In an effort to get up to speed on healthcare economics, I purchase Victor Fuchs' _Who Shall Live?_ and Arnold Kling's _
Crisis of Abundance: Rethinking How We Pay for Health Care
_ together in hopes of obtaining a balanced view of the subject. I was not disappointed in either book.
Fuchs' book was originally published in 1975, but now contains new material added in the wake of the Clinton era attempt at creating universal health care. Regardless, the original material is just as valid now as then. Fuchs outlines the roles of patients, doctors, hospitals, drugs, and financing in contributing to the costs of health care. It is written by an accomplished health care economist, but for the laymen, so mathematics does not show up frequently. In clear terms, Fuchs goes through a number of standard arguments, providing data to back up the arguments that show that some standard arguments are correct and some are wrong. After reading this, the most rabid pro-universal health care enthusiast should have their expectations tempered. I don't know if the most rabid enthusiast against universal health care will be won over by his arguments in favor of some type of system. Yes, he is in favor of something; though it is not clear that he would support any of the current proposals, it seems very clear that he is against some of the arguments used to support those proposals.
Kling's book was written much more recently. Kling's approach requires a great deal more understanding by his audience of some of the mathematical and economic arguments offered. Kling offers more specifics in the way of policy proposals, but I'm not sure how realistic they are.
One thing that both men seem to agree on is that the current system is far to prone to apply too much expensive technology for too little return. We are nearly to the point where doctors will order an MRI scan for a hangnail on the basis that we don't want to overlook something (and besides, "someone else" is paying for it). Insurance against catastrophic, unexpected, high expenses has given way to a system in which everyone wants insurance to pay for band-aids for their boo-boos. Doctors are unusually resistant to scientific management (including standard practices and checklists) and more likely to "go with their gut", follow tradition, or make moral cases for heroic efforts for every case no matter how slight the effect on outcome. Because of this, there is as much variation in costs and life expectancy between regions in the US as there is between the US and European countries (and there is as much difference in infant mortality and life expectancy between income groups in Great Britain as in the US). So both seem skeptical about the influence of finance or maintaining a commitment to insulating the average person from cost, both seem to emphasize that we should concentrate more on helping the very poor and very sick, and both seem to think that a health care plan should include some commitment to a research body that endorses (not mandates) standard approaches to diagnosis. I was surprised that neither put any emphasis on tort reform.
I enjoyed both books and found something to think about in each, but if I had to pick one to recommend to people to come up to speed on the issue, it would be the Fuchs book.
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