post by Bill Gardner
I'm thinking more about the Health Affairs article by Bobbie Milstein and his colleagues (my summary here). They used a simulation to estimate the costs and lives that could be saved as a result of three strategies for improving US health.
- Extending Health Insurance to Universal Coverage.
- Delivering Better Preventive And Chronic Care.
- Enabling Healthier Behavior And Safer Environments.
What they found was that the most cost-effective way to save lives was to promote healthier behavior and get toxins out of the environment: that is, stop disease before it starts. Next best was doing a better job at preventive and chronic care: that is, treat diseases before they get worse. The least effective, by a wide margin, was universal coverage.
Now, you may reject those conclusions. But for a moment, let's stipulate that the authors are correct, and think about what the implications are.
Progressives: We have spent generations fighting for universal coverage. Was this the right hill to die on? Sure, universal coverage and health behavior change + environmental protection are not mutually exclusive. Nevertheless, winning a political battle requires concentration of force. Why was universal coverage more important than strategies that would save many more lives?
Fiscal conservatives and libertarians: We are committed to reducing the dead weight cost of governmental health care expenditure, but we do not want to ration care. You do not need to pay for care -- or ration it -- if it isn't needed because people are not getting sick. Shouldn't health behavior change + environmental protection be the foundation of our health policy?
We are spending too much time fighting about how to pay for disease, instead of how we can promote health.