25 August 2013

Ordinary people? Who cares?

What happens when entrenched interests dictate government policy:

For most of modern history, your health care was a matter between you and your doctor. Since World War II, in much of the developed world, it’s been between you, your doctor, and your government. In America, it’s now between you, your doctor, your government, your insurer, your employer, your insurer’s outsourced health-care-administration-services company . . . Anybody else? Oh, let’s not forget [the Inland Revenue Service], which, in the biggest expansion of the agency in the post-war era, has hired 16,500 new agents to determine whether your hernia merits an audit.  Obamacare’s Hierarchy of Privilege, Mark Steyn, writing about the US Affordable Care Act, 'National Review Online', 23 August
This is truly policy as if outcomes are irrelevant, unless the outcomes targeted are those that improve things only for policymakers and bureaucrats, at the expense of the rest of the population. It's policy dictated by the needs and bargaining power of existing institutions. It has nothing to do with the well-being of the rest of the population.

If politicians were genuinely concerned about healthcare they'd measure success in terms of health outcomes. Who knows? They might even reward people on the basis of how well they achieve these outcomes. And if they wanted to channel market interests into the improvement of their citizens' health they might, eventually, issue Health Bonds. I'm not holding my breath: I think it's more likely that such bonds would first be issued by non-governmental actors; people not beholden to existing public- or private-sector interests.

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