Further Remarks On Obamacare
Nobody with whom I've talked politics could confuse me for someone who's in the tank for Obama, but the more I think about his policy approach to the health industry the more infatuated I feel myself getting. It strikes me as the best possible compromise between the public's mental illness and a reality-based approach.
As I said to airstrip today, while it would be political suicide for anyone to come right out against the government-assisted cartels that dominate the supply of medicine, Obama is willing to push it as far as he can by forcing medicine to be evidence-based in a way that's damn near elegant. Linking payments to objectively defined outcomes brings up a classic public choice problem: who decides the criteria, and how do we keep the system from being captured and gamed? But in this case the answer to the first part is that it doesn't particularly matter, because the answer to the second part is provided by the way that feedback is baked into the system.
In the process of tracking outcomes, it'll create a massive data bank which can then be examined to see which metrics correlate with which. For example, if it turns out after several years that maximizing HDL:LDL ratio statistically does nothing to diminish the incidence of heart attacks, then some bureaubot will inevitably notice this -- doctors consequently will stop getting paid to achieve that, and said bureaubot will get a gold star for saving the hive money. I expect little improvement at first but massive gains in the long run.
Most government interventions in anything fail dismally because nobody is interested collecting the data to see if they actually work; in rare cases like this where that's actually a primary objective, I'm willing to risk the 9th Circle of Libertarian Hell. If you're down with the notion that we need less, this is about as good as gets.
As I said to airstrip today, while it would be political suicide for anyone to come right out against the government-assisted cartels that dominate the supply of medicine, Obama is willing to push it as far as he can by forcing medicine to be evidence-based in a way that's damn near elegant. Linking payments to objectively defined outcomes brings up a classic public choice problem: who decides the criteria, and how do we keep the system from being captured and gamed? But in this case the answer to the first part is that it doesn't particularly matter, because the answer to the second part is provided by the way that feedback is baked into the system.
In the process of tracking outcomes, it'll create a massive data bank which can then be examined to see which metrics correlate with which. For example, if it turns out after several years that maximizing HDL:LDL ratio statistically does nothing to diminish the incidence of heart attacks, then some bureaubot will inevitably notice this -- doctors consequently will stop getting paid to achieve that, and said bureaubot will get a gold star for saving the hive money. I expect little improvement at first but massive gains in the long run.
Most government interventions in anything fail dismally because nobody is interested collecting the data to see if they actually work; in rare cases like this where that's actually a primary objective, I'm willing to risk the 9th Circle of Libertarian Hell. If you're down with the notion that we need less, this is about as good as gets.