Monday, December 8, 2014

Choice Architecture and Medical Reform

New from Cass Sunstein.

Behaviorally Informed Health Policy? Patient Autonomy, Active Choosing, and Paternalism

What do you think? An error in a health care decision (including the decision to abstain) could carry with it a pretty sizable downside risk. Time and attention are valuable, so sticking with the status quo is a very quick, and often reliable way of economizing on these scarce resources. Except when it fails, as well it might in medical decisions. Can't centrally-planned default rules help to minimize these downside risks while still preserving the fundamental right to choose?

When it comes to medicine, I admit to a pro-Sunstein bias. Unless folks can find a decent way to once and for all sever the unproductive, anachronistic link between employment and health insurance, there will continue to be unseemly distortions in health delivery systems. It would be much easier and more economically efficient to ditch the current system and much more humane to go full-blown single payer (but not single provider!). The chimera system is nearly as stupid as it is cruel and wasteful. The PPACA for all its good intentions, maintains the un-negotiated bundling of your job with your health coverage.

Medicine isn't euvoluntary. Which is exactly why it shouldn't be treated as if it were a rent-seeking contest. Gosh.

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Do you have suggestions on where we could find more examples of this phenomenon?