Milton Friedman is not dead: He has an article in today's Wall Street Journal

[Guillermo I. Benharar Vallarino]

The 3/20/2010 WSJ reprinted a 1996 article by Milton Friedman (Patron Saint of Free Markets)-A Way out of Soviet-style Medicine .  He uses a chapter from Solhzhenitsyn's The Cancer Ward. to make a point. Friedman's point is that employer sponsored health coverage, Medicare, and Medicaid took away  freedom of choice for doctors & patients and led to an increase in medical costs.  Dr. Friedman prefers tax exemptions for all medical expenses for consumers (no more employer coverage)  and a medical savings account for each person to pay for his/her own care.

 

http://online.wsj.com/article/SB10001424052748704784904575111273624... 

 

An editorial referring to the1996 article states: "Stripped of its romantic illusions, ObamaCare is really about who commands the country's medical resources. It vastly accelerates the march toward a totally state-driven system, in contrast to reforms that would fix today's distorted status quo by putting consumers in control."

http://online.wsj.com/article/SB10001424052748704207504575130321235...

 

Dr. Friedman and the WSJ editorial overlook the fact that physicians are agents of their patients because of a doctor's medical training.  Also, patients cannot (nor MDs) make medical purchasing decisions because they do know the cost of all the alternative inputs to treat a patient.  A common operation in this country, a knee replacement, requires "hardware" to be installed to repair the knee joint. There are several companies that produce the part and the price varies.  But that price is unknown to the doctor & patient-the same is true for every input into the delivery of medical care, including the cost of labor, loan servicing, facility maintenance/repair, payment for non-medical supplies.....etc. Also on this network, you point out the obesity is increasing the #1 factor in increase medical care costs. 

 

Questions:

1.  How can consumer choice and controlling the price of healthcare inputs be accomplished in the a highly specialized/technical  field like medicine. 

2. How can you factor in the cost of obesity into the price of medical care inputs to control costs?

[Tamar Knox]

PUBLIC HEALTH PROFESSOR SAYS HEALTH REFORM HAS NOTHING TO DO WITH PUBLIC HEALTH
Both of the writers you mentioned are not aware of the dynamics of health and healthcare. They are not alone. Powerful organizations are going unchallenged for very simplistic and incorrect statements about health/healthcare. Both articles are not rooted in reality...only data...which can mislead if not looked at carefully.

Statements like ones made by Dr. George Avery of Purdue need to be openly challenged by public health types. Avery says health reform and public health don't mix because public health is a local responsibility. BUT he fails to mention what can be done at the local level (he never mentions progress we made with smoking);avoids any mention problems like obesity that are driving health costs (....Medicare??); does not mention seat belt laws; loss of federal funds for failure to have aggressive drunk driving laws at the state level; gains made in HIV prevention.
He cannot make those statements because the Cato Institute argues that government should not impose any regulations at any level. He does not see a role for local or federal policy in public health--he simply cannot imagine it.
http://www.cato.org/pub_display.php?pub_id=11588" target="_blank

[George Avery]

Mr. Knox argues a logical inconsistency: Local public health departments do some good in public health, ergo the federal government will do great things by financing healthcare. The argument is logically inconclusive, the conclusion does not follow from the premise, which is the point I made (and he completely failes to address) in my op/ed piece in the Daily Caller. For the record, my point was that public health is BEST addressed at the local level, that the reform legislation completely fails to address the issue of population health, and traditionally in the United States (something a Canadian may not recognize) this type of legislation has actually damaged the public health systems.

[Marisel Brown]

Dear Dr. Avery:
Thank you for posting a response on the D4H Ning Network. We appreciate your taking the time to respond to a member's post. We welcome as much back/forth or point/counterspoint exchanges as fingers flying across thousands of keyboards allow.

I would like to draw your attention to a report prepared by the Trust for America's Health (TfAH) that illustrates your point re: local level/community-based population health prevention interventions targeting chronic disease. I do not know if you are aware that House & Senate healthcare reform bills included several (though miniscule in comparison to sick care) population health improvement provisions.
Links to four documents follow:
1. RWJ-Investment in prevention ROI nearly 10%
http://www.rwjf.org/publichealth/product.jsp?id=32831" target="_blank

2. State-by state listing of community-based public health prevention projects

3. TfAH's comparison of revention components of Health/Senate healthcare reform legislation
http://healthyamericans.org/assets/files/ChartofKeyPreventionPriori...

A December 2009 policy brief prepared by the Robert Wood Johnson Foundation & the National Association of County & City Health Officials echoes your sentiment re: role of public health departments as key to prevention.
http://healthyamericans.org/assets/files/HMA.pdf" target="_blank

Once again, thank your commenting.
Marisel Brown
Program Manager
Public Health Institute