Friday, August 28, 2009

Two Cents on Healthcare, Part 3

My previous posts on this topic have met with some healthy and informative discussion. In this post I hope to address some of those comments and then bring my position back into focus.

I started with this:

“I fully support dramatic health care reform. I don’t know what the right solution is but what we’re doing now isn’t it.”

I really mean that last part: I don’t know what the ultimate solution should look like. I’m not an expert but then it doesn’t take an expert to see the writing on the wall: we’re trending in a dangerous direction.

After that, I railed a bit against our current system and posted references supporting my claim that we pay way to much for a system that is not the “best in the world”. This struck a chord with some readers. Paula Haren responded:

“Wow, pull a couple of various quotes and put them all together and your an expert! Considering I have spent lots of time as a nurse(>10yr) and a patient and a wife of someone with cancer and considerable medical debt depite excellent insurance....I must respectful disagree. Sorry Mike, but its just not that simple. And yes, the US does have the best health care in regards to inovation...Spend as much time at Cleveland Clinic as I have and you will see all these people who's socialized medicine has under or miss served (or did not serve at all) their medical needs. I think you would have to put down The New York Times and get in the trenches to appreciate what I am saying.
Just wanted to add my 2 cents!”

To healthcare providers: I meant no offense to you personally. Most of my medical care encounters have been excellent and I attribute that to having good insurance that affords me access to good doctors and nurses. Unfortunately far too many of us do not have access to good care or when they depend on it are hit with obscene debt; and systemic problems lead to poorer outcomes for us on so many levels it’s depressing. As an aside: how is it that you have “considerable medical debt despite excellent insurance”? That sounds like a contradiction to me.

imageAfter doing additional research, I’m sticking to my original claim: the United States is not a leader in health care (not even close). Here’s a nice assortment of numbers that don’t make us look so great. And a couple more from the CIA World Factbook (which is fun to browse, by the way):

With respect to Paula’s experience at the Cleveland Clinic, I’d say she probably does see a lot of good medicine but her highly ranked hospital—which is in the top ten in 11 categories—is hardly representative of the nation. In contrast, my hospital ranks in only two categories and gets an unimpressive #45 in each.

In addition to anecdotal counterclaims like that, I’m also seeing a lot of fear. This comment from Miki Hempleman is representative of what I’ve heard from several people:

“I totally understand your feelings Michael and were it all it is SAID to be, I might also swallow the "magic pill" ... but it's not. Read more in depth and you will see it is VERY scary a proposition and will NOT do what they say it will. And I for one am in no hurry to move into a system that will not work.

Nervous tho after hearing and talking to good friends that are both Canadians and Brits. It's not that great a deal all the way around. Your aunt?? I believe... whomever, had some very good insight as well.

Getting nervous, real nervous about where we are headed as a country. Man I hope we aren't going to take a ride down the slippery slope. It's SUCH a fine line for us to unravel.”

And it’s really no wonder. Every day interest groups, political action committees, corporations, concerned citizens, and politicians scoop buckets of muck out of the sewers to toss at each other through every medium. Absolutely absurd claims like Obama death panels would be frightening indeed if there was any truth to them.

This fear of change is something I simply do not understand. Maybe it’s just my engineer-wired brain: if something is broken, you fix it. I’m not so naive to believe that this problem is solvable overnight or that a first-pass fix will be perfect (so few things ever are). Instead, I’m pragmatic enough to realize that we’re not setting in stone the next year, decade, or century of healthcare-related policies. Positive change will happen just like everything else: one step at a time (and getting from zero to one is the hardest part).

Finally, I want to refocus my position on this issue:

  • Everyone should have health care coverage
  • Coverage should be similar to what I have (I’m middle class, I pay small $15-20 co-pays for office visits, and all the important stuff is covered)
  • Coverage should be mandatory
  • Coverage need not be free (but it must be affordable)
  • These steps are necessary for the fiscal stability of our nation as the status quo is unsustainable (thanks for the video, Steve!)

We could hypothetically do this with private insurance and some new legislation. I’m not opposed to that idea out right, I just don’t think it’s practically possible. In the health care equation between the patient, doctor, and insurance companies, only the insurance companies have a direct incentive to keep costs down and they’re doing a lousy job at it:

image 

I’m afraid I’ve run out of time to cover all the specific points that Tiffany and Tim discussed. I think they did a fine job and I will likely come back to some of their discussion in the future. They have both clearly put a lot of thought into how specific reform could be implemented and I like the dialog.