Decius wrote:

flynn23 wrote:
Things that would ultimately 'trickle down' which would benefit from LESS government intervention are healthcare...

I'd be interesting in hearing more of your views on that. There is a big effort to nationalize healthcare here, and its not just pushed by liberals. Some big business seems to think that the cooresponding tax burden would be lower. Personally, I'd like to see other options on the table. I don't think universal health care is nessecary to fix some of the existing coverage gaps in our society.

What are the biggest inefficiencies generated by overregulation today? You have a much better view of this than me. It has always struck me as odd that some one with a 3 year college degree who makes nearly as much as I do gets athsma inhalers for me at the drug store and operates the cash register. I realize that some people are afraid of getting the wrong medicine, but is there a cheaper way? What about drug testing? It seems there are risks associated with that which lead to the amount of regulation.

Socializing health care is the most commonly mentioned technique for providing universal health care. I would define universal health care as the ability for any citizen to have access to quality affordable health care services, including preventative, ambulatory, specialized, and pharmaceutical, not just trauma or Medicaid-like services (ie. free clinic). Socializing this, or using the government to manage, oversee, and provide, will not work in the US. Most other nations which have this system are rapidly moving away from it. The simple reason why is cost, but the underlying reason is that it stifles innovation.

The US actually has the best quality services in the world, but the standard deviation of who gets them and how often they are deployed is also the highest in the world. Government regulation is only partly to blame. I think of it more as getting the government to incentivize change rather than to keep the current institution. Much like telecommunications!

You could provide universal health care but you'd have to radically re-align the system so that stakeholders compete based upon outcomes (ie results) instead of treating based upon episode and billing fee for service. This would not provide a system where every citizen would get the same "level" of health care service, but it would provide that every citizen would get quality affordable service based upon a tiering of cost per outcome. So the poor would get results, but the rich would get them faster, with more bells and whistles, and more conveniently at a higher price. Much like any other product or service you procure today.

This would whittle out poor quality providers, encourage 'telemedicine' (using the best provider no matter where located, even if out of the US), eliminate waste and redundancy in the system, and ultimately lower prices and accelerate innovation. That's because all stakeholders in the system would be competing for the best results per dollar, as opposed to whatever they are today. It's all over the map, but is definitely NOT results. It's things like membership growth for health plans, premium deflation for employers/payors, and revenue per patient for providers.

This isn't a radical idea. It's been proposed for 30+ years. But it's only recently become feasible due to things like the Internet and the capturing of data in EMR's and other digital systems across the health care ecosystem. Believe me, they are still about 10 years behind in even that basic infrastructure. But it's POSSIBLE if the investment were made. In fact, there are studies that conclude that you could pay for the investment and even make a tidy profit from the quality savings that come out of it. Things like reducing medical errors, redundancy, and boosting quality. Healthy people cost less is a theory that has not been shown to be untrue.

If you want to see how Friedman's ideas would be translated into solving health care, I suggest you read Michael Porter's book. Porter and Friedman never worked together, but you couldn't tell that from reading what Porter says. While Porter/Friedman might take an almost academic perspective of 'free market' that doesn't necessarily jive with the way that people (globally especially) think of health care services and the benefit to society, the jist of his ideas are the only ones which I think will work. So much so that my next business venture is very much based upon this thinking and how I think it needs to be operationalized.

RE: Nobel economist Milton Friedman dead at 94 - Nov. 16, 2006