Fareed Zakaria: Health IT is no magic bullet
By Bernie Monegain
Healthcare IT News, October 21, 2015
As Fareed Zakaria sees it, the remedy for America’s ailing and expensive health system is clear.
It might be hard for some to swallow, but, in his view, it is sure and proven.
“There’s absolutely no question that when we look at the ability to provide good healthcare at an affordable price, lower levels of massive inequality in healthcare outcomes or provision, a single government payer and multiple private providers is the answer. It’s absolutely clear that is the only way you can achieve that goal,” Zakaria said. “The revolution that’s needed here is not an information revolution, it’s a political revolution.”
Zakaria is a journalist, author and host of Fareed Zakaria GPS, a Sunday morning staple on CNN that delves into global issues and ways to solve them. For purposes of his broadcast “GPS” stands for Global Public Square.
Zakaria spoke to a crowd of more than 600 healthcare CIOs at the annual CHIME Fall Forum, October. 16 in Orlando, Fla.
“The fundamental point, I think, that you have to understand about healthcare is information technology, globalization are not magical solutions,” Zakaria told the audience.
This is especially so, because the fundamental structure of healthcare “makes it very difficult to achieve certain economies of scale.”
“What I’m always struck by when I look at healthcare,” Zakaria said, “is the fundamental accuracy, impressions of the 1961 or 1962 article written by Kenneth Arrow, a Nobel Prize winning economist, who said healthcare is not going to operate like any other market.”
Indeed, noted economist, New York Times columnist and author Paul Krugman also references Arrow’s work.
“One of the most influential economic papers of the postwar era was Kenneth Arrow’s Uncertainty and the welfare economics of health care, which demonstrated – decisively, I and many others believe – that health care can’t be marketed like bread or TVs,” Krugman wrote in a 2009 column.
Exactly Zakaria’s point.
Healthcare “is all non-tradable work,” he explained. Yet, “people look at healthcare and they ask themselves, ‘Why aren’t you getting more and more productivity?'”
That approach works in most industries.
“We have wrung inflation out of literally every industry,” Zakaria noted. “In most cases you’ve seen enormous price deflation. Think about computers; think about technology.”
Higher education and healthcare have been elusive when it comes to controlling spiraling costs. In fact inflation rates have been two to three times higher than the national average, he said.
“In both cases, you have the consumer not paying, very complicated government regulation that involves lots of third parties that pay and reimburse on very complicated schedules,” Zakaria said. “So all the normal price mechanisms that are at work that allow supply and demand to find equilibrium do not exist. “
As Zakaria sees it, the answer does not lie in technology – at least not in technology alone, but rather in the structure of the health system itself and leaders should be prepared to unravel the structure.
“I don’t mean to be the bearer of bad news. What I mean is you have a very complicated job ahead of you, which is the structure. In addition to that you have a Democratic system, which makes it very hard to change the structure.”
Kenneth J. Arrow, “Uncertainty and the Welfare Economics of Medical Care,” The American Economic Review, December 1963: https://www.aeaweb.org/aer/top20/53.5.941-973.pdf
By Don McCanne, MD
Although Fareed Zakaria has wavered in the past on what we need to do to improve the health care system in the United States, he has now come to the firm conclusion that we need single payer.
As he states, “There’s absolutely no question that when we look at the ability to provide good healthcare at an affordable price, lower levels of massive inequality in healthcare outcomes or provision, a single government payer and multiple private providers is the answer. It’s absolutely clear that is the only way you can achieve that goal.”
He cites the 1963 landmark article by Nobel laureate Kenneth Arrow, “Uncertainty and the Welfare Economics of Medical Care,” (link above) explaining why health care cannot achieve a competitive equilibrium in the marketplace. In today’s terms, Arrow’s work explains why it is foolish to continue to rely on a marketplace of private health plans plus various public programs to try to manage spending in our $3 trillion health care industry.
As Nobel laureate Paul Krugman states, “health care can’t be marketed like bread or TVs.”
Imagine marketing fire or police or disaster relief services like bread or TVs. Those services should be there, ready for any of us whenever we need them. The same is true for health care. That would work just fine if we made our government the single payer.