Baumol and Health Care Costs
The New York Times has a nice analysis of health care cost control using the insights of economist William Baumol, whose work reminds us to be wary of indulging in excessive optimism about cutting health care costs with new legislation. Essentially, Baumol has argued that technological improvements do not significantly reduce the demand for health care professionals. Given the inflation of wages and other commodities relevant to health care, Baumol’s work predicts that health care costs are unlikely to rise slower than inflation.
Here’s a good bit:
Dr. Baumol and a colleague, William G. Bowen, described the cost disease in a 1966 book on the economics of the performing arts. Their point was that some sectors of the economy are burdened by an inexorable rise in labor costs because they tend not to benefit from increased efficiency. As an example, they used a Mozart string quintet composed in 1787: 223 years later, it still requires five musicians and the same amount of time to play.
Despite all sorts of technological advances, health care, like the performing arts, suffers from the cost disease. So do other public services like education, police work and garbage collection. While some industries enjoy sharp increases in productivity (cars can be built faster than ever, retail inventory can be managed better), endeavors like health care are as labor-intensive as ever.
At the same time, demand for health care never lets up. So while slow sales of video games or clothing can reduce prices, health care prices never ease. And while the robots that help build cars have replaced human beings on the assembly line, robots that help out in modern operating rooms are not as economically efficient.
“We do now have robots performing surgery, but the robot is under constant supervision of the surgeon during the process,” Dr. Baumol said. “You haven’t saved labor. You have done other good things, but it isn’t a way of cheapening the process.”
It’s important to note, then, that the most effective ways to cut cost inflation given Baumol’s insight is through market-based means: shock the supply or rein in demand in the market. The current health care proposals passed by the United States Senate and House of Representatives do the opposite. As I’ve written before, both proposals would, by expanding coverage or insurance, impose an economic wedge between the price consumers pay and the price producers receive. When this wedge occurs, over-consumption of resources is all but guaranteed. So, effectively, the health care bills will increase demand and thus increase costs beyond the baseline level of inflation.
Fortunately, there are other options. The Show-Me Institute has written before about certain health care reform proposals, like health savings accounts (HSAs), that restrain demand without exacerbating the harmful effects of an economic wedge. Unfortunately, the House bill and especially the Senate bill attack HSAs and make them significantly less attractive.