I attended a group meeting in favor of health reform and was struck by the lack of realistic thinking. In some ways those favoring reform are as impractical and perhaps naive as those strongly opposing. This in turn got me to think about false assumptions and expectations.
1. Rationing— (the R word) Somehow our conservative friends don’t think there is rationing of care now and that there will be with health reform. In fact health care is now explicitly rationed by cost. It’s a little like the supreme court’s concept that money=free speech (campaign contributions). If you’ve more money you have more speech, and in health care………. In neither case is it appropriate.
The challenge of health reform is to “ration” care by appropriateness and efficacy, a concept opposed by our conservative friends.
2. Have access to everything: The evil twin of rationing. Many available interventions are minimally effective and prohibitively expensive. Neither the consumer nor the health industrial complex fully appreciates either of these truths. Until they do we are doomed to have double digit increases in health expenditures as we do “everything” for everyone.
We need comparison and cost efficacy studies to guide us. Wouldn’t you know this is opposed both by drug companies and our conservative brethren.
3. Socialized Medicine–Medicine has long been “socialized”. We have around 100 million citizens receiving government sponsored health care. Our soldiers serve and retire, guess what one of their benefits is………. Our elderly priced out of the market by “private industry” have been well served by medicare. Those without insurance who are cared for for “free” at emergency rooms are indeed receiving a the most expensive and inefficient socialized medical service–paid for by someone else. Ironically or perhaps hypocritically the ER access rule is cited by our conservative friends as the answer to health care access.
4. Don’t want Government making decisions about health care (a variant of #3)— Instead we have profit driven insurance companies controlling our access and charging excessive premiums to maintain their profits. In an ideal world there would be neither. And indeed for the wealthy no such limitation exists. They simply pay whatever is necessary.
By accepting the need for third party payers we cede our “complete” control and are to some extent dependent on the good offices of the insurer–government or private. That’s life.
5. Health Savings Accounts are the answer: The question is the answer to what? If you said a means of the wealthy to shelter money for their health care I’d agree. If you think it’s an answer to the health insurance problems of the great majority you’d be mistaken. (as noted here and here)
Do you have any false health Gods?
You are so on target.
My take on the health care debate is that reducing demand for medical services is the primary need. But, I’m also in favor of reducing delivery costs.
To reduce demand we’ve got to improve the quality of the food supply. Current government farm policy encourages farming practices that generate enormous quantities of wheat, sugar, soybeans, and corn. About three decades ago Ross Hume Hall estimated that Americans were obtaining about 70 percent of their calories from these four food crops.
I recently sent President Obama a letter outlining my concerns about the food supply and the quality of nutrition instruction Americans are exposed to in advertising, media, and academia.