Healthcare, II

Some really good comments yesterday, and I don't really take issue with any of them, nor do I want to get involved in a specific-case discussion, which doesn't serve a whole lot of purpose. Some of the disagreement is really just semantic anyway...most everyone agrees that there is plenty of room for reform, and plenty of room to improve the way we deliver health care.

There were some good defenses of the British NIH and of the Canadian system...but those systems work where they are for a couple of reasons, most notably that England and Canada are not the United States. Americans are fatter than most every other country (and therefore have more obesity-related diseases), more demanding (prescription drug use and doctors visits are higher among Americans than anyone else) and much more litigious (which leads to what many doctors refer to as "defensive medicine" - it is easier to order a test or prescribe a drug than to run the risk of being sued for missing something). Ally did a really good job yesterday of explaining why a lot of our problems are not the fault of government or insurance companies or hospital operators but rather of the American people

The NIH is a total no-go, I think, because I am pretty sure it would require at least one Constitutional Amendment. The Federal Government does not have the authority to nationalize an entire industry, take all of the assets (hospitals, ambulances, equipment, etc.) by edict or by eminent domain, and them inform all of the doctors and nurses that they now have to work for the government. I know that Constitutional limits are flaunted by Congress and the President all the time, but this would be a stretch.

[Here is another dirty little secret: Americans subsidize the health care of everyone else in the world. We end up paying for most of the innovation, and everyone else piggy-backs on the profitability model here. So, for the rest of the world, you should be rooting against single-payer care in the US that would force innovation to either disappear or have its costs shared internationally.]

We have a totally perverted system whereby we pay as socialists, but we still consume as capitalists. As Trigger points out, we do NOT have "market based" health care. Markets involve people making consumptions decisions based on costs and benefits. Cost is nowhere in our health care decision-tree. Imagine that, when buying a car, everyone paid the average price of a car, but you could pick any car you wanted off of the lot. What happens? Everyone drives Bentleys, and the cost of a car rises to $185,000.

Our system of "insurance" is part of the problem as well. Insurance is the spreading of the risk of unusual or catastrophic events...what he do is pay communally for everything. To keep with car analogies: you pay for your gas, tires, oil changes and other routine maintenance out of your pocket, but you have insurance that covers accidents and whatnot. Just a random question...if everything was included in your auto insurance, how much do you think an oil change would cost? Certainly not $19.

We share everything, including routine costs and the costs of self-inflicted disorders, with no allowance for the behaviors of the person involved (except smoking). Because of the way that Americans consume routine care, the costs of that care are astronomical, which then trickles down into the difficulties of obtaining care for the truly catastrophic (and a couple people told good stories about cancer and organ failure and whatnot.)

And that all sort of gets me back to the initial point from yesterday...not that we do not need or could not benefit from Health care reform, just that this current proposal is a disaster. There are certainly some positives (wider insurance coverage, better accommodations for people who are truly just the victims of bad luck), but the overall premise of the bill is flawed. It addresses none of the root causes of our soaring health care costs, it simply promises that the government will pick up the tab for more people. Our government already refuses to live within its means, and this will just do more to continue with our pressing bankruptcy.

In the interest of not being a total negative-nancy, I will throw out the following as a potential solution that would probably work in the US, and would dramatically lower overall costs. I would propose that we go back to an actual insurance model, whereby routine and expected costs are paid out of pocket by the user (or, there is just some limit...say your first $1,000, or $2,500 a year or something) and insurance exists to cover the unexpected and the catastrophic.

Whether that insurance is provided by private companies or by the government is really not as important so long as the principle is preserved: patients and doctors interact directly on most care, without the need for an insurance company or a bureaucrat to determine what should be paid for and how much it should cost. (There is a role for government, as well...most notably for people with serious, genetic pre-existing conditions). However, we do not bankrupt people or families because of an unforeseen and unlikely illness.

Thoughts?