So one view — the view that I hold — is that we need competing integrated providers. Granted, the case for integration is also the case that at least some on the left make for a socialized system modeled on the National Health Service in Britain or the VHA. It’s not obvious to me that a single government-run integrated provider would prove more effective than competing integrated providers, particularly since a single government-run integrated provider would be unusually susceptible to political pressures against, for example, the offshoring of medical diagnosis and treatment, the substitution of technology for labor, periodic reforms of staffing and compensation, etc.
The goal is thus not competition between insurers as we know them. Rather, it is to first, in Christensen’s words, “put care and insurance in the same bed,” and then to have these new insurance entities duke it out.
This strikes me as the kind of thing that has the potential to work. Don’t get me wrong, I’d be shorting this idea like crazy. However, that’s because I would short all attempts at health care reform.
My sense is that people don’t want to stop dumping lots of resources on the sick.
Which ultimately is fine. For example, we could have a world in which people didn’t really care about personal space or privacy. Folks would sleep in rooms full of bunk beds; eat in giant cafeterias and bathe in communal showers.
Such a world would likely consist primarily of gigantic skyscrapers each housing thousands upon thousands of people. The production of non-residential goods and services would be far higher not only because resources would be freed but because the arrangement of folks would be far more conducive to agglomeration externalities.
However, that’s not how people feel and we pay a “price” for it. Yet, like goes on, even as people sleep in their own bedrooms and eat in their own kitchens. Such waste has not ground humanity to a halt.
Likewise if people cannot bear the thought of doing everything they can to save the sick and dying, life will still go on. Humanity will not grind to halt. We can wring our hands about the waste, but ultimately such a world would probably feel as icky as the world with no personal space.
There are probably things that can be done on the supply side to ease suffering, but I don’t anything will be done on the demand side to keep this from eating up more and more of human production.