After hearing about 800 million mentions of “healthcare reform” in the past couple of months, this weekend I visited my normal (not-HC-geek) family in Maryland for Mom’s 80th birthday. (Woohoo! Large clan descends, six siblings and most of the grandlings.)
Inevitably the subject of reform came up, and I realized not everyone is aware of the discussion. And of those who are, not everyone is sure what the heck they’re all talking about. What do you think they’re talking about on Capitol Hill? Is it:
- Making sure everyone has insurance? (20% of Americans don’t.)
- Lowering costs? (Per capita, US healthcare is about 50% more expensive than other developed nations.)
- Making sure everyone can get good care in a crisis?
- Lowering costs? (Per capita, US healthcare is about 50% more expensive than other developed nations.)
- Improving outcomes? (Everyone around here has heard that the World Health Organization ranks the US 39th. And, btw, yesterday I heard that the life expectancy of an American with depression or bipolar is the same as your average citizen of Bangladesh.)
- Other?
No fair saying “All of the above.” We’d have enough of a challenge accomplishing any one of those, let alone any two or three. My question is, what do you think they’re arguing about (and failing to achieve)?
Of course, there’s also what they should be aiming for. But for the moment I’ll settle for what they are trying to do.
It drives me nuts when I hear people say “Who’s going to pay for all this??” Any competent manager in any lean industry would look at the second bullet above (50% excess cost) and the first (20% have no coverage) and would see that removing just some of the bloat would easily care for it.
So I really wonder, what are they talking about?
The reason that this issue has finally come to a head is not the number of uninsured. There have always been a certain percentage of the US population with no health insurance, so if you are going to address this issue from an ethical standpoint, having 10 uninsured citizens is equally wrong as having 10,000,000.
The reason that everyone is freaking out about healthcare right now is cost. Talking heads have been squawking for years at how quickly insurance costs have gone up, and anybody who’s ever had to pay for COBRA or owned a small business knows this. This cost increase comes from several places:
– Inefficiency
– Fraud
– Profit motive
– Litigation
– The disconnect between cost of procedures and prices that citizens pay for them
It’s amazing to me that in this country we speak of how important it is to have “health insurance” when really what we should be discussing is “health care provision.” Insurance != care!!!
I won’t expound on each point above, but I’ll give some vignettes:
Why does it cost $3000 to perform an MRI, when an insured patient only has to pay a minimal copay, if anything?
Why do insurance companies pay for procedures and not outcomes?
Why should a pre-existing condition OF ANY KIND prevent you from being given healthcare? These are usually the people who are most in need of costly procedures and care!
Why does our medical education system require would-be doctors to work 120+ hours a week for years and take on a debt load that will take HUGE salaries to pay off? Japan, which has much higher life expectancy than the US, gives students MDs after 6 years, but they enter medical school FROM HIGH SCHOOL.
Why in our society do we assume that medical intervention will magically solve all health problems? One of the reasons that lawsuits are so prevalent is that people assume medicine to be some kind of panacea to solve all problems. US Citizens (NOTABLY, AND SPECIFICALLY, DOCTORS!) need to realize and accept that medicine is an inexact science, more of an art really. Anyone who’s been sick with something more complicated than bronchitis or the flu will realize that if you speak to 20 different doctors you’ll get 40 different opinions on the best treatment. Patients have to come to grips with the fact that no medical treatment is a guaranteed cure and that doctors are human beings and make mistakes.
I have a work friend whose mother is in a nursing more right now, and she is desperate to get her out of there. Why? Because the primary interest of nursing homes is to keep charging medicare/medicaid THIRTY THOUSAND DOLLARS A WEEK, rather than to heal her mother. Employees don’t even bother to learn each individual resident’s baseline information. This woman is naturally very cool – her baseline body temperature is about 96.5, so when she has a fever of 101 it’s much more serious than someone whose baseline is 98.5.
All these things are interconnected. Making it easier to become a doctor more cheaply will prevent doctors from becoming overworked debt-slaves. Changing the incentives to train them to become local general practitioners will allow them to really KNOW their patients and provide better personalized care, and possibly greatly reduce lawsuits. Etc etc etc.
My impression of congress’s activities reminds me of the apocryphal elephant story where each person only sees one small piece of the elephant. We cannot expect to treat this elephant unless we can see its WHOLE and address the problem as a WHOLE. Slightly adjusting the way that we provide “insurance” doesn’t fix the problem that we should be focused on the provision of CARE and no INSURANCE. Of course the fact that pharma and insurance companies comprise a HUGE portion of our economy makes this very difficult.
This may ultimately prove to be the equivalent of Rome’s overstretching for us. If we cannot figure out how to reduce costs and improve outcomes we’re in serious trouble.
So, Ben, the question was, what do you think they mean in DC when they talk about “reform” and “Who’s going to pay for it?”
Reform = “do the least possible in order to get ‘a bill’ of some kind passed in the senate so they can get re-elected next year”
Who’s going to pay for it = “Anyone, as long as it’s not me”
The second point is a problem in the US with everything. Everyone wants services but nobody wants to pay taxes… :)