health-care policy is in the hands of people who disagree, and who regard health insurance not as the solution but as the problem."

Please respond with any additional insights, any differences in opinion, etc. and help move this discussion forward. I am still far from coming to any sort of conclusion on the matter.