John Goodman rides again
Thursday, March 19 2009
John Goodman has to be among the least helpful voices in the health care debate, and yet Health Affairs still gives him a platform from which to dissemble. His latest salvo is interesting, if only because it seems to be directed at physicians and medical journals:
Much analysis published in medical journals suggests that other countries have found superior solutions to these problems. This conclusion is at odds with economic research that is published in journals physicians seldom read, using methodologies that are unfamiliar to physicians.
I say “interesting”, because I’m not sure what to make of it. Are physicians really driving the debate about health care reform towards foreign models? Are the wonks in government not reading the economics literature? No, both times, I would bet. Then Goodman frames his argument with this question:
For the US, the practical question is, can the adoption of another country’s health care system offer a reasonable chance of improving US private sector methods?
And, of course, his answer is “no”. But this isn’t a question anybody else is asking. The rest of us already answered one important question: does our health care system need reform? Heck yes. Now we’re onto another question: how are we going to fix it? Nobody is suggesting we adopt “another country’s health care system”.
There is, however, good evidence that some countries might do certain things better than we do – so it helps to ask whether we might be able to adopt those specific practices, without reproducing the entire system. The reason this works is the same reason Goodman’s paper appears to work: look at a given number of countries across a given number of parameters, and it’s likely that each will perform better than the others at least some of the time. What Goodman does is point out the specific parameters where the U.S. outperforms specific countries, and argues that this makes the US better than any other country. It is just as easy – and just as trivial – to write a paper pointing out the many specific countries that outperform the US on specific parameters, ergo the US system is the worst. Neither approach answers our question: how are we going to fix our health care system?
What we should be asking, among other questions, is: what are other countries doing right, that we might adopt and adapt to build a better health care system here in the US? John Goodman can’t bring himself to ask that question, because he’s committed to an ideological answer that doesn’t admit the premise that other countries might be doing something right – or that we might be doing something wrong.
I find it absolutely mind-numbing that:
1. There are 100 scholarly articles giving the “other side” of the international health care debate that rarely ever appear in Health Affairs;
2. By accepting this post you are virtually admitting the truth of that claim;
3. You are continuing not to publish this information; and
4. You are nonetheless willing to allow it to be linked to from your blog site.
You might want to read Dr. Goodman’s book, Lives at Risk; it’s findings about health care and health care systems in other countries is revealing. And it answers an important question you don’t seem to be willing to ask: if health care is so good in all these countries why are they, almost without fail, searching for market solutions?
@Richard: Perhaps it will un-numb to look at the problem like this:
1. There are at least 100 articles that John Goodman can parse in favor of his own ideological commitments, but many or most are already in the general literature on health care reform; Health Affairs has no monopoly on that literature.
2. I link only because blog etiquette requires me to.
3. I don’t need to publish myself what I’ve already linked to.
4. See #2.
As for other countries, see this post: http://duncancross.net/2008/09/105/. Whatever problems other countries are having, their searches for “market solutions” are nothing like a wholesale rejection of the notion that government has a role in universal health care.