What Happens When You Change an Entire Health Care System?
Few issues today are as heatedly debated as health care reform, which has inspired some of the most antagonistic moments in recent American politics (remember “You lie!”?). As a debate, it seems perfectly designed to push us to the brink of collective madness. Beneath the difficult moral argument about what’s fair and right lies yet another difficult argument, an irredeemably wonky one about cost, value, and economic incentives. It’s a deadly combination—the policy equivalent of texting while driving.
Considering how well-developed the moral argument is—not to mention how many billions, even trillions, of dollars are at stake in whatever we do—we know surprisingly little about the real-world effects of making changes to health care systems. The economic debate about health care has been mostly theoretical, or based on models. When it comes to what really happens to patients, doctors, and budgets when health care systems change, the evidence is shockingly sparse. It’s not easy, after all, to experiment on a health care system.
Stepping into that gap is the MIT economist Amy Finkelstein, who recently won the prestigious John Bates Clark Medal, largely for her work on the economics of health care. The medal is awarded each year by the American Economic Association to the best economist under 40, and carries immense prestige in the field. (About 40 percent of Clark winners eventually are awarded the Nobel.)
For more than a decade, Finkelstein has worked to understand the nuances of the health care system—and to add some hard data to what passes for informed debate. “Many, if not all debates in health care are argued out of opinion and anecdote,” says Amitabh Chandra, a professor of public policy at the Harvard Kennedy School. “It’s always a story about how my doctor treated me, or about what happened to my uncle when he had a heart attack. What Amy has done, and done repeatedly, is say, ‘I’m going to use lots and lots of data and give you a more realistic, complete characterization of what’s happening.’ She can give us the number that helps us weigh costs and benefits.”