Yesterday I wasted almost a full hour trying to write the next post on Health Care. I started and scrapped three different posts.
I just am not sure what I want to say next about this topic. The truth is, I feel like a tiny minority here. I clearly see the need for reform and innovation in both the payer system as well as the medical delivery industry. But, I just don’t see any solutions that I feel I can strongly support. I am neither for the current proposed reform, nor am I vehemently against it.
So instead of just blindly choosing a side and waving their signs and banners, I want to just discuss the reforms we need to make and share my views on how we might proceed.
As I’ve said all along, cost is the #1 problem with health care. We simply can’t sustain the level of inflation we are experiencing in the medical industry. We are spending way too much per captia, and as a total of GDP on our health care. Other countries are completely outpacing us on the value for the dollar they are getting in their health care systems.
However, no one wants to ‘spend less’ on health care as we might with eating out or going to the movies. Everyone wants our medical industry to continue to be the most technologically advanced in the world. No one wants to go to the hospital and hear from their doctor that an old X-RAY will have to do because they just couldn’t afford the awesome new MRI machine.
Attempts to control costs by legislation are just plain unfair to the industry and to consumers.
In spite of the amount of money we pay (per capita) for health care in this country, we are NOT the most healthy country on the earth, or the most well cared for. All our money goes into a pit of a payer system and to purchase those luxury items for the armies of doctors, insurers, lawyers, accountants, billing clerks, and hospital administrators.
So how do we drive down costs and raise the level of care we receive, all without jeopardizing the medical innovation we enjoy?
We need to innovate how we pay for health care.
I don’t really like the idea of a national health insurance plan that competes with other insurance companies. This concept is bad because it gives the deep-pocketed, bankruptcy-proof government the option to undercut all other insurance companies and essentially wipe them out of business. Soon my workplace will drop all other plans and only offer the government plan to save costs, and voila! We have a single payer system! However, it is an effective way to control cost. Whatever the government says it pays is what it pays.
If the national health insurance is simply a subsidy for those who truly can’t afford health insurance, I would be more happy, but then I’m still unhappy because I don’t think my precious tax dollars should go to a for-profit insurance company to pay for their executive jets, and I’m also not completely comfortable with the poor, who pay no tax at all, collecting money from the rest of us in order to get the same level of premium care.
I really like the idea of insurance cooperatives. These exist already for many utilities in rural areas, and are a similar concept to Credit Unions. The idea is that the members of the coop run a non-profit organization to simply deliver the required services. No one profits, and profitable years are banked against the unprofitable years. The revenues and dividends and goodies all belong to the members of the coop.
In a way, a government-run plan would be like a coop – takes out the profit for private industry, but I like the coop better because it reduces the red-tape and bureaucracy a government run agency would no doubt bring. But who are we kidding? All payer systems from private insurers to government programs specialize in red tape and bureaucracy. Their job is to make it as hard as possible for people to get their money.
All of these solutions are still not great, but changing the payer system alone cannot drive down the cost of healthcare. Sure, eliminating the profiteering of the insurance companies and associated overhead required at each Doctor’s office would help, but it would not so much as make a dent, in my belief.
We need to innovate how we deliver health care in this country.
The uninsured have one option in this country: to wait until they are sick enough to go to the emergency room. There, we use our most expensive resources to return these people to a non-emergent condition. (Note: we don’t even treat their illnesses, we just stop the bleeding, so they are going to be back, because often the root cause is not ever taken care of!)
When I lived in Brazil, I noticed something interesting about their health care system. Most large neighborhoods had a nearby “posto de saude” (community health center). These were small buildings that were meant for simple diagnosis and treatment of disease. The more complex conditions were sent into the doctor and hospital system, but most sniffles and colds and strep could be diagnosed and treated by the nurse practitioner who ran the center.
Cost wasn’t an issue in these health centers. You never paid for treatment. The goal was to diagnose, treat, or triage conditions early to help maintain the public health. (Pig flu anyone?) Even expatriots like myself could be seen at these centers.
Innovations like that, some change to the way we think about and consume health care, could also help us in this fight for reform.
4. We the People
We, the people, need to reform OURSELVES!
We need to live healthier, eat less, eat more healthy, and drive down our own health care costs by choosing good habits and teaching those habits to our children.
Talk to doctors and they will tell you, they spend a lot of time and money on patients who just simply won’t make lifestyle changes. They simply refuse to stop smoking, drinking, and overeating or start exercising. We expect to be able to live however we want, and that any problem will be fixed by a new wonder drug. We work longer hours and take stimulants to stay up, and then we take sleeping pills to help us go to sleep. We stress ourselves past our limits, and then we spend on mental health care. We take medication for acid reflux, allergies, high blood pressure, and athsma, and yet we refuse to eat healthier, get out and get some fresh air, exercise, or stop smoking – all of which contribute to the other disorders. We prefer to be treated medically than we prefer to live right.
This becomes even more critical as we move more toward a white-collar workforce, where a large percentage of our workers sit at desks all day long. We need to focus again on living well and healthily.
I will just say that I am committed to not be afraid of this issue and conversation. I think almost everyone shares the common goal that we want a sustainable health care system that can better care for the citizens, and continue to be the world leader in health care innovation. If anyone can meet those goals in a blog comment, let me know… I haven’t been able to do it in a week’s worth of research, thinking, and writing.