Paul Krugman: The Real Chicken-Checkup Fallacy

[babylonsister]

http://krugman.blogs.nytimes.com/2010/04/23/the-real-chicken-checkup-fallacy/

The Real Chicken-Checkup Fallacy
Paul Krugman


Everyone’s having fun with the chickens for checkups story, in which Sue Lowden, the leading Republican Senate candidate in Nevada, expressed a desire to return to the good old days in which people who wanted a checkup from their doctor would offer a chicken in exchange. And she’s not backing down!

But I think even the mocking critics are missing the main point. Sure, it’s funny to see a 21st-century political candidate pining for the days of a barter economy. But her remarks would have been breathtakingly ignorant even if she had called for payments in cash.

The key fact about health care — the central issue in health care economics — is that it’s all about the big-ticket items. Checkups don’t cost much; neither does the treatment of minor illnesses. The money that matters goes to bypasses and dialysis — costs that are highly unpredictable, and that almost nobody can afford to pay out of pocket. Modern health care, if it’s going to be provided at all, has to be paid for mainly out of insurance.

Conservatives don’t like this; if few of them propose paying in chickens, there is nonetheless a constant refrain of calls for making the market for health care more like the market for bread, with consumers paying out of medical accounts and engaging in comparison shopping. There is, for example, vast romanticizing of things like Lasik and cosmetic surgery, which are held up as models for health care as a whole — even though they’re actually very poor models. (They’re discretionary and fairly cheap — not at all like the procedures that dominate health costs in the real world.)

Why this preference for cash? Because even conservatives know in their hearts that insurance markets are deeply imperfect, which means that standard free-market arguments become very weak once insurers are involved. And so they pretend that we don’t really need all that insurance.

The business with the chickens adds an additional level of absurdity. But Ms. Lowden’s perspective is ludicrous even without the feathers.

[DesertFlower]

1. i'm 68 and i can tell you that my

grandparents did not bring a chicken to the doctor.

[Hekate]

6. Ditto. The whole thing is absurd. nt

[Cha]

2. I guess Krugman didn't read DU when

some were asking.."who even has that kind of cash around?"

[gristy]

4. Krugman makes that very point

"The money that matters goes to bypasses and dialysis — costs that are highly unpredictable, and that almost nobody can afford to pay out of pocket."

[Cha]

5. Right..I was just refering to this part..

"But I think even the mocking critics are missing the main point. Sure, it’s funny to see a 21st-century political candidate pining for the days of a barter economy. But her remarks would have been breathtakingly ignorant even if she had called for payments in cash."

[madmax]

8. And forget diseases like Cancer

It will wipe you out and you die anyway. Your family is left with nothing and worse yet, loose all and still have debt.

I love the Krug.

[Jennicut]

3. Medical accounts would work for the very healthy. For those of us with actual daily health issues,

the cost is too high for that. As I diabetic, to treat me costs more then $6,000 a year, which is a standard medical account. It is more like $10,000 and up. Insulin with insurance costs me $70 a month.

[Hekate]

7. The "shopping around" meme falls apart as soon as you have an emergency calling for a specialist...

When my GYN quit taking Blue Cross I was able to shop around by asking my female friends, but I had the leisure to do so.

When our son was 16 he was in a bicycle accident. By the time we got to the ER the team was already in place, and thank God for that, because he needed a neurologist and a plastic surgeon. How in the name of all that's holy are people supposed to comparison shop for specialists you never expect to need? And the cost! It was approximately the value of our entire house before it was over. Blue Cross came through -- it took some prodding and negotiating, but they came through and did what they were supposed to do.

Krugman, as always, gets it.

Hekate

[depakid]

9. "Modern health care, if it’s going to be provided at all, has to be paid for mainly out of insurance

No, it needs to be paid for out of a common fund- without the fragmentation, inefficiency and waste.

Thought the general point of absurdity is well taken- Paul could probably use to spend a little time with George Lakoff.