Code Red: Two Economists Examine the U.S. Healthcare System

January 26, 2011

A Health Reform Christmas Carol: Part Three

Filed under: Uncategorized — David Dranove and Craig Garthwaite (from Oct 11, 2013) @ 10:38 am

We were walking along Main Street in Anytown. I didn’t recognize the place, but somehow the scene was familiar. It was a warm summer day and children were outside playing and laughing. I half expected to see a sign saying “No Worrying Allowed.” We walked past one small cottage that seemed very familiar. A young man was mowing the front lawn. An older man – it must have been his father – came out the front door and turned to his son. “Timothy, I know how hard it must be for you living at home. You’ll get a job some day; don’t despair. In the meantime, your parents really appreciate your work around the house.”

Timothy? Could that really be? The mood darkened. And then my guide started in on his tale. Where anyone else would see happiness written in the faces of the children, I looked to their future and despaired.

My guide was telling me about his brother who had battled pancreatic cancer a decade earlier. His brother had received state-of-the art medical treatment from some of the nation’s best doctors. The cancer ultimately won – pancreatic cancer always wins in the end – but his brother survived more than a year after diagnosis.

My guide was grateful for the extra time that modern medicine had afforded his brother, but he was also troubled. The expense must have been enormous; insurance paid for most of it but not without considerable hassles. Dealing with insurance bureaucrats was harrowing, and at the worst possible time! My guide even wondered if all the expense was worth it. His brother enjoyed a few months free of symptoms but the last six months were filled with pain and sorrow. And he wondered about the many Americans who lacked insurance. Would they have received the same care as his brother?

My guide told me that since that time, the healthcare system had changed a lot. With the dramatic growth of Medicaid, most Americans now had insurance coverage. But the government now had a much bigger role in deciding what medicines would be available and experimentation of the sort his brother received was a thing of the past. Having failed to control costs by improving the efficiency of healthcare delivery, Medicaid and Medicare threatened to bankrupt the nation, so the government slashed physician fees and doctors now seemed to have much less time for their patients. Some cancer patients were receiving care from nurse practitioners! The few remaining private insurers seemed to exist solely to process medical bills; any attempts to hold down costs had been hamstrung by regulation. My guide wondered what would happen to him if he was diagnosed with pancreatic cancer.

Time seemed to pass quickly and we soon found ourselves at the outskirts of Anytown. We were on a one lane road filled with others like us – troubled souls looking for direction. Ahead I could see a fork in the road with three paths to follow. As we approached, I could see that the path to the left seemed to end in an abyss. The same with the rightmost path. Only the middle path seemed open. It was no wonder that everyone was heading that way.

As we reached the fork, my guide asked me which path I wanted to take. My rational mind told me to follow the middle path. I began my first step down the middle when my instincts told me to stop. With my right foot suspended in mid-air and my left foot firmly planted back in Anytown I looked ahead and saw that the middle path stretched on forever. The scenery was unchanging. If I chose this path, I would be on it forever.

“I don’t understand,” I said to my guide. “The other two paths lead to an abyss and this is a road to nowhere. Do I really have a choice? What is the point?”

My guide turned to me. “How do you know where the other paths lead? How does anyone know? No one has tried them!”

“But the paths end in nothingness.”

“Nothing that you can see. But what if there is another side?”

“That would be a leap of faith, wouldn’t it?”


“Wait a second. Who are you?”

“I am the ghost of health reform yet to come.”

And then my guide and I were one and the same. We stepped back from the middle path, made our choice, and leaped.

I awoke and finally understood what needed to be done.

P.S. May Joel find peace.


  1. Love the story – was waiting for this third part. Completely agree – we need to take a leap of faith that the reform that is yet to come is an answer because there is no other! Well done.

    Comment by Jerry Larson — January 26, 2011 @ 10:46 am

  2. This is a great story. I also completely agree why not take risks

    Comment by Erick Zimmerman — March 21, 2011 @ 3:06 pm

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