Yesterday I wasted almost a full hour trying to write the next post on Health Care. I started and scrapped three different posts.
I just am not sure what I want to say next about this topic. The truth is, I feel like a tiny minority here. I clearly see the need for reform and innovation in both the payer system as well as the medical delivery industry. But, I just don’t see any solutions that I feel I can strongly support. I am neither for the current proposed reform, nor am I vehemently against it.
So instead of just blindly choosing a side and waving their signs and banners, I want to just discuss the reforms we need to make and share my views on how we might proceed.
1. Cost
As I’ve said all along, cost is the #1 problem with health care. We simply can’t sustain the level of inflation we are experiencing in the medical industry. We are spending way too much per captia, and as a total of GDP on our health care. Other countries are completely outpacing us on the value for the dollar they are getting in their health care systems.
However, no one wants to ‘spend less’ on health care as we might with eating out or going to the movies. Everyone wants our medical industry to continue to be the most technologically advanced in the world. No one wants to go to the hospital and hear from their doctor that an old X-RAY will have to do because they just couldn’t afford the awesome new MRI machine.
Attempts to control costs by legislation are just plain unfair to the industry and to consumers.
In spite of the amount of money we pay (per capita) for health care in this country, we are NOT the most healthy country on the earth, or the most well cared for. All our money goes into a pit of a payer system and to purchase those luxury items for the armies of doctors, insurers, lawyers, accountants, billing clerks, and hospital administrators.
So how do we drive down costs and raise the level of care we receive, all without jeopardizing the medical innovation we enjoy?
2. Payer
We need to innovate how we pay for health care.
I don’t really like the idea of a national health insurance plan that competes with other insurance companies. This concept is bad because it gives the deep-pocketed, bankruptcy-proof government the option to undercut all other insurance companies and essentially wipe them out of business. Soon my workplace will drop all other plans and only offer the government plan to save costs, and voila! We have a single payer system! However, it is an effective way to control cost. Whatever the government says it pays is what it pays.
If the national health insurance is simply a subsidy for those who truly can’t afford health insurance, I would be more happy, but then I’m still unhappy because I don’t think my precious tax dollars should go to a for-profit insurance company to pay for their executive jets, and I’m also not completely comfortable with the poor, who pay no tax at all, collecting money from the rest of us in order to get the same level of premium care.
I really like the idea of insurance cooperatives. These exist already for many utilities in rural areas, and are a similar concept to Credit Unions. The idea is that the members of the coop run a non-profit organization to simply deliver the required services. No one profits, and profitable years are banked against the unprofitable years. The revenues and dividends and goodies all belong to the members of the coop.
In a way, a government-run plan would be like a coop – takes out the profit for private industry, but I like the coop better because it reduces the red-tape and bureaucracy a government run agency would no doubt bring. But who are we kidding? All payer systems from private insurers to government programs specialize in red tape and bureaucracy. Their job is to make it as hard as possible for people to get their money.
All of these solutions are still not great, but changing the payer system alone cannot drive down the cost of healthcare. Sure, eliminating the profiteering of the insurance companies and associated overhead required at each Doctor’s office would help, but it would not so much as make a dent, in my belief.
3. Industry
We need to innovate how we deliver health care in this country.
The uninsured have one option in this country: to wait until they are sick enough to go to the emergency room. There, we use our most expensive resources to return these people to a non-emergent condition. (Note: we don’t even treat their illnesses, we just stop the bleeding, so they are going to be back, because often the root cause is not ever taken care of!)
When I lived in Brazil, I noticed something interesting about their health care system. Most large neighborhoods had a nearby “posto de saude” (community health center). These were small buildings that were meant for simple diagnosis and treatment of disease. The more complex conditions were sent into the doctor and hospital system, but most sniffles and colds and strep could be diagnosed and treated by the nurse practitioner who ran the center.
Cost wasn’t an issue in these health centers. You never paid for treatment. The goal was to diagnose, treat, or triage conditions early to help maintain the public health. (Pig flu anyone?) Even expatriots like myself could be seen at these centers.
Innovations like that, some change to the way we think about and consume health care, could also help us in this fight for reform.
4. We the People
We, the people, need to reform OURSELVES!
We need to live healthier, eat less, eat more healthy, and drive down our own health care costs by choosing good habits and teaching those habits to our children.
Talk to doctors and they will tell you, they spend a lot of time and money on patients who just simply won’t make lifestyle changes. They simply refuse to stop smoking, drinking, and overeating or start exercising. We expect to be able to live however we want, and that any problem will be fixed by a new wonder drug. We work longer hours and take stimulants to stay up, and then we take sleeping pills to help us go to sleep. We stress ourselves past our limits, and then we spend on mental health care. We take medication for acid reflux, allergies, high blood pressure, and athsma, and yet we refuse to eat healthier, get out and get some fresh air, exercise, or stop smoking – all of which contribute to the other disorders. We prefer to be treated medically than we prefer to live right.
This becomes even more critical as we move more toward a white-collar workforce, where a large percentage of our workers sit at desks all day long. We need to focus again on living well and healthily.
In Parting
I will just say that I am committed to not be afraid of this issue and conversation. I think almost everyone shares the common goal that we want a sustainable health care system that can better care for the citizens, and continue to be the world leader in health care innovation. If anyone can meet those goals in a blog comment, let me know… I haven’t been able to do it in a week’s worth of research, thinking, and writing.
WE, I have really appreciated your posts about health care reform this past while. Especially this one. As someone who works in health care, I have a lot of mixed feelings about reform. Like you I feel that we do need some sort of reform, but I am not comfortable with any of the solutions that I have heard about. To be honest, I’m not really sure what the answer is, and will not even attempt to make one- I’m still trying to figure out what my personal opinion is. But I agree with many things you have recently brought up. I think we as a people need to put as much passion into reforming ourselves as we are into reforming the system. I think we spend way too much money on our “emergency” interventions, and not enough on things like preventative interventions and things like the clinics you talked about in Brazil.
Not to stir the pot too much, but I also feel like people want to have thier cake and eat it too with the health care system. Nobody wants to pay for it, but nobody is willing to go without care or watch people die because they don’t recieve care. Not that I am saying anyone should be okay with people not recieving care or watching people die when they don’t recieve care that could save thier lives. I just wonder, is it really possible? Is it really possible to provide EVERYONE with EVERY type of care they could possibly need to survive, and still have it be affordable to EVERYONE? It sounds like a really good idea, and if we can figure it out, I’m all for it. But there is a part of me that sometimes says it’s not realistically possible. I would like it to be, I really would. But sometimes I wonder if it really is. Just sharing some of my thoughts and questions.
Which brings me to another question that I sometimes have which I think also contributes to this whole reform thing: Do you view health care as a privelage or a right? Before you go off on me for this question, really stop and think about it. I’m not saying which it is or should be. But think about it……is health care a privelage or a right? Or does it have to be so black and white, could it be somewhere in the middle? Is that even possible? To be honest, when I think about it like that, I go back and forth on my opinions and sometimes I just don’t know.
Wow, my feelings exactly Alan! I go back and forth too.
On the right vs privilege thing…it seems that our current system treats “emergency” care as a right and “on-going, real treatment” like a privilege – whether or not you think that’s right – that’s what it seems to be. Theoretically maybe this already is the right (or close to the right) ideology. But then to WE’s earlier point – this ideology does foster higher costs in the system due to unnecessary “emergency care”.
It could very well be that the current proposals for change will make both types of care a right and that theoretically this is actually the right scenario. But will that make costs and care worse because you can’t provide everything to everyone and expect everyone’s cost to stay low and care to stay high?
I know! Maybe “on-going, real treatment” should be a right and “emergency care” should be a privilege. Give and take on the government-run, free programs. Switch them so that hopefully the ‘freeloaders’ (not name-calling, just an economic term) will migrate to the other side. Then change the horrible ‘payer’system to decrease costs in general and be done. Viola! Actually, I’m sure there are all kinds of holes in this idea too since there have been holes in every other idea I can think of…
Also, WE – I like how you said that you are not scared to have the conversation. I, too, get fed up by those on both sides of the current political issue that just bully. People take these extremist ideas and run with them batting their head against a wall and listening to no one. But maybe I should give us all a break for our irrational behavior because like I commented on your first health care post – we always suspect the worst especially when it has to do with something that we really know so little about.
Ps. I dare you to read my comment and figure out which meaning of the word ‘right’ I meant each time I used it =)