Owning your own health care?

I recently came across a 2004 article by Amy Feldman on one possible -- according to some even inevitable -- near future for health care in the United States. The idea is to shift progressively more "ownership" (i.e., purchasing power) to individuals, and away from government and businesses. The underlying assumption is the usual one of capitalist-driven solutions to problems: empower the customer and she will do a better job at managing the resources; if it's your money you are spending, you'll be more careful with it.

To some extent, of course, this is true. I grew up in Italy, where there is socialized medicine (though one can always purchase private services -- the two aren't mutually exclusive), and sure enough one recurring problem in the Bel Paese (beautiful country :) is the fact that people abuse the system by buying more medicines than they need to.

On the other hand, one can argue that this is all good and well for everyday maladies, but that when it comes to serious stuff that requires long-term cure or hospitalization, most people aren't prone quite to that much abuse (after all, who really wants to go through more surgical operations or days in the hospital than is really needed?). Of course, it is in the interest of medical practitioners to overstate needs, so that they can make more money. Perhaps, but I'm not so sure that empowering the "customer" (really, the patient) would make much of a difference in those cases. How many people would argue with a doctor over crucial, possibly life-saving, measures that the doctor says are needed?

The idea of making people more responsible for how they manage everything, from health care to retirement accounts is theoretically sound. Why wouldn't we want to be more in charge of our own lives? Who would argue against increasing personal responsibility in all areas of life? But the practice of this trend tends to ignore some fundamental facts of human psychology. Most of us are simply not equipped to make sound financial or health care decisions, and "shopping around" is something for which we either don't have the time or that simply exposes us to a barrage of information that we cannot properly process.

This may sound like another patronizing liberal call for deferring to "experts," and if so, I'm guilty as charged. But I consider myself an intelligent and over-educated citizen, and I still don't feel at all comfortable making crucial financial and health care decisions on my own -- regardless of how much information I can find on the Internet at the click of a button (indeed, the problem is that I can find too much information, most of which is either garbage or hard to assess critically).

Amy Feldman's article attributes the idea of individually-owned health care to Regina Herzlinger, a Harvard Business School professor associated with the Manhattan Institute, the conservative think tank who brought us the nonsensical slogan of "compassionate conservatism" on which George W. successfully run before it was obvious for all to see that he is surely conservative, but he ain't no compassionate fellow.

I forced myself to keep reading about Herzlinger nonetheless, and found the catch later on in the article. The Harvard professor does realize the obvious consequence of what she is proposing: more individual control of health care will likely result in an increased divide between the rich who can afford good care and the poor who can't, exacerbating the current trend. Moreover, Herzlinger does acknowledge that the sickest people will not fare well under such system. Hence -- and presumably to the chagrin of her fellows at the Manhattan Institute -- Herzlinger actually advocates a balanced system in which the government (!!) intervenes to protect the poor and sick. Well, then, that makes (medical and social, if not economic) sense, but of course begins to sound a lot like your typical European system, anathema to conservatives in this country.

As Italian writer Umberto Eco once quipped, there is a simple solution to any complex problem -- and it's usually wrong. Outright individual ownership of health care services is a simple solution, and it is wrong. A mixed system, on the other hand, would probably balance the best of both worlds. But can we get the "compassionate" conservatives on board with it?