The problem with healthcare solutions, is that they dont address the problem at its most basic level, and that is the skin is in the wrong place. Ie, skin = whos finances are at stake. Insurance companies dictate to Dr’s, and balk at paying, or covering specific items as doing so makes them more money. Patients have no clue if there insurance is fake, poor, or great, as very few use it beyond the trivial things, and many really use it for trivial matters, as they dont directly pay. Many Doctors have no clue what procedures actually cost, and some practice proactive malpractice, which may protect them, but run roughshod over the patients financials. Hospitals and clinics force Dr’s to work on volume, and proactively find ways to maximize revenue, and when they get revenue, they expand, such that they can always whine for more. Malpractice carriers advice physicians to focus on procedures which may not be the best for the patients finances, but minimize their, and their clients financial risks. Govt gets yanked around by lobbyists, at the whims of who can pay the most for revenue enhancement. Med schools charge outrageous sums, knowing that med students can get loans, irrespective of whether they really can pay them back or not. Each sector wants the best for itself, and let the others hang out to dry… and usually, that means the patient, as they have the smallest voice, and no lobbyist. And lastly, no one wants to admit there is an elephant in the room, who has been there nearly forever, known as health care rationing.
Is the free market a solution?
Some say, the freemarket is the solution… but lets think a bit. The public expects a certain level of care. Would it be cool, for an insurance company, to pull a credit card trick, and say just when you needed surgery, they decided it was only covered at 50% instead of 80%? Or to use contracts of adhesion and slight of hand to change coverage limits under the table? Sure, the free market would correct, but it might take a few quarters, all the while windfall profits could be made. Or what about far out concepts, like coverage up to $5000 would be local, and liberal. For anything more than that, it goes out for bids, anywhere in the world. Perhaps the best deal can be found in startup hospital powered by generators in a tent half way around the world. Again, the free market will correct, but how many folks are affected in the mean time. Or what about docs, and hospitals like those in McAllen TX, where profit motivation results in some of the highest care costs and use of tests/procedures in the world. Left unchecked, McAllen would probably become the richest area of the country…. but at what cost to the rest of the nation?
Is Government a solution?
Is the government the solution…. do you want to argue with a beancounter over some form, while your appendix is freaking out, and your doc is sitting worried to death it could blow at any moment? Or, what if the govt decides the one and only drug for your condition is not medically warranted. A generic is all you need, besides the FDA says there are identical… and of course, the binding agents and alternative processes that are used react, rendering it ineffective for you, and perhaps 50 others, but 1000000 folks do fine with it. Remember lobbyists are in the game, and whoever has the greatest pull gets the best deal… and that means the patient will loose. Look at Medicare part D for example, of how to win huge in the insurance business, yet the patient, doc, hospital pharmacy, and govt get hung out to dry. Of course, the exception is congress…. lobbyists dont have much pull when it comes to the governments own.
Is the current system a solution?
Is the current system a solution…. well, for many, who have rarely used it, or find it works well for trivial matters, its a perfect thing. For others, on plans similar to what congress has, it works very well, whether for trivial, or major things. On the other hand, for those in a major car crash, or with a serious diseases, far too often, they find out the hard way, their “great” insurance turned out to be only great for a few months, and then its a disaster. For others, they hit the limit, ie healthcare is rationed typically to 1-2 million dollars, after that, you are cancelled, and left to fend for yourself. And for others, say those in a early stage startup who can’t provide insurance… well their employees have to buy it out right, with after tax money. Why should such employees, many of whom put in 100 hour weeks have to subsidize all those in the F1000, who get it tax free. Otoh, mear mention of taxing health benefits, and folks scream… yet, they are the ones living off the work of others already. Go figure.
Nope… none of the above in and of themselves are solutions, they dont address the root cause(s), which lead to lack of coverage, overuse, high costs, and low value. I’ve read partly through 1015 pages of the proposed legislation… it doesnt address the root causes either, albeit it does dance around them a bit.