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07/18/2009

Massachusetts Health Reform, Version 2.0?, by Arnold Kling

From the Boston Globe.


The 10-member commission, which includes key legislators and members of Governor Deval Patrick's administration, voted unanimously to largely scrap the current system, in which insurers typically pay doctors and hospitals a negotiated fee for each individual procedure or visit. That arrangement is widely seen as leading to unneeded tests and procedures.

Instead, the group wants private insurers and the state and federal Medicaid program to pay providers a set payment for each patient that covers all that person's care for an entire year and to make the radical shift within five years. Providers would have to work within a predetermined budget, forcing them to better coordinate patients' care, which could improve quality and reduce costs.

I think it is fair to conclude from this that the Massachusetts health reform plan, which in some ways is the model for the plans currently under discussion in Congress, was a failure. Thanks to Mark Ambinder for the pointer.

Maybe the commission's proposal is a step in the right direction. Even if it is, I would suggest that perhaps no expert knows how to design the health care system. We may need a lot of trial and error. Government takeover means that you try something new every few years...maybe. Your choices are limited because entrenched interests preclude many options.

With markets, trial and error takes place continuously. A lot more things get tried. Failure gets weeded out more ruthlessly.

Of course, no one on the Left believes that. The core belief there is that experts know best, and that experts are only thwarted by evil corporations and stupid conservatives. The notion that no expert knows very much, and that the evolution of market processes produces better outcomes, is too threatening to contemplate.


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