X-Message-Number: 5102
From:  (David Stodolsky)
Subject: Re: The U.S. Healthcare Crisis
Date: Fri, 3 Nov 95 20:57:50 +0100

Saul Kent <> writes:
> 	However, the U.S. government has been a major partner in defining the
> healthcare system in this country and, in my opinion, the solutions to the

> problem need to come from *greater* competition, rather than greater 
government
> control.

I don't recall stating that I thought solutions could come from greater
government control. However, greater competition may also not be the
answer. For competition to work effectively, participants must know
what they are purchasing. This, in general, is not true for individuals
in the health care market. There are also intergenerational effects
which rule out individuals as a decision makers (i. e., how do you
purchase prenatal care for your mother?). The preventative vs. acute
care is another trade-off which has been handled badly in the USA.
Finally, some problems can't be handled this way at all, such as infectious
disease (e. g., small pox, polio, etc.). The failure to deal effectively
with Ebola and related new agents internationally is leading inevitably
to a new pandemic, which will likely exceed the toll from AIDS.

If competition is going to be effective, it will likely be among service
provider organizations bidding for health maintenance "contracts"
from other organizations.


> 	Any theory that attempts to explain problems in medicine in the U.S. that
> fails to take into account the corrupting influence of government is, in my
> opinion, grossly inadequate.

Corruption is an inevitable consequence of power concentration. However,
extreme care in institution building is required to avoid such
concentration. For the moment, I see no alternative to some pretty
big organizations in dealing with the health-care problem. Hopefully,
appropriate use of new computer-networking technology will yield some
more distributed solutions. The work I am doing on contagion management
systems may be a step in this direction. However, any competition
in this system will have nothing to do with economic variables. It
would deal directly with health risk variables. (i.e., Do you want to get
in bed with that real nice looking person with a 1% risk of HIV positivity
or the rather plain one with .1% risk?)

dss


David S. Stodolsky      Euromath Center     University of Copenhagen
   Tel.: +45 38 33 03 30   Fax: +45 38 33 88 80 (C)


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