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« Old Age Kit | Main | Spring Flowers »

March 21, 2008 |Permalink |Comments (0)

Cost and Value

Nice conversation going on about the fundamental goals of health care reform...

This post from Ezra Klein's blog draw an important and often overlooked distinction. If you like thinking about our health care system and how it can be improved, his blog is a great place to start. He is reacting to a post written by Kevin Drum...

How Kevin was able to get an early glance at my next tattoo is anyone' guess (I had the whole thing translated into kanji, too!), but that's a pretty perfect description of how I understand the role of the progressive health reformer. It's also why I joke at panels that my plan for health reform is invading France and taking their system. I'm down with no blood for oil, but I'd give some blood for universal coverage.

Meanwhile, a quick thought on cost control: When talking about costs, folks need to distinguish whether they're talking about getting more value for each dollar or reducing total spending. The two might not be the same. Prevention, for instance, gets far more value out of each dollar. But if it keeps people alive a whole lot longer, that's more time for them to contract various illnesses, and when they grow old, to die from something expensive. So though prevention may mean our health dollars are doing a whole lot more good, it may not mean we're spending less as a total percentage of GDP. Conversely, we could outlaw coverage of statins, which would save some money, but kill a lot of folks. Now, I'm not saying the two ends are opposed. Indeed, getting good value is probably a complementary goal to spending less. But it's not the same thing.


Getting more is not always necessarily better than getting less of something. We want better health care (and better measures of health) rather than just getting more care- regardless of its ultimate impact on public health.

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