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Quest for Perfection

Economic Theory Revisited

Quest for Perfection

I hope the American Board of Ophthalmology directors are wiser than all of us, but I doubt it. They are human beings, too, and are as imperfect as the rest of us. All tests they create will be limited and imperfect. To date, there are still no great tests of moral character, ethical behavior and commonsense judgment under stressful situations—all issues that need to be addressed at the medical student, intern and resident levels to weed out poor-quality doctors when they can be closely observed.

Attempting to improve clinical outcomes through Maintenance of Certification will not provide a single piece of follow-up data to indicate that all measures in place decreased the rate of endophthalmitis or loss of vision associated with glaucoma, AMD, retinal detachment or LASIK! Bad outcomes will still happen.
 
Sam Omar, MD
Longwood, Fla.

 

Economic Theory Revisited

Although I caught only the last half of Uwe Reinhardt’s speech at the Annual Meeting, I had heard his line before.

Of course he was congenial to the crowd. However, he commented that he was puzzled about why Americans would want any choice in health plan or provider since, to him, it made no difference. Clearly, he regarded his audience as a bunch of fungible drones who should be grateful to have any patients at all.

He commented that there will be an increasing population of people who cannot afford health care. I guess his answer is burdensome taxation of the productive members of society. Dodging some of the glaring macro issues involved here, including illegal immigration, he did not address the continued challenge of creating a workforce that will have the productivity and earning power to, God forbid, actually be responsible for their own health care resource consumption.

Yes, it is true that we will have to dumb down the health system, complete with rationing care, if we continue to drift economically into a quasi second- or third-world status. None of the developing nations will ever afford our standard of care. They do benefit from some downdraft of our health care innovations, but when America slips down the slope Dr. Reinhardt recommends, all nations will lose that benefit.

I was disappointed that Dr. Reinhardt expressed so little faith in probably the most efficient alternative: tax-deductible medical savings accounts (MSAs), coupled with catastrophic insurance. The Federal government could in fact fund these MSAs for the poor and provide a private catastrophic policy more cheaply than setting up the massive apparatchik system Dr. Reinhardt really wants for all.

He claims that doctors would not want such a system, since they would have problems collecting from the poor. Well, for my money, I would rather write off some claims for the poor, appropriately charge the middle-class people who drive to my office in their expensive cars and have my freedom.

Dr. Reinhardt regards it as terribly inefficient that Americans will likely continue to “muddle through” the next 10 years developing some kind of health care with choice. Clearly he would think it much less “wasteful” of resources to simply proceed to a system that rations care and denies resources.

It is really almost impossible to look to economists for the answers to such issues, since their very careers are manifestations of lack of competition and choice. (Think of how tenure works.)

The greatest enemy of most career economists is a society in which individuals make their own choices and take some responsibility for their economic freedom. We do not all take out fire insurance so we can burn our houses down and build new ones, but that is exactly what we do now with so-called health “insurance.”

At some future date I would recommend a rebuttal from Robert Moffitt, PhD, of the Heritage Foundation. All Academy members should hear his thoughts.

Well, that is my rambling commentary on health care economics, and I didn’t even charge a speaker’s fee!

Glendon T. Moody, MD
Tempe, Ariz.

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