QandO

January 23, 2004

Health Care in America
Posted by Jon Henke

Galen - a doctor, so he speaks with some authority - has some comments on the health care discussion in America today....

People are beside themselves to find the bad guy, the magic bullet that will solve the health care issue. It's the insurance companies, it's the trial lawyers, it's the doctors, it's the government, blah, blah, blah.

It's all of these. And none of these. Blaming a single entity is like blaming water [for] running downhill. If the construct of the system is flawed, you can't blame the players for trying to make things work for themselves best as possible. In a capitalist system, it means people try to make money. In a socialist system, it means people try to do nothing. The trick is to design a construct that will reward what we wish [y]our end result to be.

Galen provides some suggestions as well, but you should read them for yourself. I'll have more to say on that topic later. For now....read, digest, give him feedback, and think about it: Can we avoid nationalized health care, or is it too late? And if we can't avoid it, how do we make it as efficient - market-based - as possible?

I'll comment further, later.

LATER: Back. Check below for extended rambling on the topic.

Galen discusses his fundamental goals of a health care structure.....

First of all, we need to set a few basic goals-wide access to health care, rewards for proper utilization, and keeping patients as healthy as possible.

But......while a free market would provide all of the above in the most efficient way possible, it would not ensure equal results. (neither does life, but let's not burden the body politic with such obvious truths) That, to many people, is not an acceptable scenario - and they have the political power to demand a safety net.

That safety net may come at quite a high cost, but they don't see the cost....they just see the safety net. So, we tread steadily closer to nationalized health care. (NHC)

I should take a moment to describe the reasons I believe we are plodding towards NHC. Some time back, I was on a plane next to an older man - an oral surgeon from Virginia, as I learned. Apparently, he had been quite active arguing against socialized medicine, even giving congressional testimony on the subject, and he was quite persuasive. (of course, he had a receptive audience in me) His conclusion was that NHC was coming - there's no stopping it. We can only attempt to modify it to be as market-friendly as possible.

Add to that: my wife works in a hospital now, and is pursuing her RN certification, so we've got some exposure to the health care field. In my conversations with assorted health care professionals, the overwhelming response boiled down to "it's just so screwed up".

Yeah, it is. And with the baby-boomers beginning to enter old-age, it's only going to get worse. The great majority of medical bills come later in life and those bills are going to skyrocket in the coming decade as the baby-boomers demand - and vote for - as much medical care as possible, for as little money as possible.

And they'll get it, too. Voters generally get what they want....hard and fast.

Oh, there are options - there are ways to eliminate the health care fiasco we currently have in place, but it requires personal responsibility, up-front prices, and apparent costs. Well, voters just won't tolerate that. As often as possible, voters like their costs to be invisible. If that's not possible, they like the costs to be borne by the next generation. Good luck, kids!

So, if we assume that we cannot stop it....then we can only hope to contain it. Galen writes.....

Rewarding proper utilization is one of the easiest to discuss. Under a fee for service system, the more times patients come to the office, the more money made by the provider. On the other side of the coin, a capitated system gives a flat amount predetermined for patient care, encouraging the provider to give as little care as possible. Neither type of payment is ideal for a proper utilization system, which might provide financial incentive for people who use healthcare appropriately. This may include bonus points or discounts for kept scheduled appointments and physicals, and negative points for overuse (such as an appointment for a common cold).

Note: I'm not necessarily disagreeing here. Just asking. I don't have an answer...just a lot of questions.

Rewarding good outcomes is another potential target. Surgeries and procedures done without complications could be reimbursed at a higher rate, which would discourage providers from cutting corners. This could apply to appropriate ordering of preventative care (mammograms, colonoscopies, etc) for primary care doctors as well.

On the other hand, there's very little price competition among doctors services. Why is that? Well, it's partially because patients don't generally pay for the service. They pay a set co-pay, so it doesn't matter to them whether the amount over and above that is 100, 200, or 500.

I wonder if we need a new insurance paradigm? In part, our current problem is caused by government regulation. Business of over 50 employees are required to provide health insurance. Thus, insurance companies have businesses as clients, rather than the consumers. The benefits of cost-cutting rebound to businesses, rather than consumers, and the consumers have very little incentive to cost-cut...especially since they're provided with such sorry insurance in the first place. (remember the business? They didn't want to spend a lot on health insurance. Quality was less important than price.)

Instead of this comprehensive insurance plan we have now - the equivalent of one in which we make everybody pay for insurance on a Porsche, no matter what their needs - we need more flexible insurance. Specifically, we need insurance which covers a large percentage of catostrophic problems, but largely leaves basic costs to be borne by the consumer. You know....like car insurance. If your tires blow, you pay for it. If your car gets nailed, insurance picks it up.

How would that be possible in a nationalized health care system? Frankly, I'm not sure. Perhaps the government will step in as that insurance agent.

All this to say, I really don't have an answer. Not a politically feasible one, anyway. Unfortunately, the other side does have an answer....."Hi, we're from the government and we're here to help".

I plan on being dead, eventually.

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