A friend recently called me on the fact that I have been offering opinions regarding the recent health care proposals without offering any possible solutions. She's right, without offering solutions I'm just another member of the peanut gallery, so here are a few suggestions for moving the conversation on health care forward:
- We simply must start with cost controls. If we aren't willing to discuss cost controls in health care reform then we aren't being serious about the issue at hand. Cost control measures need to involve limiting medical malpractice liability (which the lawyers are opposed to), limiting insurance premiums for pre-existing conditions (which in reality is a method of exclusion), and limiting certain types of care that are free.
- I know that last part makes people angry. But we have to be honest about the fact that it is not possible to give the best/most advanced health care to everyone in the U.S. Our science and capabilities are growing faster than our wealth. The fact that it is possible to save lives with cutting edge heart transplants doesn't mean that we can afford to make it a right that anyone needing one can receive one. If we screw this up and declare advanced care as a right of U.S. citizenship, we will go broke and stop innovation all at the same time.
- Our administration costs are high, but the idea that a large bureaucracy like the U.S. government is well suited to lower those administration costs is laughable. The U.S. government doesn't even understand what it means to lower administration costs.
- Finally, we need to discuss what level of care we are willing to live with. It may be true that our health care costs have climbed dramatically since 1950, but so has our quality of care (and of life). If we want to provide 1950's level care, which is a huge step backwards, we can get serious about cutting costs in half. But that doesn't seem to be the desire. We can't pay 1950 prices and get 2010 health care for everyone in the U.S.
Cost controls are something the government can help with, administrative control is not. And until we decide openly whether health care is a right or a service we will talk around the issue.
These are exactly the kind of hard decisions president Obama referenced in his inauguration speech. Let's be grown ups and make them.
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ReplyDeletethoughts to your post:
control costs - yes I agree and bringing some sanity to the malpractice landscape is crucial. On the bright side, if there is real reform here, it will be a huge part of the reform in one fell swoop. Obama has also engaged drug companies to work on controlling costs. On the not so bright side, wow is it going to be tough to fight off those attorneys.
more equitable distribution of expensive procedures - you will like this one because it involves individual responsibility.
OK so not everyone gets a heart transplant but why should insurance be the deciding factor in receiving that heart transplant? Is it right that the 2 pack a day executive should get one and not someone else with better health habits but lesser or no insurance? (btw the smoker's insurance premium doesn't cover all of their costs to the system so healthy individuals are subsidizing them, too, not something I feel good about when I pay my substantial BCBS bill every month, as a self-employed couple with 2 kids, its substantial.)
Perhaps patients needing expensive procedures should be vetted based on lifestyle choices and not employer provided insurance. No one is telling them they can't smoke, but if they do pay up. This would have nice effect of providing reward and motivation to live a healthier lifestyle.
Medicare is the herd of elephants in the room, with boomers retiring in swelling numbers and the AARP crowd leading a very vocal, powerful protectionist lobby. Might be one reason for some of the waste in that system, any whiff of reform gets the phones a ringin' on capitol hill. Who is going to tell them that they don't have a right to the most advanced care available? Instead we tell that to people with no insurance.
I totally agree with you about costs but I am not convinced that all the savings can be immediately accounted for. Cost savings will surface later if programs that cost money up front are implemented:
-support for inexpensive preventive care and alternative medicine, I'm not talking voodoo but simple, inexpensive steps like acupuncture, nutritional counseling and dietary support, massage, exercise groups, web supported "coaching". Don't laugh, BCBS already is experimenting with covering some of these.
Another cost saver that is a no-brainer but continually under attack - subsidized health coverage for children so that low income kids (and not so low income kids whose parents have been laid off) don't receive primary care in the ER.
Some creative intelligent people have GOT to come up with a way to motivate people to eat better and move, and make both more convenient and affordable. School meals are an obvious target. Also figure out a way to incentivize the food industry to move in a healthier direction. You know quite a bit about the ag/food industry and the inherent issues/ politics there. What do you think? Its not a lost cause, look at the market driven movement away from HFCS and trans fats and significant rate of growth in organics (still small compared to conventional but fastest growing segment, and look out WalMart is getting into the space)
I could go on but won't.
The Mayo clinic is hosting a symposium in September, I am thinking of going if I can swing the fee, (there is need for video ethnography in designing health care services). link:
http://centerforinnovation.mayo.edu/transform/index.html
Thanks for your posts Ben. Keep thinking about it, the process is enriched when people like you and other Acton caliber types remain engaged.