The Corner

re: IPAB, Obama, and Socialism

There was a very interesting article in Saturday’s Wall Street Journal by British writer Theodore Dalrymple (that’s the pen name of the physician Anthony Daniels) where he explains that President Obama’s ideas for keeping health-care costs down — an expert commission and generic drugs — have been tried in Britain, where they didn’t have the effect President Obama is looking for:

We in Britain have been there and we have done that, and our health-care costs doubled, perhaps not as a result, but certainly at the same time.

The best that might be said for these measures is that the increase in health-care costs was lower than it might otherwise have been. That is certainly not enough to save a country from a financial apocalypse, or even enough to be a major contribution to its salvation.

In Britain we have been prescribing generics for years; I cannot remember a time when I personally did not. Our National Institute for Clinical Excellence (NICE, a typically Blairite acronym) has done cost-benefit analyses of drugs and procedures, often very sensibly, for years. But despite its best efforts, our system has been highly inventive in finding other ways of wasting immense quantities of public money.

President Obama also wants to move from a fee-for-service system, which gives doctors an incentive to perform expensive and doubtfully effective procedures, to one in which doctors are rewarded for preventing diseases that are so expensive to treat. On paper, prevention always seems much cheaper than cure. Health-care economists prove it very elegantly and convincingly over and over again.

Unfortunately, the world always proves to be more complex and refractory than the theories of even the best economists.

The French, of course, have traveled down that road too, and for all the praise their system gets, it still is unbelievably expensive and has been running gigantic deficits for years. I am always baffled by politicians who think they can make something that has failed in other countries succeed in theirs.


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