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Health Care Good, System Bad
You can make an argument that the quality of health care in the United States is as good as anywhere in the world (if you can afford it)—but the system we use to allocate and pay for that care is obviously broken and needs to be fixed.
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Posted by Dave Studeman on 03/11 at 06:16 PM
Those life expectancy/health care cost graphs drive me nuts. Correlation doesn't mean causation. In fact, it makes more sense to turn the graph around--it isn't that more dollars spent yield longer lives, it's that longer lives require more money spent. IOW, it isn't medical spending that drives life expectancy. There are many social, cultural and demographic issues that drive life expectancy (and health care costs), many of them related to the "inalienable" rights that many Americans cherish.
If you can accept that higher health care costs don't necessarily drive life expectancies, even in other countries, you start to approach the problem differently. You might ask: What *should* we expect for our extra health care dollars?
I'm someone who doesn't believe that the profit motive is a bad thing in health care insurance, but it certainly has to be better regulated than it is now. Health insurance companies are not just "insurance" companies, they are major cost and benefit managers. In fact, the profit motive has arguably led America to do better in those areas than other countries have done. Other government-run systems come to American health insurance companies for advice on their programs.
When you think about it, many of the dollars that are paid out by health insurance companies aren't really for "insurance" (which is something you typically buy for major catastrophic financial events) but are transfer payments between the healthy and unhealthy for non-catastrophic health care costs. There ought to be a different term for what health insurance companies do, because they are unlike any other segment of the insurance industry.
To me, the current administration has the right idea: a national exchange in which everyone has to buy health insurance, with community rating by the insurance companies. That minimizes the "underwriting competition" between firms and emphasizes their ability to negotiate contracts with providers, manage provider delivery systems and also manage individual high-cost cases. And the profit motive might not only be appropriate, but socially desirable in that scheme.
Posted by Sedicious on 03/11 at 08:12 PM
But the quality of care could also be so much better, if we really aligned the economic incentives appropriately (including an overhaul of FDA regulation). The measure of a health care system shouldn't be life expectancy, it should be quality of life. I know it is most urgent to get people covered who currently are not, and will support almost any reform now that will accomplish that. But as soon as we've made that change, a much deeper overhaul should be undertaken. Proper emphasis on prevention of illness is only the tip of the iceberg, compared to the potential for life enhancement.
Posted by postfuturist on 03/14 at 04:26 PM
Is there a grave risk a universal healthcare system could become too bureaucratized, as Medicare and Medicaid are today? That too much funding will wind up going to the administrators rather than the clients?
Posted by Omar Fink on 03/18 at 11:31 AM
1. The statistics are misleading and you need to get them correct before moving on.
--1a There are not as many millions of people in the US who want health care and can't afford it as have been represented by statistics. When you eliminate those who actually have some eligibility for coverage but don't use it and those who make the decision to not purchase it when they can afford it, you are left with only a few millions (maybe 4-5m) who cannot get the health care they need.
--1b Representing the quality of health care with life expectancy numbers is not correct. The size and makeup of the population group determine those numbers far more than the health care system. Japan is represented by one of the highest life expectancy numbers. Japanese who live in the US show the same life expectancy. This suggests the differences are created more by culture and lifestyle, than the health care system.
--1c 3% of total health care cost goes to the insurance companies. Representing them as evil gougers does nothing to solve the real problems.
2. Our drugs are expensive because we do more R&D work in this country and have more government regulation (for valid safety concerns) than any other country. The rest of the world can sit back and let us do the heavy lifting and reap the benefits when cheaper generic versions of drugs become available later. It's a simple choice to balance safety against cost and decide how much safety and what level of state of the art drugs we are willing to pay for and not willing to pay for.
3. The drug issue is a good analogy for the rest of the health care system. It IS the best in the world and we are constantly demanding both more of it and higher levels of care than any other system in the world. It is mostly this demand that is driving the costs up. All we have to do to lower costs is reduce the quantity and quality of tests, drugs, private rooms and all the other "frills" that we take for granted. We don't want to do that, but that's the hard truth.
4. The Democrats solutions: Coverage mandates (make the pool larger, cover pre-existing conditions, expand Medicaid) will increase coverage spread (which is not a major factor - see statistics above) but will continue to drive the costs up. More government control inevitably introduces more waste and reduces free choice.
5. The Republicans solutions: Open market competition, reducing fraud and waste, and tort reform may help, but they are not the driving issues pushing our costs up. The driving issues are our lifestyles and our demands of our healthcare system.
6 The Mayo Clinic has done studies and implemented solutions that appear to work, to both increase the quality of care and to cut costs at the same time. They have concentrated on the quality of results instead of quantities of tests, procedures and drugs.
7. Getting both the patient and the doctor to focus on quality of care means taking on more individual responsibility. This is normally accomplished best by free market principles, not more regulation and government intervention that decreases the sense of personal responsibility and initiative. Education is a key factor. We could probably get more "bang for the buck" by teaching our population to eat more like the Japanese than any other single factor suggested in the current health care reform debates.
Posted by postfuturist on 03/18 at 06:09 PM
Right on-target comment. Right now-- and no longer being progressive I go by today, not the tomorrow that recedes into the future-- there are far too many irresponsible people who would use universal healthcare as a life support of sorts. I know dozens of itinerants who don't take care of themselves because the prospect of medicare & medicaid paying their bills until they become hopelessly ill (at which time they go into assisted living and, later, into a nursing home) is comforting even if it lessens their lifespans. It is surprising how many undeucated, even by contemporary educational 'standards', exist. Many don't know the rudiments of nutrition. Utterly shocking is the libertarian interest in having the state pay the medical bills of those they care about, even though libertarians claim to detest the govt. So it was no surprise to me that "healthcare" (a euphemism meaning most people DO NOT take care of themselves and require govt assistance in perpetua) would come to such a parlous state: "when we get sick from poor nutrition, smoking, drinking, and dope, the state will take care of us until we die, at which time our funeral benefits will be paid for". 'Healthcare' is a monument to unaccountability, at this time; and again, I go by now, the inertia is omnipotent. Today when people say they hate big government they mean they want those outside their circle of family & friends to die, so they can get funds for healthcare even if many don't need the funds at all, and even if their bookkeeping is merely complicated by the infusion of govt funds to no real net gain. And that of course is general, practically global: "I hate big guvmint except for the funds from big govt that keep my grandparents alive even if they have hundreds of thousands or millions in assets & disposable income". We can all now see that people care more about the status of themselves and those close to them than they do about their own health. So the unaccountability will continue another decade or so; who knows what will happen after that; I'm a futurist no longer and haven't the foggiest notion of what will occur in the next decade-- let alone after that. And as long as libertarians and Repuglicans ae involved in h+, I have no intention whatsoever of being involved and letting those rightwing hypocrites manipulate me in any way. It has been a long joke-- but the joke is now OVER.
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