By his own description, he’s just a little country economist. But his rural burrow is among the ivied halls of Princeton, and Uwe Reinhardt is one of the most incisive economists writing today about the conundrum of health care costs. He spoke earlier this month at the annual meeting of NEHI, and they’ve kindly posted four chunks of about 15 minutes each of his speech here.
One of the more memorable passages:
I wrote a blog post where I said the idea that human life is priceless is romantic and silly.
So I testified before — Waxman’s committee, I guess it was — and Congressman Gingry from Georgia, MD, asked me, “Did you write this?”
I said: You just told me I wrote it, yes, I did.
He said: How dare you tell me what my life is worth?
I said: But I never told you what you should think your life is worth. I was talking about how much I would pay for your life — and it’s finite.
And he was muttering, ‘This German thinking of another era.’ And I said, ‘No no no, it had nothing to do with that. You sent my son into combat without a flak jacket, don’t tell me you didn’t put a price on his life. Not enough flak jackets right? And this kid out there in an unarmored humvee without a flak jacket. How do you think I feel about that?
And interestingly, he took the entire exchange out of the written record, it’s not in there. So I do think a lot about human value and I thought my son’s life was priced rather poorly by the Congress and the DOD.
On a lighter note, Uwe bemoaned the love many hospitals have for new technology, whether or not it’s a significant improvement. He said:
‘I always say, ‘Partners, why don’t you put ‘We have the only glandular shlumpinator in Boston’? You don’t even have to have it, but people will say, ‘If I had a baby, that’s where I’d go. It may need shlumpination.’ This would sell, even if it hurt. You, in fact, shouldn’t shlumpinate a kid.’
Like every other health care economist I’ve ever seen, Uwe recommends that the United States move toward an Asian or European-style system that provides better care to more people for less. He has several specific recommendations in his talk, including this:
“I would get rid of individual negotiation on prices with providers. You’re not buying anything cheaply for anyone doing that. All you do is shift costs and create what is arguably the most hideous price-discriminatory system that exists in the world. If you’re a middle-class uninsured person, you pay list [price.] And the biggest insurers pay small. And then Medicaid essentially engages in fraud in the low prices it pays. This is a hideous system…
This system we now have is expensive, mindless, inefficient, and unfair and we have to get rid of it.”