The Mondrian Awards
I am establishing the Mondrian Award for Ineffectiveness in Health Policy. The award will go to the program, agency or proposal that promises the least health outcome for the most dollars spent.
Once this idea catches on, I think it could take on a life of its own. The GAO, for example, could award an annual Mondrian to some deserving federal agency. The CMS could give a Hospital of the Year Mondrian. Each hospital, in turn, could give an annual award to a deserving department or staff doctor.
The award takes its name from Piet Mondrian, an early pioneer of minimalism in the visual arts who had a big influence on Mies van der Rohe, the architect/designer who famously said "Less is more."
Here are the rules. You can't get a Mondrian by just throwing paper money on a bonfire. The money has to be spent on something that plausibly improves health. Other than that, there are no rules.
Were he alive today, Lyndon Johnson would surely qualify for a Lifetime Achievement Mondrian for giving us Medicare. This program has an unfunded liability six times the size of Social Security's. Yet according to MIT economist Amy Finkelstein, it has improved the health care of the elderly not one whit.
A Lifetime Achievement award should also go to the creator of Medicare Part D. This new drug program for seniors has an unfunded liability twice the size of Social Security's. Yet according to researchers at Texas A&M (under the direction of Medicare Trustee Thomas R. Saving), of every $14 spent, $13 replaces money that would have been spent on drugs anyway. The trouble here is: I can't find anyone willing to accept the award.
In the Creative New Proposals category, I've been working on my own entry. Let's see . . . how can you spend a lot of money and not achieve anything?. . . I've got it! Spend it on healthy people . . . So who are the healthiest people around?. . . Ah, children, of course . . . But didn't I read that insuring people improves their health?. . . turns out that's debatable, but . . . why not insure kids who are already insured?. . . Brilliant! . . . But, how can we be sure that the new insurance won't be better than the old?. . . hmm?. . . of course! Have the new insurance pay doctors at half the rates of the old insurance . . . So, there you have it. Voila!
Time out. I know what you are thinking: "Foul! Goodman, that's not your idea. You stole that idea from Harry Reid and Nancy Pelosi."
Okay, I confess. I'm not very good at this. That's why I'm opening up the contest for wider participation.
If you're thinking about competing for an International Mondrian, be forewarned. The bar is already awfully high. Bono, Ashley Judd , Sharon Stone, Bill Clinton, Angelina Jolie, Richard Gere, et al. have come up with a plan to spend billions in sub-Saharan Africa in a way that almost certainly will raise mortality and lower life expectancy there. More on that in a subsequent Alert.
At this point, you're probably wondering, "What do I actually get if I win a Mondrian" Hey, we're not the Robert Wood Johnson Foundation. The prize is minimal.
Cheers
John
For Amy Finkelstein's analysis of the affects of Medicare see:
http://econ-www.mit.edu/files/788
For an analysis of Medicare Part D by Andrew Rettenmaier and Zijun Wang see:
http://www.ncpathinktank.org/pub/ba463/
Your humor is welcome. It is absolutely incredible that our nation creates laws that are hurtful, and expensive at the same time. And we willingly vote for politicians who tell us in advance that they will continue to do the same. Are we nuts?
Great idea. But try not to overstretch the findings you cite — someone else besides me might have actually read the papers.
You wrote:
“Yet according to MIT economist Amy Finkelstein, it has improved the health care of the elderly not one whit.”
Actually, she concludes:
“We find that while the introduction of Medicare appears to have had no impact on elderly mortality in its first ten years, it did substantially reduce the right tail of out of pocket medical spending by the elderly.”
Close, but only a cigarette butt, and no cigar. The civil rights effects of Medicare and Medicaid were substantial. Nonetheless, Amy’s work is extremely important and needs to be expanded further. And several other papers, including a few published by NBER, did pick up improved health effects, although we can argue about the magnitude and direct causation.
You are gooood!
Clever, clever, clever — I am gravely concerned that our health care community does not understand the situation if a Democrat is elected President — How can we rally that behemoth industry into action?
Hilarious
“Yet according to MIT economist Amy Finkelstein, it has improved the health care of the elderly not one whit.”
I think you’ve gone a little overboard with this statement. Just downloaded Finkelstein’s study. It raises a lot of questions.
This kind of analysis shows the problems of economists trying to run health care policy. It’s just as dangerous as former Clinton “whiz kid” Atul Gawande.
I bet you personally want to check into a coronary care unit (“CICU”) if God forbid you have a heart attack or a serious cardiac rhythm problem. The rise of Medicare spending is a lot more complicated than economist Finkelstein — and you — understand or let on. How about factoring in the role of randomized clinical trials and the spread of evidence based medicine and practice guidelines and societal demands for physician and hospital accountability? It all takes money. The private sector — see HMOs — doesn’t want to pay for it — or pays for it after taking off it’s shareholder and executive pay demanded top 15 – 25% or more. Our society believes in a system of justice that provides state of the art medical technology to not just those who can afford it. Why should elderly poor African Americans in Mississippi not enjoy CICU’s to the same extent as rich seniors in Darien, Connecticut? Right now, the biggest social safety net we have besides Medicare is the prison system. And I know prisons are a favorite subject for free market proponents. While we’re on the subject of Medicare, I’d like to see you campaign against Medicare HMOs which cost 12-22% more than fee-for-service Medicare.
This kind of analysis and your reducing it to the sentence above does serious scholarship no favor. You and Finkelstein sound like medical Luddites.
It’s this kind of mean-spirited policy analysis that’s going to result in a big backlash by voters next 2008 and cost all of us a lot more money and heartache than we deserve.
I suggest you tone down the rhetoric. This is not reflective of your usual careful analysis.
Excellent! Truly brilliant.
You missed an opportunity here. The Mondrian Award should be accompanied by a Moebius Prize, for the endless repetition of the same blunder.
If it were only your fans who patrolled this site then you could bask in their adoration. Some of us though know more about health care and health care policy than you would care us to know and so find your humor to be destructive of improved health care solutions rather than the amusement that you hoped to generate.
Why do health insurance companies want the Pelosi/Reid plan that you mock? Have they gone over to the dark side too? Is it getting a little lonely on top of the hill?
The Mondrian Award concept is great, and I can’t imagine a time when there have been more viable candidates.
But the big winners were the original perpetrators in 1942 and 1965.
Great idea!
Excellent idea, we also ought to have an award for most overpaid health care PR shill. We can call it the Goodman Award.