Bob Galvin is a smart guy. So I was interested to read his interview with consumer-directed health care advocate Regina Herzlinger in the latest Health Affairs. But this is just crap:
Galvin: On the whole, wouldn't you say the jury is still out on whether a single-payer system can control quality better?
Herzlinger: No, no. The OECD and Commonwealth data showed that the U.S. had better preventive care, diabetes care, and childhood leukemia scores in addition to breast cancer. And measures of diseases like asthma and diabetes, which have significant genetic components, must be adjusted for the composition of the population before they begin to make sense.
Fundamentally, single payer controls costs by rationing care to the sick, while consumer-driven health care controls costs through innovations in the care of the sick.
Interviewers can't let their subjects get away with lying like that. Consumer-driven health care controls costs by pushing more spending onto the consumer so that they can afford less care. It rations by income. It's not even deceptive about this: That's literally what "skin in the game" means. When you're paying more for your care, your price sensitivity increases, which in turn makes you both less able and willing to pay for care, which in turn will make you more likely to purchase valuable care and discard bad care.
That, at least is what advocates hope will happen. Whether you believe them depends on whether you believe consumers can make smart care decisions, and whether you believe wasted care can be cut out by bluntly disincentivizing all care. But the cost controls here have nothing to do with innovation; they have everything to do with increasing financial exposure so we're less willing and capable to purchase medical services.
