Medical question

What’s the coliform count in Paul Ryan’s soul?

So a senior citizen who has been terrified by the right-wing noise machine asks Paul Ryan – remember, he’s supposed to be the responsible, serious, wonky one on the ticket – about “death panels.” And instead of telling the voter frankly that there’s no such thing, Ryan quibbles with the term and then goes on to suggest that the Independent Payment Advisory Board will have the authority to tell his mother she can’t have the medical procedures she needs.

And that leads to the medical question: What’s the coliform count in Paul Ryan’s soul?

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

11 thoughts on “Medical question”

  1. This exact issue makes me think about information asymmetry, as well as markets for willing ignorance and the disinformation industry that supplies it.

  2. I really cannot tell if Mark is being sarcastic or not. Surely he can’t be surprised that a Republican, even one that’s supposed to be “wonky” (Christ I hate that word), is being disingenuous.

  3. If I understand Ryan correctly, he argues:

    1. Lowering reimbursement rates will cause providers to drop out of Medicare, because the payments are too low.
    2. We need competition, because that will lower what providers get paid.

    (Never mind that we already have competition – if not, what are all those hospital ads about and why do health insurers have sales people – and our costs are ridiculously high.)

  4. Smarmy as Ryan is here, I did find one statement of truth: We need more transparency in medical costs. I’ll never forget the visit to a doctor’s office when I asked how much a service would cost and the reply was, “What insurance do you have?”. I’m not paraphrasing, that’s a direct quote. And she wasn’t being facetious. The cost was going to be whatever stuck to the wall of the insurance company.

    Most other times I’ve asked doctors and nurses about cost they looked at me like, “How would I know?” In a sane system, that might actually be a reasonable response: Doctors would be focused on providing health care, costs would be reasonable and published at a well-known source.

    1. The trick is the level at which the transparency applies. Simply posting a list of procedures and prices doesn’t get you anywhere, because by the time you know what procedures you need you’re unlikely to be in a position to do a lot of moving around to get the lowest cost. What would be nice is a set of simple scenarios and a total cost, much like those stickers on appliances that tell you the price per year.

    2. But that’s why healthcare isn’t a real market. This simple list of fees you and Paul want will never exist. No doctor is going to tell you what your appendectomy *will* cost, because s/he hasn’t been inside your body yet and can’t assess what complications there might be, etc etc.

      Otoh, maybe some sort of range might someday be possible.

      This is all yet another argument for just opening up Medicare. Fancy footwork just makes it all more expensive. I have yet to see a really good argument against it.

      1. I guess I didn’t express myself very well. If you’re going to pretend health care is a market then the costs should/could be transparent. But you shouldn’t pretend it’s a market.

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