Stamatakis: A Wiki approach to health care

By Nick Stamatakis

Most college kids love Wikipedia. Covering everything from Lutherans to Led Zeppelin, the free,… Most college kids love Wikipedia. Covering everything from Lutherans to Led Zeppelin, the free, user-updated encyclopedia is virtually unmatched on the Web in terms of breadth and depth. Sorting through the nonsense, college students often find a good foundation for papers and projects.

Wikipedia represents the best and worst of a bottom-up approach to planning. Contributors, in an unorganized and unmanaged fashion, decide what’s important independently. Compared to traditional encyclopedias like Encyclopaedia Britannica, the Wiki process is chaotic and frantic, but nevertheless pretty effective — a 2005 study in the journal Nature found the two works to have, in general, comparable accuracy.

And now for something completely different: health care. Aside from a small FICA tax on our paychecks — for those of us who work — we don’t interact with Medicare on a daily basis. But interestingly enough, the Medicare debate between Republicans and Democrats is analogous to the debate, if there is one, between traditional encyclopedias, like Encyclopaedia Britannica, and Wikipedia. Through this prism, one can make some sense of the state of things in Washington, and in the process see that nobody has a sure-fire plan to adequately provide care.

Many Republicans, led by Rep. Paul Ryan of Wisconsin, suggest managing costs the same way Wikipedia manages information, believing fully in the wisdom of the market. Under Ryan’s plan, Medicare participants would take their limited, government-sponsored voucher into the market and seek the cheapest, most efficient health care options available. Millions of “health users,” per se, will then individually make decisions, and supposedly, through natural selection and within the confines of the per capita allotment, the most bang-for-your-voucher health care system possible would emerge.

Conversely, Democrats, believing fully in the wisdom of central planning, have the Independent Payment Advisory Board to control costs. This is a newly formed body from President Barack Obama’s Health Care and Education Reconciliation Act of 2010. Fifteen government employees will determine how to keep Medicare spending in check and propose appropriate reforms — think the editorial board of Encyclopaedia Britannica. In this system, health care rationing and unfair practices are discouraged, potentially creating a system more humane than the rough-and-tumble Republican plan.

This is, of course, an oversimplification of the plans, and it relates specifically only to doctor and hospital Medicare reimbursements, not to prescription drug costs. But it nonetheless shows the philosophical difference in how both parties want to cut costs, with the voter as the ultimate judge of merit.

For a Wikipedia method, you will get a system intrinsically less fair. According to The New York Times, less than 15 percent of Wikipedia contributors are female, leading to an imbalance in the coverage of “feminine” topics. In a different breach of fairness, a voucher system will too be naturally unfair to those who consume more health care. Plus, for very technical topics — such as medicine, incidentally — Wikipedia has far less accuracy. Establishing the exact origins of SpaghettiOs through anonymous contributions is one thing, but diagnosing renal failure is a different thing entirely. Future consumers might not have luck wading through complicated medical procedures on their own, either.

Encyclopaedia Britannica, on the other hand, often finds itself out of date. With a small editorial board — especially considering that they document the entire knowledge of mankind — articles can sit for years without being updated. And while the board attempts to stay even-handed, having a limited number of people in charge reduces the chance of mistakes being weeded out naturally.

And so it seems we have the flaws of both plans. Either the market attempts to control costs, leading to a potentially unfair distribution of resources and an uninformed populace making incorrect decisions about their personal health, or we have a government reform that imposes rigid, top-bottom regulations that are inflexible and potentially just as inaccurate. In both cases, there is little chance of actual savings.

Many methods have been utilized to control costs in this country, resulting in different payment plans and reimbursement methods — all without producing any good solutions. A final system will likely need to be highly regulated, but only in such a way that it ensures market competition will drive down costs and increase efficiency. The brute top-down and bottom-up planning schemes being discussed simply fall short.

In a way, the solution will be just like how we use Encyclopaedia Britannica and Wikipedia today. Both options by themselves are insufficient, due to being either too unwieldy or too chaotic. Use them together, however, and you will have yourself quite a term paper.

Write Nick at [email protected]