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Thursday, March 5, 2009

Health Care Reform

A friend of mine sent me an EMail with the following quotation:
If you think health care is expensive now, just wait until it's free!
I think that is an interesting quotation to receive on the day of President Obama's Health Care Summit.

At the Summit the President said:
The United States spends more per capita on health care than any other industrialized nation, yet by numerous measures, Americans are in poorer health. Medical costs can cause personal bankruptcy and threaten the global competitiveness of many companies
We have been told in the past that one of the ways other nations subsidize their industries is by having national health plans, where the cost of health insurance for workers, for example in the auto industry, is paid by the taxpayers and not the purchasers of automobiles. Makes cars marketed overseas more competitive.

I see the need for Health Care Reform of some sort, but having lived in the UK for a year with the nearest US military health care an hour away, I am not sure I favor the British Health Care System.  Not the French model.  And, I worry about the fact that while US Citizens drive north to buy prescription drugs in Canada, Canadians drive south to get procedures done.

Here is the part that bothers me.  The current health care system consists of a given number of providers (physicians, nurses, PAs, NPs, technicians and facilities).  A large amount of money is going into paying for all that.  If there was excess capacity, it would be used to deal with more patients or disposed of for its economic value.  If there was insufficient capacity people would be without health care.  We are told people are without health care.  It would seem that the first step would be to increase capacity.  That does not appear to be one of the main goals of the various proposals on the table. Instead, we are talking about insurance to bring more people into coverage.

So, who is going to work on the next person added to the insurance rolls?

As an amateur in this area it seems to me that as we bring people into coverage, as we have in the Commonwealth of Massachusetts, we need to increase the available labor and capital for health care.  Otherwise we will end up rationing health care.

If we ration health care it would seem that we would likely end up doing it in one of two ways.  First, we would make the time period between requesting an appointment and receiving one longer (this is supposed to be what happens in the UK and even Canada).  The other thing we would do is refuse treatment to certain people for certain conditions.  If you don't have private health care you might not get reconstructive surgery after a mastectomy or after a certain age you might be denied certain time consuming or expensive procedures.

I would like to see this issue of where the additional health care is coming from discussed up front by those making the decisions or voting on them.  I like the idea of expanding health care to those who don't now have it.  I just want to see it done in a reasonable and reasoned manner.

Regards  --  Cliff

PS:  My recommendation is to start now to train more Physicians Assistants and Nurse Practitioners and as part of their payback for their training put them in Public Health Service uniforms for several years and locate them out in places where there is thin medical coverage, be that in rural locations across the Great Plains or in Inner City Ghettos. Having hands on people is the first step to improved health care.


Craig H said...

What's always struck me about people who are inclined to observe "if you think it's expensive now, just wait 'til it's free", is that they remain completely unconcerned about any extant inequities in the present system, while only chafing at the prospect of paying for someone else's care. What they always fail to consider is that we're already paying for other people's care, only those people being subsidized are the rich ones receiving the benefits of all that exotic research into the most expensive of treatment options that the hospitals and medical schools all use as carrots to attract the top-talent physicians in order to add cachet and a good reputation to their portfolios. Meanwhile, as John Silber once railed, our low-income elderly can't even afford eyeglasses.

I think the main ethical issue to be resolved is what constitutes the base level of care to which ALL citizens are entitled. (I would vote eyeglasses at a minimum, and much more than that, but, hey, I guess that makes me a tax-and-spend liberal and, maybe, if it's also not too much of a pejorative, a Christian). I get sick to my stomach to read about what we can afford to do for the privileged few while the disenfranchised go without simple remedies to easily-treated health problems like failing eyesight.

Anyone who believes it costs too much ought to stop fighting the premise, and start arguing for a rational and reasonable and affordable standard that does not overtax our system to pay for it. How about, no heart transplants for aging rich people until every child has flouride treatments for their developing teeth. Then we'll see how quickly comprehensive and affordable healthcare might be agreed.

C R Krieger said...

I was glad that Kad Barma used entitled and didn't say health care is a right.  The idea that something like health care is a right seems very strange to me.  Rights are against Governments and while we may sometimes think of our Government as toxic, it is nature itself that brings us bad genes and disease.

I agree that we should be providing eye care for seniors, and for children, who can't afford it.  How else will seniors see the ballot in order to vote and children see the page in order to learn.

But, there are likely to be a lot of unintended consequences in any version of healthcare reform.  For example, one of my friends drops about $20K a year of his own money on an experimental Parkinson's treatment.  It is working great for him.  From this investment of his money will come, someday, a better and cheaper treatment for all people.  In the mean time, my friend (and others) is underwriting this development.  And, if we were to take away this right of his to spend his money as he sees fit we would then distort the economy.  He might go overseas for his treatments, moving to Argentina.  Not that he would, but he could go to the underground economy--the black market--for his treatments.  As Professor C Northcote Parkinson observed in The Law and the Profits he might just exchange a couple of cases of wine for his treatments.

Further, I suspect that the money rich people spend for great treatment at teaching hospitals has indirect benefits up and down the line. One of those benefits might be better training and the making of better medical equipment available to all.

In the mean time, I still maintain that what hasn't been addressed is where we will get these additional health care providers--providers that we need now--to treat those who are today without coverage or treatment, but who we want to bring under the wing of some national health care insurance.

If we opt for eyeglasses for all, are there the optometrists to do all the eye exams needed, or is this going to be a case of standing at a mirror in Rite Aid, trying on glasses until something works?

Regards  --  Cliff

C R Krieger said...

Here is a blogger, Mike Rappaport, asking the question of if health care is a right.  He quickly ducks, but then moves to the correct issue.  That issue is how do we provide sufficient health care.  The first comment on the post is interesting.  My impression is that the commenter is a Brit.

Regards  --  Cliff