Kling on health care management

by Russ Roberts on June 30, 2008

in Health, Podcast

The latest episode of EconTalk is a conversation with Arnold Kling on how to improve health care outcomes in hospitals. Given how complex the human body is, specialization doesn’t always improve health–the heart doctor worries about a heart attack and neglects the impact of bed rest on infection. Arnold wants to see better planning within hospitals to take account of the complexity of the human body. I wonder why the incentives aren’t in place for that to happen already. Arnold has lots of interesting observations about our current system and what it does, both good and bad, to human beings.

I am working on interviewing a hospital administrator in the fall.

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henderson June 30, 2008 at 4:12 pm

[ "I wonder why the incentives aren't in place..." ]


…so a massive national labor cartel (medical doctors), strictly enforced by Federal & state government against American consumers — lacks genuine interest in the fundamental needs of its customers… and clings to outdated & inefficient service procedures. But it continually reaps huge, monopoly profits.

…Golly Gee, whatever could be the 'problem' with that economic model and incentives (??)


{P.S. …when is the last time you observed your doctor/dentist even wash their hands before they examined you on a routine office visit ?}

Gil June 30, 2008 at 8:45 pm

Say what you will about medical conspiracy theories and all, but I'm sure most people would rather be diagnosed with cancer in this day and age than a couple hundred years ago and get something like a cow dung poultice.

Babinich June 30, 2008 at 9:54 pm

Gil said:

"I'm sure most people would rather be diagnosed with cancer in this day and age than a couple hundred years ago and get something like a cow dung poultice."

I know what you're trying to say but as someone that lost a parent to cancer all I have to say is that cancer is a terror both mentally and physically.

As for Arnold Kling's "Crisis of Abundance: Rethinking How We Pay for Health Care" all I have to say is that it is tremendous work. Buy it or get it on loan from the library; it is worth the time to read this work.

tw July 1, 2008 at 8:52 am

I enjoyed the podcast, but noticed one glaring hole. You talked quite a while about the importance of having a shepherd for a patient to guide him through the different silos within the hospital system.

This is what the Mayo Clinic does, and one reason why the level of quality there is so high. I'm surprised that Mr. Kling didn't examine the industry to see if indeed his recommended practice is already in use.

Perhaps he did mention this in his book, which I haven't read, and you just didn't have time to bring it up in the podcast. But it sure seemed like a glaring hole in the podcast.

I'll be interested to hear your interview of a hospital administrator. My suggestion would be to follow that up with a leader at Mayo or perhaps the Cleveland Clinic….and perhaps going further with a look at "Innovations in Health Care."

Certainly that may present a more optimistic view than the two-tiered system that Mr. Kling predicts.

save_the_rustbelt July 1, 2008 at 9:43 am

We have known for a least a decade the biggest problem in hospitals is too few nurses exhausted from doing too much work.

It is one of the few issues on which there is 99.9% agreement from anyone that matters.

Yet we are doing almost nothing about the problem. Universities are cutting or restricting nursing programs because 1) the programs are not glamorous and 2) it is cheaper to educate economists and poets than nurses, and 3) nursing professors are not a power block in the academic hierarchy.

There are plenty of other issues, including weeding out or retraining mediocre physicians.

save_the_rustbelt July 1, 2008 at 9:46 am


Interview 3 or 4 hospital administrators to get a balanced view -some have agendas (and some are goodballs!).

Scott July 1, 2008 at 11:53 am

I have a recommendation for a hospital administrator. Her name is Laura Synnott. She teaches a healthcare administration graduate course at Carnegie Mellon and has over 20 years experience as a healthcare administrator. Her info is here: https://www.heinz.cmu.edu/bio/faculty/synnott.html
It was a great class and she is very personable.

M. Hodak July 2, 2008 at 4:18 pm

"Universities are cutting or restricting nursing programs…"

Could you point to a any statistic showing a decline in nurses? We could certainly use more nurses (just as more of any kind of medical professional would be nice–surgeons, GPs, radiologists, etc.), but that quote appears to misleadingly suggest that we are graduating fewer nurses now than before, when the numbers I see are significant (i.e., double-digit) increases over each of the last five years.

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