Developments this week highlight the problems with the neoliberal decision to privatize medicine in the U.S. Certainly the Affordable Care Act (ACA), which entrenches responsibility for access to healthcare to private insurance companies and then attempts to contrive a market for patients to shop between insurance plans as some sort of proxy for shopping for doctors, is the most famous recent example of this decision. Never mind that in market terms medicine is a classic credence good: you may not know either before or after purchase whether you are getting a good deal, and the barriers to knowing this are nearly insuperable owing to the inherent complexity of medicine and the inherent uncertainty behind most medical judgment, even perfectly executed by brilliant practitioners. Medical care just isn’t one of those things that works well as a market good.
Meantime, this week, President Obama signed the 21st Century Cures Act. This bipartisan bill makes an enormous investment in research into urgent health problems from Alzheimer’s, to opiate addition, to cancer, and continues to fund the promising developments in “precision medicine.” This is an obvious good. What could be wrong? The tradeoff, beyond the now stale point that there is no investment in the social determinants of health – like urban infrastructure – is that it loosens regulatory requirements for drug approval even further. As the Washington Post reports: