Health care reform can be a net win for all parties

Published in Standard-Examiner, August 1, 2008

Vijay K. Mathur


During President Bill Clinton’s administration health care controversy began with an intelligent and serious debate among its supporters and opponents about the merits and demerits of the proposal to reform health care. However, as time progressed the debate degenerated into a politicized, “caricaturized” circus sideshow with Harry and Louise in a television commercial as its main characters.

Interest groups championing their own self interests lost sight of the main issues in the debate, like how to provide health insurance, quality medical care, drugs at a reasonable price. My intent here is to point out that the parties involved in the debate and the general electorate must take lessons from the “prisoners’ dilemma game” so that they do not repeat the same mistakes when the new President takes over and makes a health care reform proposal.

Game theory – a branch of mathematics – is the study of conflict and strategic interactions between thoughtful, rational, “untrusting”, and sometimes deceitful and uncooperative opponents motivated by self interest. Prisoners’ dilemma game, an experimental game, was invented in 1950 at the Rand Corporation. Simply put, the game demonstrates that self interests of two criminals, partners in a crime, who know their guilt (charged with the same crime and held separately), persuade them to adopt the strategy of confessing to the crime and thus suffering heavier punishment. Had these criminal trusted each other and adopted a cooperative strategy of not confessing to the crime, both could have gotten off with lighter sentences.

The parties in the health care reform debate are politicians, small businesses, big businesses, insurance industry, doctors, hospitals, AMA, drug industry, right-to-life and right-to choice groups, religious institutions, and other consumer groups like AARP, women’s groups and labor.

If these groups defect from the reform and pursue their self interests we will all face escalating medical care cost, insurance cost and inadequate care. Decisions based on self interests in the market place promote individual as well as society’s welfare only when private decisions do not impose significant costs or benefits on others (labeled as spillover effects). Health care market fails due to spillover effects, because many individual decisions on health care impose costs and benefits on the rest of the society. For example, those who do not buy health insurance and show up in emergency care increase insurance cost of others. Hence, health care reform requires a cooperative strategy.

There are many prisoners’ dilemma games in the on-going debate. For example, small businesses do not want employer mandates, but big businesses consider them “free riders”; many religious groups would not want abortion as part of the health care or health insurance packages, but certain women’s groups would like it to be included; AMA would like its members’ merger activities and price fixing activities to be exempt from antitrust laws, but insurance industry may oppose the idea. If the parties involved do not follow a cooperative strategy, they and the general public will lose and end up facing higher costs for same or less health care.

Health care reform does not have to be a “zero sum game”, like a recreational game where one party wins and the other loses. With a cooperative strategy, reform could be a “net win” for all parties concerned, especially in the long run. In addition, unlike the prisoners’ dilemma problem where criminals have to make the decision to confess or not confess to the crime unaware of the others’ decision, the parties in the health care reform game do not face this problem. They can see the benefits of their cooperative strategy as well as the losses if any one defects.

Society is better off if all parties surrender their narrow self-interests in order to gain the security of health care at reasonable costs to all. Conservatives and liberals alike in and out of Congress have to realize that the way out of the prisoners’ dilemma is to adopt a cooperative strategy, because defection from health care reform could be tragic to the nation. Prosperity of a nation over the long run is closely tied to human capital formation, and health of the people is the primary input in that formation.

Mathur is former professor of economics and chair, and currently professor emeritus of economics in the economics department of Cleveland State University, Cleveland, Ohio. At present he resides in Ogden Utah.