If Not Health Reform X, Then What?
(The Part Two in the Series)
People seem to be taking sides in our little medblogger health care debates; I hear a lot of people that would be unhappy with a single-payer solution, but not a whole lot of other ideas to fix our health care system (ie: more negative ads than positive ones). The fundamental thing I don’t understand from libertarians is this: what’s a better option? Libertarians would have you believe that if we all just were responsible for our own health care costs, we would decrease our spending and la la la everything would be okay. But that’s not going to happen.
We have a law on the books saying that any ER has to screen patients who walk through the door. Now, you can take this law and do one of two things with it:
1) Keep it, and deal with the consequences that it creates.
2) Repeal it. (But let’s be honest, people, no one but wealthy crazies actually believes that this is reasonable policy.) So we repeal it, and ERs are allowed to turn away emergency patients (or patients who think they might be emergencies). We’re going to let people die on the streets? This would never, ever happen, and if it did–talk about health care revolution.
So here we are. We as a society have agreed that we will take care of the acutely ill, no matter the cost.
From where I’m standing, then, if we’re going to take care of the acutely ill, we might as well keep societal costs lower by preventing people from becoming acutely ill (or from developing the consequences of chronic illness). Am I crazy? Am I missing something here? You can’t tell me that our system makes sense in this way. We will allow an uninsured diabetic to go years without any preventive care, because lack of ability to pay, but once his foot becomes necrotic and he needs an amputation, and gets an ICU stay for becoming septic–oh well, let’s definitely pay for that!?
So here are the facts: single-payer would not cost us any more in ABSOLUTE dollars than we are paying today (as evaluated in the California Health Care Options Project, The Vermont Single-Payer Study, The Maryland Single-Payer Study, Massachusetts Health Care Studies, and Maine’s Single-Payer Microsimulation. Just to be clear, these analyses were done by The Lewin Group and Mathematica Consulting, two economic analyst groups. Not single-payer supporters.
(A note: single-payer critics will say that single-payer causes tax increases; while this is technically true, as money would be directed to the government, it would not be new money, it would essentially be the same money that employers are already paying for health insurance to HMOs right now.)
Single-payer would cover everyone.
Single-payer would slow costs.
Single-payer would allow people true choice–to see any doctor they wanted, provided that the doctor was available to see them.
Single-payer would allow for lower prescription drug costs.
Single-payer would not “cherry pick” healthy people; single-payer would eliminate the American concept of “pre-existing conditions.”
Look, if you have a problem with the “political feasibility” of single-payer, that’s fine, we can debate that. If you’re weary of allowing a government entity to set all health care reimbursement, that’s fine, we can debate that. But to stick your thumbs in your ears and ignore that we’re already ready to pay for emergency care, because of the consequences of the alternative is just stupid, plain and simple.
So, what’s your better solution?
First, Graham. Get yr economics straight. It’s not the free emergency room visits that is driving the cost of healthcare. It’s the excessive things you doctors feel compelled to do during the last 18 mos of life.
As for the poor dying in the street, no one likes that. But–why must the poor and wretched get EQUAL or equivalent treatment? I find hospitals rather revoltingly egalitarian, with all sorts of classes mixing that in every other part of society would kept separate.
SOLUTION: We should re-instate charity hospitals for those who can’t pay. Make them servicable, but not pleasant. Or, perhaps we could go the Mother Theresa route and not make them particularly servicable at all, just provide some dignity and solace. Such institution would keep the poor and dying off the street at minimal cost to everyone else.
Well, as a health care professional from Europe, what strikes me with the American health debate is the complete absense of the qualified first-line practician.
Most patients in European models never make it to the ER in the first place, because of the first-line practician (GP in Britain etc.) and his/hers vital function of providing low-cost, low-impact interventions, thus restricting ER treatment to those really in need of it. Now, how you finance this is of course a question of preferences, but mandatory GP coverage to buffer out your ERs would seem like a good move to me, single-payer or not.
One last thing: “(That)…would keep the poor and dying off the street…” Now there’s a piece of strong ambition from God’s own country. Come to think of it, I rather prefer standards here in wussy pseudo-communist Europe, taxes n’all.
Did my insensitivity hurt your precious European heart? Individuals are responsible for their healthcare, not “society.” What does “society” mean–well, simply the coercive arm of the state taking what is mine and giving it to someone else (with a generous cut for the bureaucrat who performs the service.)
Christ said, the poor shall always be with us. Individuals–not society–are responsible for responding to that inevitable state of human affairs.
I’m sorry, LetThem, but that simply won’t work. Do you truly, honestly suggest that the sick should have their financial lives ruined because of a catastrophic illness? Or that people with chronic disease (which has now become the norm of medicine), who are insured but spend through their “lifetime cap” on their health insurance, should either a) be denied care or b) take on unsurmountable debt?
That makes absolutely no sense.
You’re not clear if you believe that we should have health insurance at all–you make no distinction–but if you do believe in health insurance, you clearly don’t understand how health insurance works.
(And if you do, where is the money going to come from for those “charity” hospitals?)
I think we should implement some sort of rewards system for healthy living, which encourages regular doctor visits, exercise, a good diet, free screenings, and adherence to medications. Oh, not smoking or drinking (or quitting) is a bonus too.
People will be able to trade these rewards in for better care and thusly, we could implement a two-tier system — a baseline level of care which everyone deserves and a higher one for people who work hard to stay healthy but by luck or fate, do not fare well.
Unfortunately, I cannot see how such a system would succeed in a country as big as ours, nor can I see how we would implement it w/o enforcing ridiculous requirements: how can you measure how often people exercise? give them points for signing up a t a gym? having a blue collar job? farming? I have no idea.
Graham,
People have “their financial lives” ruined for a whole host of reasons. I am not responsible for a small business owner’s bad business decisions that bankrupt him; why am I responsible for an individual’s bad decision not to insure?
Again, Graham, look at the economics. THe best people to reduce the cost of healthcare are consumers because only they know what is best for THEM to skimp on or spend on. You want some government bureaucrat to do it. That’s insane–how many times must the failure of centrally planned industries be rubbed in the face of cosmopolitan, secularists, anti-Christians before they realize the bankruptcy of such an approach.
You want a policy solution: HSAs. Let people insure for the truly catastrophic and pay for everything else themselves.
Cake–
You *definitely* aren’t the healthcare field, otherwise you’d realize that
consumerspatients do NOT know what is best for them. People think they need antibiotics when they don’t; people think they need CT scans or xrays when they don’t; people want to leave the ER against medical advice all the time.And what do we do with the people who can’t afford insurance, don’t get it through their job, or are flat out denied it by the insurance industry?
Look at the economics. Insurance works by putting people into risk pools–the larger, the better. The healthy pay for the sick.
If you know anything about health care spending, you know that 5% of patients make up 50% of the cost. HSAs plug up a dripping faucet while a firehose is shooting out full blast right around the corner.
And, you Graham, clearly do work in the medical field because you so perfectly reflect its biases, self-interest, and blindness. First, do you know the etymology of “patient”; it comes from “patientum,” the Latin word for suffering. It is not an identity I chose, thank you.
Second, by definition, as long as people act freely, they’re doing what they want and, therefore, acting in their own interest. That a doctor might (in his usually highly unscientific, un-evidence based opinion) believe they act in ways that damage their health is simply HIS IMPOSITION of his normative standards on others. People value other things beyond their health. Shocker@! No wonder you like planned economies–you’re a little fascist at heart.
Third, as I did say in my previous post, yes, a tiny number of people make up 50% of the cost in healthcare. And, that’s the expense we should insure for. However, if we could control the other half thru HSAs that would great–wouldn’t it?
Fourth, HSAs will allow many to self-insure against the possibility of highly expensive care.
Fifth, yes, that will leave us with a small number of people due to their poverty or stupidity are saddled with tremendous medical bills. Well, if we could thru HSAs return power to the consumer, I will accept that number of impoverished sick people rather than turn over 1/7th of the national economy to some horrid government bureaucrary.
Sixth, if you were so concerned about other people, you would dedicate your life to helping gratis those impoverished people–rather than advocating to enslave us all so that the government can pay you well to do what you wish to do.
Just because you do what you want doesn’t mean you’re acting in your own interests. If someone’s interests are staying healthy and alive, they may not understand the consequences of getting (or not getting) a certain procedure done.
I want my car to work and take me where I need to go. If I go to the mechanic and I’m told I need a new transmission, and I truly do, but think I’ll just be fine, then I’m acting against my own larger interests.
Cake, I could present you with 10 situations where you, as a patient, would be required to make a health care decision that you would with HSAs, and you wouldn’t necessarily know what to do. (And others could present me with 10 situations and I wouldn’t know what to do, either.)
And I’m sorry, but yes, there is such a thing as public health, and when you choose to go untreated for a communicable disease, it affects me and my health too. Should the TB patient be allowed to go about his or her daily business without treatment, because he or she has decided on an individual level, it’s too expensive?
Graham,
1. I think that most people who refuse what their doctor tells them know that they may be damaging their, they simply have other concerns or over-riding desires. Health is simply not the end-all and be-all. Remember Francis of Assisi!
2. That doctors think like you is scary; As a healthcare consumer I don’t pay someone to tell me what my interests are. I pay them to do tasks, analyze problems, and sadly due to the absurd cartelization of medicine–get me the drugs I like.
3. Yes, HSAs would empower patients and they would have to make difficult decisions. But, hey, graham, they would still allow you to seek medical advice to determine the best choice. Further, they would create a market for good information about the healthcare system. I don’t see your point.
4. There is a thing called public health. I’m fine with the government mandating treatment for highly communicable diseases. But, that’s your red herring, desparate debater’s point. Health care costs are not about TB or influenza or leprosy (is that really communicable–or is it a myth?) They’re about heart disase, cancer, diabetes, obesity, etc.
EatCake, you know you’re quoting Hobbes right? Has your thinking evolved past “The Great Leviathan” or do you wish we were still living like they were in the 1700′s?