Easy choices on health care: There aren’t any

Few of these choices are “easy”, in the sense that there is some simple rule you can pass that we know will really improve Medicare’s financing. End-of-life counseling for Medicare is probably a fine idea, but even under entirely unrealistic assumptions, it doesn’t save the program. The best end-of-life care is not necessasrily the cheapest (chemotherapy, for example, may be used to shrink tumors in order to make patients comfortable, not just to save their lives). And while end-of-life-counseling can improve decision-making, it doesn’t necessarily ensure that patients (or their grief-stricken families) will cease demanding expensive, probably futile, interventions. We have no idea whether allowing Medicare to reimburse for end-of-life counseling would save even as much in health costs as it costs to employ all those new counselors. Especially since we don’t actually have a huge reserve army of qualified end-of-life counselors waiting in the wings for the government to call them to duty.

Immigration is even less “easy”, because the main constraint on foriegn doctors is not visas, but residency slots. While there are some less-desireable specialties that don’t fill their slots, most are oversubscribed. Experienced foreign doctors bristle at being told they have to come over here and go back through years of training in order to practice, which constrains the supply of exactly the top-notch, experienced candidates we’d like to bring over here to boost our health care system. And even if they come, this will initially cost money, not save it, since residency slots are government-subsidized.

Similarly, “better management” of pharma innovation has been proposed for years, but there’s not actually all that much evidence that prizes, rather than patents, would unlock a whole lot of development potential.