After hearing platitudes from politicians–we’re the best…….etc…–it’s refreshing to find one who seems to understand the problem.
Most of that legislation — and most of the health care debate in America for the last 50 years — has been how to pay for health care. I don’t think the problem is how you pay for health care. It’s what we’re buying. We’re buying a product that is very ineffective, very inefficient, and doesn’t have real impact on population health.Our population health statistics in this country are a little bit better than Cuba’s, and we spend huge sums of money. So, ultimately, we have to change the way health care is organized and delivered, and we need to recognize that the objective of the health care system is not simply to finance medical care. It’s to keep people healthy.
You can cut people from Medicaid, but where do they go? They go to the emergency room, and so then you’re paying for a stroke rather than managing their blood pressure. They don’t go away.The only way that saves you money … is if you also pass a law that says, ‘If you show up at the ER without insurance coverage, we’ll let you die on the ambulance ramp.’ That’s the only way, and no one is suggesting that.
Medicynical Note: Health care has long been a unbalanced equation. On one side we have unlimited expectations of care paid for by insurance or just some one else; expectations of unlimited profits by providers (hospitals, pharmaceutical companies, doctors); and a paradoxic lack of concern about costs. On the other hand we have no viable funding scheme to meet these expectations.
Health care inflation is like a bubble fed by our willingness to use debt both personal and national to pay anything demanded for even a limited benefit –a little like buying tulips in 17th century Holland. I won’t repeat the litany of our tolerance of inefficiency and the wide difference in costs between our non-system and more systematic approaches of every other industrial nation. We are unique (American exceptionalism strikes again) and on an unsustainable course.
Our republican friends want an as yet undefined free market system. What they mean is anyone’s guess. One could envision that under such a system insurers (provider) would be “free” to limit their risk and deny coverage (service) to anyone they chose–as any business does. Hospitals would be “free” to deny service to those unable to pay for service.
Where this “free market” leads is anyone’s guess. If we are willing to deny access to care to people who can’t pay (you might reread Jonathan Swift’s A Modest Proposal) in our “free market,” it will be a public health disaster.
If we as a nation feel some responsibility to assure access to care we’ll have a system with multiple levels of care quality and service, essentially one of explicit economic rationing. It would, at a minimum, require a complicated formula for government subsidization of those unable to afford insurance.
In the end we’ll get what we deserve.