300 MILLION AMERICANS CAN BE WRONG. I do like the continual sharpening of differences between the libertarian health care wonks and, well, me. Today, Cato's Michael Cannon files the shank a bit more and stabs down to the heart of it: I think panels of experts should watch over health care decisions, he thinks individual patients should evaluate care (he is responding to a study that found individual patients are incompetent at evaluating care -- he believes that, if the world were radically different than it is, that study would be incorrect). More basically, he thinks that health care is comparable to buying a Subaru, and I do not. So I guess that's the question: Do you think you'll ever have the training to, in the aftermath of a heart attack or cancer diagnosis, approach your care provider's treatment suggestions as you would a car purchase? More to the point, have you ever made a bad car purchase? I, for instance, bought a Ford Focus. I did so after a lot of research. I made a mistake. They break a lot, and have low resale values, and are now discontinued. Luckily (well, sort of), my mistake just translates into maintenance costs, backseat discomfort, and an inability to sell my car. To make the same error when deciding between trauma treatments would be considerably costlier. And to be sure, matching the right treatments to your risk factors, diagnoses, finances, health status, and even genetic profile strike me as a considerably more complicated equation than which coupe to buy ("but the Focus comes in hatchback! And blue!"). Elsewhere, Cannon offers the perfectly fair objection that panels of experts appointed by the government are subject to capture by special interests. As he writes, "[a]re politicians never fooled by a ($2,000) handshake? Which is easier: to fool all of the people all of the time, or to fool 535 people at any given time?" I think that's a less certain question than he actually frames it as, even given current policies and trends. Indeed, I think fooling the people is easier than fooling medical boards. That aside, there are ways to create a politically insulated structure for health decisions (as you see in the military today), but we can even go a step farther. If Michael wants to sign up, I'm happy to rip the money out of politics entirely and move towards full public fianncing of campaigns, obviating his objections. Deal?
--Ezra Klein
