Rent-Seeking
Even if you are not familiar with the term “rent-seeking,” you are likely familiar with its effects. Rent-seeking is the process by which businesses seek profits by making investments in the political process. A business might invest in lobbying or political contributions or some sort of quid pro quo concession in return for laws blocking competitors, mandating their product’s use or providing direct subsidies. In some industries, the return on these political investments dwarf other potential investments in the core business. For example, in the ethanol business, it is almost inconceivable that there is any investment in plant or equipment whose return matches that from the political investment that has provided the industry a combination of direct subsidies, mandated use, and protection from foreign competitors.
In the health care field, the Holy Grail of rent-seeking is to get oneÂ’s medical device, drug, or procedure added to state health insurance mandates. Before Obamacare, health care insurance regulation had been a state function, and each state had written laws mandating that all health insurance policies written in the state
must cover certain services. By getting one’s particular service added to such a mandate, the service essentially becomes “free” to consumers in that state (of course it’s not free — everyone pays in the form of higher premiums, but the marginal price for the service goes to zero).
Imagine you have a procedure — let’s use laser elimination of birthmarks as an example. This procedures requires a series of treatments using a fairly expensive piece of equipment to produce results that are of enormous value to a few people with extensive birthmarks, and of smaller value to many other people with smaller birthmarks. Business growth in such a field is typically good at first as those who most value the procedure pay for it. But it can be hard to grow outside of a relatively small niche, as most potential customers may consider it to be an expensive elective cosmetic procedure that, given other uses for their money, they can do without. What can an aspiring dermatologic surgeon do? Run to the government!
In 1997, the
University of Indiana conducted a study of the laser treatment of these birthmarks. I don’t know who funded the study, but tellingly the study findings did not really touch on the efficacy of the treatment or its risks. The study surveyed a number of dermatologic surgeons. What was its primary finding? ”Based on current health care policy guidelines, laser treatment of port-wine stains should be regarded, and covered, as a medical necessity by all insurance providers.” In other words, the sole purpose of this research was to convince legislators to add this procedure to their state’s insurance mandates. To date, this procedure has been added to the must-carry list in only two states, but in those two states doctors no longer have to convince price-sensitive patients that this elective procedure is worth the cost – after all, its free!