If the Hartford Business Journal was really, really hard up for cash, it could dump Cohen the Extraordinary But Expensive Columnist and replace him with some mediocre, discount guy.
That would be sad for you, but it would be part of the market discipline that allocates resources and sort of, kind of, gives you what you’re willing to pay for.
Without Cohen to navigate your way through life, you would be worse off, but, on the other hand, the alternative might have been doubling the subscription price, forcing you to choose between food for your family or, of course, the Wisdom of Cohen. Not an easy choice.
Although it’s rarely discussed with much gusto, mediocre options are important elements of the market dynamic. Mediocre cars, mediocre homes, mediocre frozen chicken wings — they’re all part of the complex package of options that allows us to make choices about how we live.
The issue isn’t discussed with much enthusiasm, in part because that “mediocre” thing is thought to be insulting. But, mediocre isn’t necessarily so terrible, except when it comes to newspaper columnists. A mediocre car can still get you from here to there, even if it’s not exactly the kind of chick-magnet of a Buick Park Avenue that I drive.
One of the subtle evasions making “health care reform” so difficult is the failure to explain the importance of mediocre health care. What politician wants to champion the notion of providing so-so medical treatment to those without the resources to get the very best?
The health care community understands the magic of the marketplace. The hilarious hospital ads that occasionally appear on television often suggest, somewhat gently, that you’d better toddle on over to the major medical center, or the large regional health center, when you’re really sick — as opposed to risking your lives with the community hospital hicks.
The underlying theme? Some of you will receive mediocre medical care.
One of the reasons that health insurance is so expensive in Connecticut, for instance, is the legislative mischief that layers on mandated coverage — a political effort to inhibit the marketing of (dare we say the word out loud?) mediocre health insurance to those who can’t afford, or don’t want, the very best.
The magic of the market doesn’t make the impact of mediocre health care easy to predict. Incentives can transform mediocrity into superiority.
The Yale School of Medicine and Yale-New Haven Children’s Hospital produced a research garden of delights this summer, pondering the strange mix of incentives and, at least in theory, mediocre medical care.
The conclusion, almost worthy of a test run on Saturday Night Live, suggested that among a certain population of infants with serious congenital defects, the uninsured infants actually received superior medical care to those with insurance.
The kids were expensive to treat, the Yale researchers explained, so that the community hospitals were reluctant to give up the insured kids’ guaranteed revenue, for ‘better care” at specialized children’s hospitals. The community hospitals were relieved to give up the uninsured kids for “better care” at the specialized facilities because they would swallow the costs.
A similar theoretical story makes the rounds of health economics classes. The smirking scenario: if your child has asthma, the best thing for him or her is greedy, profit-seeking, evil insurance coverage. Why? Because profit-seekers will demand that the child receive early, consistent, high-quality coverage, since the alternative is expensive emergency room visits that are, well, mediocre.
Wasn’t this column terrific? You’re lucky. In the wrong hands, it could have been mediocre.
Laurence D. Cohen is a freelance writer.
