Where is the YIMBY movement for healthcare?

This field is wide open, and someone should step in

In the progress movement, some cause areas are about technical breakthroughs, such as fusion power or a cure for aging. In other areas, the problems are not technical, but social. Housing, for instance, is technologically a solved problem. We know how to build houses, but housing is blocked by law and activism.

The YIMBY movement is now well established and gaining momentum in the fight against the regulations and culture that hold back housing. More broadly, similar forces hold back building all kinds of things, including power lines, transit, and other infrastructure. The same spirit that animates YIMBY, and some of the same community of writers and activists, has also been pushing to reform regulation such as NEPA.

Healthcare has both types of problems. We need breakthroughs in science and technology to beat cancer, heart disease, neurodegenerative diseases, and aging. But also, healthcare (in the US at least) is far more expensive and less effective than it should be.

I am no expert, but I am struck that:

• The doctor-patient relationship has been disintermediated by not one but two parties: insurers and employers.

• It is not a fee-for-service relationship. The price system in medicine has been mangled beyond recognition. Patients are not told prices; doctors avoid, even disdain, any discussion of prices; and the prices make no rational sense even if and when you do discover them. This destroys all ability to make rational economic choices about healthcare.

• Patients often switch insurers, meaning that no insurer has an interest in the patient's long-term health. This is a disaster in a world where most health issues build up slowly over decades and many of them are affected by lifestyle choices.

• Insurers are highly regulated in what types of plans they can offer and in what they can and cannot cover. There's no real room for insurer creativity or consumer choice, or for either party to exercise judgment.

• A lot of money is spent at end of life, with little gained by in many cases except a few years or months (if that) of a painful, bedridden existence.

Just to name a few.

Bill Gurley wrote in 2017 that “we have the worst of both worlds … the illusion of a free market and the illusion of regulated market with the apparent benefit of neither.” John Arnold said more recently that health care is “not a fair and open market” and that it has basically every market failure. Or in Alex Tabarrok’s words, “any theory of what is wrong with American health care is true because American health care is wrong in every possible way.”

We could do much better, without any scientific or pharmaceutical breakthroughs, by reforming law and culture.

Where is the equivalent of the YIMBY movement for healthcare? Where are the people pointing out the gross violation of economic wisdom and common sense? Where are the campaigners for reform against the worst inefficiencies?

This field is wide open, and some smart writer or savvy activist should step in and fill the vacuum.

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UPDATE: Niskanen has a report by Lawson Mansell: “Healthcare abundance: An agenda to strengthen healthcare supply”

UPDATE 2: The Institute for Justice is also working to repeal certificate of need laws.