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Some things never change - a reflection on the live of Dr. Victor R. Fuchs

The dean of healthcare economists, Victor R. Fuchs, is dead. While we mourn his passing, and recall his profound influence, it's worth reflecting on a sobering fact—healthcare is even worse today than it was in 1975, when Dr. Fuchs released his famous book, Who Shall Live? Health, Economics and Social Choice. At the time, Who Shall Live? was required reading for health professionals. (And it still is, if the recently released 3rd edition is any indication). In the book, Dr. Fuchs noted that American healthcare policy was on the wrong track. Sadly, that is still the case. According to The New York Times obituary, "Some considered the book unseemly. There was something distasteful, his critics said, about applying economic analysis to a field concerned with life and death."


In the decades since, one could confidently come to the opposite conclusion. Namely, that we're not applying enough economic analysis to life and death. For example, America is still spending more and more on healthcare and doesn't have anything to show for it. Our healthcare costs are twice that of other advanced countries, and yet our outcomes are lackluster. Some things never change. During his career, Dr. Fuchs identified the biggest problem facing the U.S. healthcare system—a lack of willingness to make hard choices. Real change will require both policy makers and the public to make tough tradeoffs. Unsurprisingly, that still has not happened, and the consequences of continuing to evade reality will only serve to compound our problems. In order to contain costs we need to prioritize primary care, emphasize affordable end-of-life care (e.g., hospice) and escape the clutches of the coding system, which shackles physicians and burdens everyone with bureaucracy. Implementing these three changes would dramatically increase access to care, improve the quality of care and reduce spending. For those interested, my book, The Journey's End, offers a roadmap for making this happen.

Of course, you don't need to be a dean of healthcare economists to see the value in that.


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