I could say that David Dranove’s Code Red is the best book I’ve ever read about the economics of health care but it wouldn’t be saying very much because I don’t think I’ve ever read any another book about the economics of health care. So I can’t do a strict comparison, but my guess is that it’s a pretty good book in any event—lots of particulars about what works and doesn’t work in health care and some (perhaps not enough) about what might be made to work in a new presidency.
And clarity: Dranove has a lot of that on offer, but with a catch. The catch—perhaps the central takeaway point of the whole book—is that health care is inherently complicated, a simply massive spaghetti-net of exceptions, qualifications, special cases and GOK what else. And yet even so, he doesn’t do everything: unless I missed it, there is not a word about what might be the most successful public health care program, the Veterans’ Administration (well, maybe an even better one is the one that Congress provides for itself, but it’s a special case).
If you had to get it down to a soundbyte, I suppose that one candidate might be “the rise and inglorious collapse of the HMO”—the “health management organizations” that swept over the landscape in the 90s, leaving almost everyone unhappy, and quickly receding on the advent of the “PPO,” the “preferred provider organization.” The PPO, if you haven’t figured it out yet, is supposed to be a kind of “HMO lite,” without the same level of consumer dissatisfaction, but perhaps also without the potential for economy tht the HMO was supposed to offer.
Dranove doesn’t waste a lot of energy regretting the failure of the HMO: he concedes, at least that they emerged as an administrative nightmare. He does argue, at least in passing, that HMOs were actually pretty good (or at any rate, not obviously bad) at health care, even if they were dreadful at paperwork. He does insist that the problems that HMOs were intended to solve remain with us: lack of meaningful quality control, or cost control.
Dranove does have one drab candidate for a pathway to improvement in both quality or price: more and better electronic data sharing. It’s astounding how often, 30 years into the computer age, doctors still do their paperwork with obsidian chips on sandstone (but I did see my internist with a laptop last month, first time ever for me).
He also suggests (channeling Burton Weisbrod) “that the most impoertang long-run engine of our healthcare system is technological change.” X-rays and antiseptics revolutionized medicine a generation ago; microsurgery and genetic tinkering may do it for the next.
--David Dranove, Code Red: An Economist Explains How to Revive the Healthcare System Without Destroying It (
No comments:
Post a Comment