There are over a dozen state and federal health care reform initiatives on the table today. To evaluate the various proposals, we have to agree on what we want to accomplish. Otherwise, we’ll spend our time debating which road to take when we don’t even know our destination.
What are we trying to accomplish with health care reform?
Lower costs today? A sustainable trend rate so care is affordable for the foreseeable future? Better outcomes, defined as healthier people and/or fewer avoidable deaths and/or higher levels of functionality? Coverage for all so no one goes without? Equitable reimbursement? Less interference in the doctor-patient relationship? Greater self-responsibility on the part of consumers? A reduced financial burden on employers, especially small ones and really big ones with lots of retirees? Ever healthier, longer-lived citizens?
All of the above?
A strawman. We have to begin with the user of the services – the individual and family.
Americans want to be as healthy as possible, they want their kids to be healthy, and they want to have enough money left over after paying for this health to buy food and shelter and education and clothing and an X-box. They also want to have good jobs that pay enough so they can afford the necessities and frivolities, and they want those jobs to be around tomorrow and the next day.
If that makes sense (and it’s so mom-and-apple-pie and basic it has to), we have a basic premise from which we can start.
And when we disagree, we go back to this basic premise and use that as the basis for discussion.
Can we start from here?
If you’re actually looking for responses, and not just posting rhetorically, what I want is for everyone to be covered.
No one should have to risk bankruptcy simply because they have lost their job, and happen to be sick.
Everything else would be great also, but let’s be sure everyone has access to the current health care system first.
Then we can start tackling the other problems such as relieving the responsibility of health care from business, the quality issues etc.
Ah, the American Dream: a life free from worry, a life where no want is unrequited. The problem is that once you have the extra money for the xbox et al, the first thing you think about is NOT “hey, I could go for some health insurance.”
Solving the issue of the millions of uninsured is not going to begin with fomenting consumer choice. People are unwilling to admit their mortality to an extent that they refuse to admit they’d be better off with health insurance. Frankly, the process necessary to become insured coupled with getting a claim completed means its just as easy to skip along your merry way and hope you never get sick.
I feel like the problems facing healthcare are similar to those facing education reform: we have no idea how to improve things, everyone in Europe seems to be able to do everything better and cheaper, we talk about it endlessly, and no matter how many economists or politicians we throw at it nothing happens.
That said, I think your idea of finding a baseline and approaching healthcare issues on an individual basis is a sound idea.
I’m with Marc on this one. Getting everyone covered at a cost the society can afford and sustain would be my preferred starting point. Tackling the quality and efficency issues can be addressed on a parallel track, but universal coverage with affordable and sustainable financing should be the top priority, in my opinion.
The profits of ‘health plans’ show that there is really no true competition and no true ‘marketplace’ for purchasing health care-be it disease management or wellness.
As an outsider, it appears that those of you in the mindset of managed care (read: managed middleman profits) at all costs desire to maintain the hoax managed care has perpetrated on Americans.
You have had–let’s see Clinton was elected in ’92–about fifteen years to give us improved quality / controlled costs / availability as promised.
Sounds like you guys want a four- or five- strikes and you’re out ballgame. I hope that this congress and the new administration has the good sense to see what little the middlemen have done for us.
I just got inspired and wrote an entry about this article from the NY times:
http://www.nytimes.com/2007/01/28/magazine/28nutritionism.t.html?ex=1327640400&en=a18a7f35515014c7&ei=5090&partner=rssuserland&emc=rss
The article essentially argues that reductionism in approaches to the American diet (called “nutritionism” by the author) are to blame for many of our major current health woes.
The best quote is as follows:
“It might be argued that, at this point in history, we should simply accept that fast food is our food culture. Over time, people will get used to eating this way and our health will improve. But for natural selection to help populations adapt to the Western diet, we’d have to be prepared to let those whom it sickens die. That’s not what we’re doing. Rather, we’re turning to the health-care industry to help us “adapt.” Medicine is learning how to keep alive the people whom the Western diet is making sick. It’s gotten good at extending the lives of people with heart disease, and now it’s working on obesity and diabetes. Capitalism is itself marvelously adaptive, able to turn the problems it creates into lucrative business opportunities: diet pills, heart-bypass operations, insulin pumps, bariatric surgery. But while fast food may be good business for the health-care industry, surely the cost to society — estimated at more than $200 billion a year in diet-related health-care costs — is unsustainable.”
I continue to think we have our approaches to healthcare backwards and my belief in starting from scratch has been strengthened.
I’ll take the flip-side of your rhetorical – yet obviously important – question/starting point.
Regardless of the path or the over-reaching goal, anything that remotely resembles a “solution” will require (directly or indirectly) some very basic changes. Or to put it another way: at the end of the day, after whatever means we take to reach whatever ends we choose, a few basic – but crucial – reforms must necessarily occur.
NUMERO UNO:
You can argue about who pays for health insurance or how health care is paid for all you want, but it really doesn’t matter how much money you spend or whether it is a free-for-all marketplace of providers and payors or strict socialism, crappy medicine is crappy medicine – and increased access to all the Nexium, Zyprexa, Vioxx, drug-eluding stents, and other expensive wasteful/harmful treatments in the world is not going to feel like reform to anyone.
Why does everyone assume more is better? It is often not. Just to make an intentionally specious, yet serious, observation: 18,000 deaths can be attributed to lack of insurance (Kaiser or RWJF?), while estimates put iatrogenic/preventable deaths at 98,000 anually(IOM, 1999). This number is 8 years old and does not include preventable deaths that occured outside hospitals. Autopsy studies shows that not only do doctors misdiagnose 40% of terminal patients but that this error rate has not improved SINCE 1938.
Individually and collectively, empirically and measurably WRONG decisions/drugs/devices propagate until someone either has to be a whistle-blower (Vioxx) or just finally decides to challenge group-think (HRT). What was just as disturbing as the FDA’s role in the Vioxx debacle was organized medicine’s. Sure, doctors were given misleading or incomplete info, but that is not the point. Who is in the best position and who is trusted to notice such things? Not necessarily individual doctors but “the medical profession” should have at least had a way to notice that a drug that was only marginally more effective than NSAIDs was costing more than just money.
Doctors – as a profession – need to clean their house up or all of this lovely economic and political debate will really be for naught. You can piss in a cup and tell people it is wine for only so long.
I must say that part of the major problem are the Pharmaceutical companies. Our politicians have allowed these companies to become obsessed with sales. We seem not to care remedies for getting well. We seem to be concerned with the money that is poured into our states because of the bandages that are placed on sicknessess in lieu of the healing process. An example is anit-depressant medication. I am sure there is a cure, however the secret is well kept, for fear of loss of revenue.
I agree with Joe Paduda. Furthermore, I believe that there is a solution that can put us on the path to achieving the goals he specifies with the additional benefit of addressing another BIG social problem in our country, illegal immigration. Briefly, it follows:
Medical Insurance and Immigration
A Common Solution
How is it possible for these two issues to be related? If Congress enacts legislation to require proof of “minimum standards” medical insurance (an idea of methodology to follow) by all US citizens and residents AND anyone visiting the country, suddenly we have a national policy of medical insurance for all citizens and residents, and a policy which would address illegal immigration. Persons who drive automobiles in this country must provide proof of minimum standards liability coverage, so why not extend the policy for medical insurance. Such a policy would also address immigration issues without the need for additional policy constructs. We already police immigration, so policing issues would not be negatively affected.
Proposed methodology for providing proof:
With annual tax and a new “included medical coverage” return
At the birth of new citizens
At entrance to country for anyone with a work permit, visa, etc. (for foreign residents and visitors)
Furthermore:
Insurance would remain private.
Additional coverage may be purchased at individual’s discretion.
Qualifying citizens will continue to be covered under existing federal Medicare program.
NO ONE MAY BE DENIED COVERAGE!
Additional recommendation:
Insurance policies should not be provided through employment. Citizens and residents should have the right to acquire insurance privately, without the fear of rejection. I suggest this for a variety of reasons, including:
1. Eliminates the continual renegotiating and re-enrollment sessions between businesses and providers which adds to overall administration costs.
2. Promotes stability in doctor/patient relationships.
3. When insurers are allowed the right of denial of coverage, citizens begin to hide relevant health concerns or choose to find service without submitting a claim. This does nothing but subvert quality health care and having a quality health care system.
4. With the entire population receiving coverage, the pool will be large enough for a healthy mix of low and high risk insured.
5. The burden on emergency room care will be substantially reduced as the current uninsured become mainstreamed.
I have additional ideas about prescription drugs and their high costs and restricted availability. I will be including that idea in a subsequent posting.