Category Archives: General Cynicism

Kristof on our health care system.

Thaddeus McCotter (R) from Michigan in an op ed puts forth the republican view–perhaps the forthcoming health plan. He’s in favor of “patient-centered wellness.” Wellness, who can argue with that!

His argument is vague. He forgets that the current economic problems and deficits are legacies of his republican president. He overlooks the fact that his party which favors the dismantling of government programs including Medicare and Social security and argues that what we need for sick poor people is more “Federally Qualified Health Centers.” He talks of “rationing” forgetting that we currently ration care economically–etc., etc, etc.

His recommendation:

• “Consequently, we understand health care reform must match — not resist — these economic and communications advances by decentralizing government to provide the sensible, affordable reforms that foster patient-centered wellness, which empowers American citizens to be consumers of health care through transparency and free market forces.”

  “The heart of patient-centered wellness for our people-powered world is prudent, targeted, multi-track reforms that reduces costs by leveraging the communications revolution and market forces to increase the supply of health care amid rising demand. Immediate, obvious measures include reforming medical liability laws; ending exclusions for pre-existing conditions; expanding health savings accounts; providing tax credits for purchasing private health insurance; allowing association health plans; permitting health insurance purchases across state lines; encouraging individuals to insure against changes in health status; incentivizing preventative health care; and applying information technology to enhance transparency and increase efficiencies.”

For those that get sick;

• “For the less fortunate and most vulnerable amongst us, there must be an expansion of Federally Qualified Health Centers (FQHCs), which will provide patients with preventive and routine treatment; and end underserved people’s use of emergency rooms for primary health-care treatments. Doctors and other health care professionals can be incentivized to provide their services at these clinics for either immediate or future considerations; and a “Patient Navigator” program attached to each FQHC can assist the underserved in accessing the health care system.”

Medicynical Note: Lots of generalities and “incentivizations,” but few details. What’s missing is a commitment to community rating rather than individual rating and a mandate to cover those with illness. If I read it right insurers, under the republican “reform,” will be able to charge whatever they wish to those with high risk and illness. This will deny those people health insurance and force them into the “FQHC’s.” This is quite a resourceful approach, allowing insurers to cover those with the lowest risk (and protect their profits) while foisting off on government those who need care. I guess the drafters of the republican proposals have to protect their supporters’ interests.

Some ideas such as insuring against change in health status are very creative. Isn’t that what health insurance is supposed to do? Health Savings Accounts are an ineffective solution for the great majority with incomes near the median (down to about $50,000/year) who can’t afford even basic insurance much less have excess income to save. I wonder who high deductible Health Savings Accounts benefit?

On the positive side who can argue against preventive health care or better access to information–I guess the republicans can’t.

In the next few days the House GOP is set to release a healthcare bill. We may have more as it’s recommendations are made public. If this is a sample, don’t expect much.

Years ago I was dumfounded by an economist friend, (not Casey Mulligan who is referenced in this week’s Economist) when he argued that having more people in overpopulated Bangladesh was good. He concluded this believing that if there were more people there would be more innovators. At the time Bangladesh, a country the size of Wisconsin had about 90 million people. It was considered a population emergency.

This was of course during the period when our own government undermined population control efforts (BCP’s, education and such).

Now Bangladesh is approaching 150 million people, and these has been little change in poverty, landlessness, and economic well being–except for the sliver of well to do people at the top who always seem to benefit.

In any case this week’s Economist addresses demographic and concludes:

• “And falling fertility is a boon for what it makes possible, which is economic growth. Demography used to be thought of as neutral for growth. But that was because, until the 1990s, there were few developing countries with records of declining fertility and rising incomes. Now there are dozens and they show that as countries move from large families and poverty into wealth and ageing they pass through a Goldilocks period: a generation or two in which fertility is neither too high nor too low and in which there are few dependent children, few dependent grandparents—and a bulge of adults in the middle who, if conditions are right, make the factories hum. For countries in demographic transition, the fall to replacement fertility is a unique and precious opportunity.”

Medicynical note: I can’t resist pointing out the devastation of ignoring population growth for the Reagan/Bush/Bush years. And also take the opportunity to point out that these same people are now downplaying the impact of global warming on civilization. Could they be wrong yet again!

In his review of Carrying the Heart and The Deadly Dinner Party and Other Medical Detective Stories(NY Review of Books November 5, 2009) Jerome Groopman catches the desperation of modern medicine, a proud profession that has evolved into a money generating soulless machine.

• “But only recently has medical care been recast in our society as if it took place in a factory, with doctors and nurses as shift workers, laboring on an assembly line of the ill. The new people in charge, many with degrees in management economics, believe that care should be configured as a commodity, its contents reduced to equations, all of its dimensions measured and priced, all patient choices formulated as retail purchases. The experience of illness is being stripped of its symbolism and meaning, emptied of feeling and conflict. The new era rightly embraces science but wrongly relinquishes the soul.”

Medicynical Note: Doctors do piecework for insurers. Whether that changes in a modified health care system is doubtful.

For the most part our non-system of care has lost whatever relationship there was between doctors and patients and replaced it with a hucksterish carnival sideshow atmosphere–step right up here young man we have a medicine, procedure, rejuvenant that will change your life and only run the risk of a 4 hour erection.