INC.COM: The NFIB appears to put a lot of emphasis on controlling health expenses by turning patients into smart shoppers making cost-benefit calculations. But when the choices are between sickness and health, or even life and death, don't they often defy rationality? How successful can such an approach be?
GRABOYES: I'll answer this one circuitously by talking first about a house.
Last year, I bought a house built in 1955. It has a gas heater, some carbon monoxide detectors, and lots of electrical wiring. I don't know any more about how those work or when they are malfunctioning than I do about my heart and lungs. I know that gas goes through the burner and blood goes through my heart, but not much more than that. And yet both can mean the difference between sickness and health, life and death. In the case of the heater, proper functioning also determines my family's life and health, whereas my heart is pretty much just me. The bottom line is that I do not have the skills or knowledge to guide the proper maintenance of either the heater or my heart. And if a malfunction in either leaves me gasping for breath, I won't be in much of a position to make calm, collected decisions.
In the case of my house, however, there is an information infrastructure that is partially missing in our health care system. When I bought the house, a skilled inspector examined the house and issued a report. There is a database of problems associated with the history of my home. The bank that holds my mortgage, the insurer who indemnifies the property, the city in which I live, and other assorted characters form a latticework of checks and balances to minimize the chance that the heater will turn lethal. In the case of health care and health insurance, the equivalent network is stunted and the information flows far less effective at providing information.
Two themes pop up constantly in discussions about health care. One theme portrays health care as uniquely important to one's sickness and health, life and death. But HVAC technicians, pilots, electricians, auto mechanics, architects, inspectors, food handlers, bus drivers, bridge engineers, and countless others also hold our lives in their hands. The other theme is that in most endeavors, people are really smart and capable of decisions, but somehow in the case of health care, they're dumb as paperweights.
But even in our information-constricted health care system, there's ample evidence that people are pretty smart and capable of controlling their destinies. Some clever health economists have examined the differences in health care treatments and outcomes in families headed by physicians and families headed by ordinary laymen. If the people-are-dim-but-doctors-are-smart hypothesis holds true, doctors' family members ought to do much better in medical situations than ordinary folks' family members. But they don't. Somehow, ordinary folks delegate the information-gathering in myriad ways -- by consulting with multiple doctors, by asking friends, neighbors, and clergymen, by consulting books and websites. And they do this even in a health care system where information is notoriously hard to acquire. That said, I'm quite sure that the decisions made by laymen and by physicians are not as good as they could be.
The final installments of our conversation with the NFIB will be the long-promised discussion of the role NFIB envisions for government.