Wednesday, January 27, 2010

More on health care debate from T. R. Reid (Part 2)

As promised, here's more from the important book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, by T. R. Reid:

Our nation's healthcare system has become excessively expensive, ineffective, and unjust. Among the world's developed nations, the United States stands at or near the bottom in most important rankings of access to and quality of medical care. (pp. 8-9).

The thesis of this book is that we can bring about fundamental change by borrowing ideas from foreign models of health care. For me, that conclusion stems from personal experience. I’ve worked overseas for years as a foreign correspondent; our family has lived on three continents, and we’ve used the health care systems in other wealthy countries with satisfaction. But many Americans intensely dislike the idea that we might learn useful policy ideas from other countries, particularly in medicine. (p. 11).

Anyone who dares to say that other countries do something better than we do is likely to be labeled unpatriotic or anti-American… The real patriot, the person who genuinely loves his country, or college, or company, is the person who recognizes its problems and tries to fix them. (p. 13).

Eisenhower’s strategic plan envisioned months of painful slogging across a shattered German countryside. But then his forward commanders reported an amazing discovery: a broad ribbon of highway, the best road system anybody had ever seen, stretching straight through the heart of Germany. This was the autobahn network… “I decided, as President, to put an emphasis on this kind of road-building.” (President Eisenhower – which led to the “Dwight D. Eisenhower System of Interstate and Defense Highways” – the Interstate Highway System). Eisenhower, the pragmatic commander, was willing to borrow a good policy idea, even if it had foreign lineage. (pp. 14 & 15).

Each nation’s health care system is a reflection of its history, politics, economy, and national values. (p. 16).

More to come. . .

11 comments:

Impact Houston said...

I think most people know reform is needed. I believe top minds are struggling with a good solution. The caution comes when a hasty policy is sent to the fore that brings about changes that do not truly fix the greatest problems, are not fiscally efficient due to ties to other agendas, and hinder some facets of the current system that makes it a beacon of hope for others. Or am I wrong to think that the world community looks to our system as a place to send their students and patients?

Anonymous said...

Larry,

This is a bit off the subject, but I'm curious as to your thoughts on the recent senate election for Ted Kennedy's old seat.

--Jeff

JHK3 said...

Arguments abound around this issue. However, it seems we get little if any input from those "in the trenches". Medical providers and facilities are substantially opposed to most of the current reform efforts. We should also stop using Mr. Reid's statistics to shame us into changing our system. If we can do it better, then let’s change, but not because we spend more than any other country. To that end, we spend more on every single item on any list than any other country. Housing, food, cars, electricity, even pornography. Statistics on outcomes and life expectancy are also very convenient, but don't reflect a country's values. For example, we don't abort as many babies for birth defects as other countries. We try to save a 25 week old premature birthed child. Other countries just don't. If we spend a million dollars on that child and it dies, we are hurting our statistics. 1 million wasted dollars and 1 dead child at 0 years old. For me, that is not something to be disparaged about.

Medicare can't keep up with the pace of spending. When they cut more costs out of it to try and make it solvent, they cut what is covered and how much they will pay a doctor. In some cases, a person will pay more for a manicure than a doctor will receive for treating a cold. Consider how our government misjudged how many people would take "free" money for "cash for clunkers". Take away cost barriers to medicine and like cash for clunkers, our country will out spend our income on health care.

And then the government will say, we have to cut back. That is when we will wish we had our private system back. Today senior citizens buy Medicare supplement policies, because they find the government plan incomplete. By the time they buy a supplement, Medicare part B, and D, they are out $400 or more a month.

And finally, there is not really any cost savings proposed by the pending legislation. Ask how is it going to slow the rate of growth in the cost of health care? If the answer is: we won't pay for certain services or pay doctors less, or decide who gets priority on or to treatments. Stop and think if that is what you are hoping for.

Anonymous said...

If the truth were known probably a lot of Dems are breathing a sigh of relief that they won't have to vote on the health care bill now.

Larry James said...

Impact Houston, thanks for the comment. In my view it is a mixed bag. We are importing Indian and East Asian docs continually. In specialty areas we no doubt lead the world. But our over all public health outcomes are clearly inferior and the poor suffer disproportionately. I think that is clear. We have the best system that money can buy; trouble is, millions can't afford it. And the investment and return remains a problem. For me it is a matter of justice. Reading Reid's book is eye-opening.

JHK3, the problem with the spending is return, as I've said, and it is also an issue of what we spend it on and how we distribute the resources and how we regard human health--is it right or commodity to be traded on Wall Street?

Your analysis of Medicare is a bit off. Again, is medicine to be about profit and luxury or about public service and equity? It is hard to answer those questions in a place like we have created in health care. Too many conflicts of interest to be very objective. Again Reid's book is important.

If it weren't for Medicare, millions would fall into poverty, but is that a value concern or not?
The AARP policy my mom had to supplement Medicare was less than $200 and covered all costs. Of course this is necessary because of fee scales on services and lack of a comprehensive system that would actually reduce costs by the creation of a universal pool--coounter-intuitive, but true.

We likely agree about the current bill. It is a compromise, realities that seldom produce what anyone wants. What we need is a universal, single-payor system that would create a huge national pool. It won't be perfect, but better for all of us than what we have now.

Here's the question, "Do we care to have a system that is better for everyone?"

JHK3 said...

Larry,

It has to be about profit. Even preachers, whom have nothing but the best interest of the lost at heart, must pay their mortgage and feed their families. If there is no benefit to a physician to treat someone, then they will be forced to look for another profession. If your argument is that Doctors and Hospitals charge too much or make too much money, that may be, but who gets to decide fair wages? The insurance companies take a bad rap, but really they are just the "banker" in the transaction. They finance the $100,000 heart surgery for years by taking premiums before and after the surgery. If they weren't there, like the man in your blog with cancer, who would pay the bills of the doctor. The doctor is the one saying I have the knowledge and technology to "fix" you, but I won't unless you agree to pay "$X.XX". They could do it for free, but for how long...and why?

I like your question about do we care to have a system that is better for everyone. My answer is...if we can make it better for everyone, I am all for it. But if it is going to be better for some, but worse for many, then we should not "fix" what we have, we should find a way to help those without the resources find a way to access the current system, expensive as it may be.

Medicare is the only option we know of because it is in place. But more and more providers are turning their back to it. Mostly due to the very low reimbursement rates they get from Uncle Sam. You may have noticed that recently even the Mayo clinic has said they will now have to turn Medicare patients away. If every doctor is forced to take less money for what they are already doing, they will walk away in droves. We can't expect them to do more for less and the government charge more (in taxes) and provide less and expect anyone to be happy.

As to Your Mom's cost for her Supplement policy, you are probably right. But, the supplement is not the only cost. She has to pay for Medicare part D. And the national average base cost for that is $88.33. She has to pay for Part B which is expected for most to cost $96.40. And if she is not fortunate enough to have Medicare part A paid for by her cumulative working credits, Uncle Sam would send her a bill for $461 per month. Assuming she doesn't pay for Part A, but does pay for B, D, and her supplement her monthly cost before seeing one doctor and getting one drug would be at least $384.70 per month. And that is if her supplement was only $200. Not that that is a bad deal at all, but if Medicare was never invented, what might have filled the vacuum. Some say nothing, but I doubt it.

If Pelosi and Reed think the insurance companies are evil and can't do it right, and are making too much money, and thereby charging too much, why don't they create their own (non-governmental) plan that doesn't ever discriminate, provides all the coverage they think is appropriate and then charge less than their competition. The world would beat a path to that door. But even Uncle Sam with virtually unlimited resources can't do it for less than the insurance companies.

It would be great for everyone to have coverage, but I want everyone to have a house and enough to eat too. I know you do to. But why are we pushing health care and not creating a bill to buy everyone a house and make sure that everyone has food. It seems to me those are more primary needs than health care. I know your motives are truly pure, but I am not sure about Washington's.

Any plan the government builds will be too expensive and not provide the best care. Is that what we will say is better for everyone?

Anonymous said...

Fatal flaw in our system: health care is a commodity to be traded, sold and invested in for return. We're the only nation on earth that views human health as something to be traded at the expense of the poor and much of the middle class. In Great Britain medicine is public service not a road to prosperity. Everyone must be paid, but how much and at what cost?

tingting said...

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Steve said...

The problem with health care in America reminds me of the description of Washington. Someone said it is on the border of the north and south, and has Northern Charm, and Southern efficiency.

Healthcare in the states right now has all the defects of socialism, augmented by the perception that MD's should be allowed to make a lot of money, due to their enhanced cultural status. Complicated by the threat of litigation.

For instance, I bet the Mayo Clinic could live on the medicare payments, if the MD's there did not have to pay such exorbitant malpractice insurance.

The insurance companies are not the bank, simply, but an entity that by the rule of self preservation and advancement must get as much form the patients as possible while limiting obligation, and at the same time, extract as much from the MD's as possible while paying as little as possible. The connection between customer and merchant that is the basis of a fair free market is disrupted by the middle men: the insurance companies and the litigious lawyers. Neither of them gain by an equitable relationship between customer and provider.

The system is broken, but no one dares mess with it, because the sword of Damocles ( either cancer, or Alzheimer's, or any number of scary diseases ) hangs over their heads, and inhibits any attempt at actual reform.

I live in Guatemala, and have told my friends and relatives, that if anything happens to me while in the states, and I cannot make the decision, that I want them to take me to an airport, and put me on a plane to Guatemala, one of the poorest countries in the hemisphere, where I can get adequate...I mean competent US trained physicians in modern well equipped hospitals, and only lacking the ridiculous ability to sue my providers for millions should something go wrong...to care for me. It is capitalistic, and so not every Guatemalan can afford it, but the poorest American could pay in cash for very good care in Guatemala. I mean definitely care that matches any experience i have had int he states.

The US system is broken..the middle class is willing to pay exorbitantly out of fear, totally out of proportion to the care they receive, and the lower classes are left out in the cold. And JHK3 has the audacity to blame it on premature babies.

I feel lie Ben Franklin amy have prophetically been talking about healthcare when he said that He who sacrifices freedom for security deserves neither.

JHK3 said...

Steve, I enjoy the thoughts, not just yours but everyone's. The urge to slap someone down is what has led to little getting done when it comes to solving any complex issues. In hopes of clarity above agreement, please understand, I am thrilled that we will do anything to save any baby. I am happy that we will not stop at any dollar amount in hopes of saving any life. My only point on that issue is that those can be difficult and costly procedures. It seems unfair to criticize a country on the whole for its healthcare expenses without evaluating what those expenses were for.

You are right that Doctors are forced to spend an inordinate amount of money protecting themselves. Any reform should ease that burden as well.

Let me challenge your thoughts on the middle man argument. Single payer is a middle man. So too is private insurance. But without it, there is no financing mechanism for health care. Whatever one would need form a doctor or pharmacy would have to be paid for at the time of service or paid out over time to the MD. That was what happened in the USA in the formative years. Doctors were paid with cattle, grain, or services as well as cash. But today, we have many more services and innovations because there is so much money in the health care business. The cost of that progress is sometimes an expensive treatment, which only exists because someone made a profit on it. Are we done innovating? Would people save enough money to pay for the $15,000 normal, problem free child birth? It doesn't seem likely. Financing is the only realistic way to accomplish the objective; Just as it is in buying a car, or a home.

On the other hand, cosmetic surgery and LASIK eye surgery has become much less expensive over the years primarily due to the fact that there is no "middle man". Doctors have to compete on both price and quality in these areas and many have made an upper class income doing it. Somewhere in these two options is a solution. Perhaps debate can put a face on it.

The pending legislation, according to the CBO's numbers and trend extension, the cost to insure each person in the new plan offered by the government is about $750 per person per month. It is likely to be even higher when, like Medicare, it actually starts growing. That is quite expensive for most income levels in America. In many cases significantly more than what most pay now. In the first few months, President Obama discussed the primary issue he had with our current system. He cited “the cost to our economy of 14, 15, or 16% of our economy” And contrasted it to other modern economies at “only 11, 12, or 13% of their economies.” His hope is that we would do all of this in order to save between 3 and 5%. It might be great, and perhaps cover money people, but nothing to keep it from getting more and more expensive. And adding bureaucracy and covering more people, it is not likely to be less expensive. How many business owners facing a 25% increase in the cost of their insurance coverage would be cheering merely a 22% increase?

Anonymous said...

JHK3:

You are confusing different numbers in important ways. Obama's reference is to a 4% savings of GDP ("our economy"), not saving 4% of health care costs alone. Saving 4% of our GDP (of $14T)is worth about $560 BILLION. That would represent a savings of some 25% on the overall national cost of health care. If that could be achieved, there should not be a 25% increase in the cost of insurance, but a 25% DECREASE.