KEEP MY SKIN...

KEEP MY SKIN OUT OF IT. Yesterday, I went to Cato to see right-wing health economist Arnold Kling debate the Washington Post's Sebastian Mallaby and contrarian progressive economist Jason Furman (who looks more like Chuck Klosterman than any economist has any right to) on his new book, a Crisis of Abundance. CofA argues that our health system suffers from an overuse of highly specialized and technologically advanced treatments. In that respect, it's undoubtedly correct -- modern medicine suffers from a grotesque lack of good treatment data, and I welcome Kling's proposal for a health care equivalent of the Congressional Budget Office (a nonpartisan research facility).

From there, we part. Kling's other solution relies on a massive increase in the amount of health costs that come out of pocket. The "very poor" would be subsidized, as would the "very sick" (neither term is defined in his book), but everyone else would be paying for their own care. This makes sense in a very specific sort of world -- one in which you believe consumers have the capacity to make rational health care decisions -- and to a very specific sort of person -- one who believes those who make mistakes with their health care should simply pay the costs, be they financial ruin or death.

I am not that sort of person, and I am highly dubious of that world. I see no evidence for the claim that a gas station manager in Bakersfield, California, will be able to second- or third-guess his cardiologist's recommendation of an angioplasty. Will he have the money to get a second opinion? A fourth? Or will Kling's system convince him to foolishly underestimate his risk? Economists, after all, have shown time and again that we overestimate the pain of financial loss -- that, when it comes to money, we are not nearly so rational as one might hope.

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