Saturday, December 22, 2007

Where Hillary and I agree

WA state is considering creating a statewide health insurance pool; universal health insurance coverage for all state residents. The best comment I heard was “What we need is health *care*, not health insurance.”

Which of course give me the opening I need to pontificate about the subject…

But I’ve found that a well-crafted essay – building a case by marshalling the evidence, tying it all together, etc – results in something that’s booooring to read.

So instead, I think I’ll just make a bunch of statements that I believe. You can disagree if you like, but for the most part you’ll be wrong.

We should have universal health care in the USA. It’s in keeping with my ideals, and mostly in keeping with the ideals we have traditionally espoused as a nation. For the money we’re spending on the Iraq war, we could buy aspirin and breast implants for the entire nation. (For the record, I’ll just have the aspirin, thanks.)

Health care is expensive. This is primarily because:

1) Health care costs money. We have some amazing, even miraculous, medicines and machines and procedures that save us from stuff that used to kill us. People make that effort – in R&D, in production, in training, etc – because they want to help humanity, but also because they can make money at it. If we reduce the profit motive, we’ll lose a certain amount of innovation and effort currently being made in medicine; we need to understand and plan for that if we create a system that’s more “fair”.

2) We are already paying for people who can’t pay for themselves. Most states have laws preventing hospitals from letting people die on the curb outside; when people go to the ER and then can’t pay, the hospital has to raise that money somehow, so they raise the rates they charge cash customers and insurance companies, who in turn raise the rates they charge our employers who pass that cost on to us, either by reducing benefits, making us pay for coverage, or giving fewer raises. It’s a de facto insurance system; it’s just an inefficient one, with spotty coverage and limited benefits.

3) We’re paying for malpractice insurance. Since we think life is supposed to be tragedy-free, and if anything bad happens someone must be at fault, we sue doctors so much that they have to take out insurance to be able to practice. Who do you think pays for that extra cost of doing business? Hint: it’s not the doctor.

4) We pay for empty beds and machines that aren’t being used. In order to be ready to give you toenail dialysis the same day you walk in to your local hospital (ie, when & where you want it), they have to have rooms and equipment just sitting idle (ie, not paying for itself) for large amounts of the time. That means when we *do* get there they have to charge us more to pay for the downtime.

5) We pay doctors a lot more than we pay painters, because it’s harder to get to be a doctor, and because we need them more.

Is there any other reason health care is expensive? Are bad people sucking huge undeserved profits out of the system, raising the costs?
The most common scapegoats are drug companies and insurance companies. If we took their profits out of the equation, would that result in cheap quality health care for all? Maybe, but I’ve yet to see the evidence.

I’m guessing the level of health care we desire is expensive in and of itself. Which means all we can do is look for a balanced approach that would do the following:

· Continue to provide sufficient motivation for smart dedicated people to enter the field of medicine (ie, pay doctors more than other people)

· Continue to provide sufficient motivation for companies to continue to do R&D (ie, let drug companies and medical equipment manufacturers continue to profit from their efforts)

· Stop paying people a million dollars just because they lost a toenail, or because something bad happened to them while they were looking at a hospital. Or even because their baby was stillborn, if there was no negligence on the part of the doctor. S**t happens. I’m sorry. But our litigation system is getting out of control.

· Encourage people to take care of themselves. It’s often expensive not to treat people because they get worse and worse until we *have* to foot the bill for something a lot more expensive to treat. I envision neighborhood clinics providing vaccinations, exams, all sorts of preventative medicine, as well as light emergency services, outpatient type of services, wellness programs, diet counseling, drug treatment, psychiatric services, etc. A healthier populace misses fewer work days, makes better decisions, costs society less in numerous ways (I’m betting healthy people commit less crime). I’m not saying it would pay for itself – I’m just saying it would cost a lot less than the price tag makes it seem.

So anyway, there you have it. It was disorganized, but it turned out boring anyway. You may continue with your (hopefully healthy) lives...


At Sat Dec 22, 10:37:00 PM PST, Blogger jay aitch said...

or look into something like this:

At Wed Dec 26, 04:14:00 PM PST, Blogger si said...

this post -- agreed!

as i've commented in reverse-order, i didn't have a whole lot to add -- it's difficult when one doesn't have time and you've inundated the blog-waves with thought-provoking posts (after a dearth of non-posts). :)

At Mon Jan 07, 01:26:00 PM PST, Blogger SoozeSchmooze said...

Bryan I think you have very effectively covered this you can imagine the condition of health care is a subject that is very dear to my heart..a huge concern from what I can see...I really hope that it can be resolved in the next 4 to 10 years..I want it to be all taken care of by the time I retire... :)


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