Monday, September 07, 2009

Health Care: A Parable

The White House, October 4th, 1957

Anonymous staffer #1, rushing into the Oval Office: Mr. President, the Soviets have just launched a satellite!

President Eisenhower: A what?

Anonymous staffer #1: A satellite, a man-made object circling the earth.

President Eisenhower: Like an airplane?

Anonymous staffer #1: No, much, much higher. Above the atmosphere, like the moon.

Presidential adviser #1: My God, how did they do that?

Anonymous staffer #1: They used a rocket to boost it into orbit.

President Eisenhower: If there is a race into space, we seem to be falling behind. Do we have anything similar?

Presidential adviser #1: The Army has the Explorer Program, and the Navy has Project Vanguard. We could rush one of these into full production.

President Eisenhower: Any other suggestions?

Presidential adviser #2: We could copy Sputnik. It's cheaper than making our own design, we know it works, and simply having a satellite would show we are are world-class superpower.

Presidential adviser #3: I hate the idea of just copying the Soviets. How about we copy the Soviet rocket engine, take the body from a German V-2 – since we have plenty of German scientists kicking around – and then copy the fuel from a Chinese rocket?

Presidential adviser #1: The Chinese don't have rockets.

Presidential adviser #3: The ones they shoot fireworks up with. Those are really pretty.

Presidential adviser #2: Will it work?

Scientist #1, clearing throat: Mr. President, we could have teams of scientists and engineers test the various proposals against each other, and then pick the best one. As we gain experience with rocketry and outer space, we can propose and test design suggestions, and then roll out any improvements we discover. With adequate funding, we could land on the moon in a dozen years or so.

Presidential adviser #1: A dozen years? Are you out of your mind? The President will be a decade out of office, and you are looking at six election cycles between now and then. I say we rush Explorer or Vanguard into production.

Presidential adviser #2: Copy Sputnik!

Presidential adviser #3: Copy bits and pieces from other rockets!

President Eisenhower: Well, I'm a lame duck anyway, and don't have any political capital to spend. Let's turn the problem over to Congress.

Scientist #1: Are there any scientists in Congress?

Presidential adviser #1: Lawyers, mostly. But it's not like it's rocket sci – er, they can consult with scientists, and then work out the differences in the various designs in committee.

Scientist #1: You are going to design a rocket with a group of lawyers? I mean, I like the idea of using wind tunnels, but --

Presidential adviser #2: Oh, good point. Better bring on board labor unions, the National Rifle Association, AARP, and the American Bar Association. We will need their votes in the next election.

Presidential adviser #3: And once we have hammered out the differences between Democratic and Republican rocket plans, and brought the various interest groups on board, we will have the best spacecraft ever!

President Eisenhower: Get to it! I want everyone to see what American ingenuity is all about!


Sometime in 2050:

Anonymous staffer #5006: Mr. President, we beat Lithuania into orbit!

Anonymous staffer #5007: Making sure that each congressional district and interest group got precisely the same amount of money did the trick!


Okay, now I will be serious.

We have something called the scientific method that can tell us what health care proposal is the best for the United States, and 47 million uninsured Americans who would benefit from any sort of health care access. Why not come up with an experiment – along the lines of a much-expanded Rand Health Insurance Experiment (see ) – and test the various proposals against each other?

Give each political party and interest group a set amount of time to come up with a universal plan conforming to specific criteria – you could have the Liberal Democratic Plan, the Blue Dog Democratic Plan, the Republican Plan, the Green Plan, the Libertarian Plan, plus plans by AARP, the American Medical Association, the Insurance Lobby, and even the American Bar Association, if you wanted. Throw in copies of the Canadian, French, English, German, Swiss, Japanese, and Singaporean plans, plus any other national plan that seem to be working well and can be applied to the United States.

During the time the designated interest groups are coming up with their “optimal” plans, decide on a standard set of criteria to judge the success or failure of each plan, and an amount of money to spend. At the end of the design period, select plans that conform to the starting criteria (things like universality, funding, and the like). Randomly assign the 47 million uninsured Americans to the plans, and give each plan the equal amount of money and a set time period.

If one plan is clearly worse than the median of all plans during the course of the experiment, remove it and randomly assign the people involved to one of the remaining plans. Continue until the agreed time period has completed, or there is only one plan remaining, and then use the winning plan as the national system. Or you could have an experimental group and a buy-in group, where the experimental group includes the uninsured Americans above, and the buy-in group includes individuals, groups, and companies that wish to access a particular plan with their own funds, which would provide additional data as to what plans are popular with which groups, but wouldn't affect the experiment itself.

There is a far greater chance of finding the best plan using the scientific method than there is using the wishes of the loudest interest group and the most highly-paid lobbyists interacting with a bunch of lawyers and politicians. It would also quiet (though admittedly, not completely silence) the loudest critics, since their pet health care plans would have been shown to be inferior to the winning plan.

And not only would this method provide a means of continuing improvement – since the experiment could be continued with a small group even after the vast majority goes on the universal plan, and improvements rolled out to the nation as a whole – but it would provide valuable information for every other country on the planet. So much so , in fact, that some countries may be interested in contributing scientific proposals and/or funds, in order to share in the rewards of such research. A plan that contributes not only to the welfare of the United States but to mankind as a whole would seem to be a goal worth pursuing.


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