June 20, 2007 10:59AM

Who Should Ration Health Care?

In preparation for what should be a fun health policy forum on Thursday — hey, where are you going? — I’m reading Ezra Klein’s article “The Health of Nations” from the May issue of The American Prospect. The article includes an interesting omission that might explain Klein’s preference for letting experts — rather than consumers — ration health care:

[T]he right…has argued for a move toward high‐​deductible care, in which individuals bear more financial risk and vulnerability. As the thinking goes, this increased exposure to the economic consequences of purchasing care will create savvier health‐​care consumers and individuals will use less unnecessary care…

Problem is, studies show that individuals are pretty bad at distinguishing necessary care from unnecessary care, and so they tend to cut down on mundane‐​but‐​important things like hypertension medicine, which leads to far costlier complications.

(Actually, cost‐​conscious patients also tend to cut down on health care that harms them. That’s why the best evidence available indicates — contrary to what Klein suggests — that when patients control more of the money and do more of the rationing themselves, overall, it doesn’t harm their health.)

Later, Klein offers this explanation for his claim that Great Britain’s health care system is just as productive as the U.S. system, despite spending less than half as much on medical care:

Much of the health care we receive appears to do very little good, but we don’t yet know how to separate the wheat from the chaff. Purchasing less of it, however, doesn’t appear to do much damage.

So Klein acknowledges that neither individuals nor experts appear to do a good job of separating the wheat from the chaff. Agreed.

But he appears to prefer rationing by experts, because he believes that when consumers make the necessary tradeoffs, they hurt themselves. Except that this is not true overall — and it’s very hard to find evidence that supports an argument to the contrary.

So if Klein will acknowledge that letting consumers do the rationing does not lead to worse health outcomes — and I don’t see how he cannot — then why the preference for rationing by experts?