The masses do have wisdom. Often the masses understand this country better than the politicians. But PT Barnum did not make money on the wisdom of the masses.
As I have written recently, we do have a health care crisis. This crisis stands in opposition to many Americans expressing satisfaction with their own health care situation.
Sometimes leadership requires leaders to get dangerously in front of the followers. One skill of leadership is knowing when those moments occur.
I believe this is such a moment. The cost of health care is crippling our economy. The high cost is not entirely necessary for us to provide excellent health care.
Dr. Laffer has some interesting opinions on solutions to health care costs – How to Fix the Health-Care ‘Wedge’
The health-care wedge is an economic term that reflects the difference between what health-care costs the specific provider and what the patient actually pays. When health care is subsidized, no one should be surprised that people demand more of it and that the costs to produce it increase. Mr. Obama’s health-care plan does nothing to address the gap between the price paid and the price received. Instead, it’s like a negative tax: Costs rise and people demand more than they need.
So I have a dilemma. I do want universal coverage, because I believe the lack of coverage increases costs. I also have championed a tighter link between health care costs and individual decision making. So what is an angst ridden blogger to do.
I could write a perfect bill – for my beliefs. You could develop a perfect bill for your beliefs. In fact, we could have thousands of competing bills, each perfect for at least one thoughtful intelligent author.
We must settle for a flawed bill. The question that we each must answer is the degree of flaw that we can tolerate.
While we do not yet know the details of the final bill – and I do believe that we will have a bill by the end of the year – I do have key issues.
We do need to reinvigorate the primary care base of health care. The data are very clear that increased primary care improves quality and decreases costs. I know this from the studies, and I know this from planning discharges for patients. I know this from my own experience of 20 years of doing outpatient medicine. Fortunately, all the bills that I have seen do some good things for primary care. I would do more, but we are dealing with the horse trading of politics.
I would like to see universal coverage. We need to provide secondary prevention for common diseases to decrease morbidity and health care costs. We need to remove the costs of caring for the uninsured from those who pay. We spend money on these patients when they come to the ER and get admitted, why not spend the money to decrease ER visits and hospitalizations.
I would like malpractice reform. If the Democrats would compromise here, then they would attract many dissidents. They will not because the trial lawyers give them too much money. (Please read Matt’s upcoming comment deriding this opinion.)
We need to end the SGR formula and yearly fixes.
I would like to see us strive for a health care system rather than a health care ecology. We physicians do not work well enough as a team, because the financial incentives drive us towards developing our own fiefdoms.
I would like to see a dramatic change in payment. I would accompany this with a dramatic change in documentation requirements. We spend too much time documenting inane requirements – the 9 point review of system, the family history in an 85-year-old, a daily complete physical examination. We spend too little time in our notes explaining our thought process and our plans and too much time buffing the chart for billing.
I would like to see health insurance offered at a national level. We, like the Congress, should have options (I believe that they have 10) regardless of employment. We each would decide how much we want to pay, understanding clearly what we get for what we pay. Payment for health care should not be mystical, rather straightforward and transparent.
I want many things, and will get some of them. The masses are wrong though. We do need to address health care for the economic health of our industries.
{ 5 comments… read them below or add one }
Thanks for the shout-out. Only thing is I agree with you that if you get universal coverage you will get malpractice “reform”. You won’t like it any more than you like the current, though.
Universal coverage will reduce malpractice claims more than anything else because the need to pay past and future medical bills as a result of malpractice will no longer exist. Rather than the cost of those bills being on the responsible party it will be on all of us taxpayers.
My guess is that the government will set some standard of “never” events, or just grade you truly on adverse outcomes, and there will be some board in some division of the government which reviews your work and then starts docking your income (since they’ll be paying it) for too many claims. Rather than appeal to a jury though, there will be some byzantine bureacratic process for appeals which will take longer than any malpractice claim ever thought about.
Physicians will definitely get the “win” here. You want to “reform” healthcare. Go back to providing services direct to the pubic and getting paid directly by the public. That’s the only thing that will truly save healthcare.
Or spend all your political capital on malpractice issues, which are a negligible cost overall and which have a truly negligible effect on your income overall. Although they are a big deal to your liability carriers, so the insurance industry thanks you!! And of course the tobacco industry, who are the backers of your rather pricy health courts idea, thank you!! Good company you’re keeping these days.
PS – putting malpractice “reform” in any bill that doesn’t include universal coverage is moot since it’s a state law issue. Principles of federalism and all that – surely a libertarian like yourself is aware of those.
“We need to remove the costs of caring for the uninsured from those who pay.”
The problem with this is that there will always be those who can’t (or won’t) pay, whether for their actual bills or for their insurance. And the only way to cover their care if for those who can pay to pay through inflated insurance costs to pay the inflated provider costs to cover it, or else to pay for their insurance through higher taxes. Either way, as a taxpayer who has insurance, I’m going to be paying for everyone else too, including illegal aliens, who won’t be asked to pay anything at all for their care. I believe in charity, but not charity where the kind and the amount is forced on my by DC.
I agree that there are many things about the current system which could be improved, but I don’t think the current bill is anywhere near the right way to do it.
And I really, really, don’t like the “if we don’t do it in the next week the sky will fall!” meme that the administration is pushing. They rammed the stimulus packages through that way, and we got a bill that no one had time to read so virtually no one realized that the vast majority of the spending was so far down the road that it would have no effect on the current situation (even if one thought that spending to get out of debt was a good idea), and it certainly could have waited a week or two for our representatives to actually read it. I end up suspecting that the promoters of these pieces of legislation know dang well that if the electorate actually knew what was being voted on there would be a revolt, which is why they push it through before anyone has time to think about it.
When I take part in local tea parties my sister sneers that the original tea party was because of taxation without representation, and our representatives voted for this so what am I complaining about. I point out to her that when my rep doesn’t even try to read the bill, and therefore has no idea what he’s voting on, I am NOT being represented. True health care reform (and they now seem to be calling it “health care insurance reform” will only occur when ALL Americans are represented in the process.
On a lighter note, section 100(a)(4) of the bill is entitled “Health Delivery Reform”. Which has me wondering how do you delivery health? Is it shipped UPS?
In my experience, I haven’t found very many people who oppose the democrats’ rushed, over-reaching agenda as being against reform per se. It’s just that this partisan plan will not save money, it will interfere more in the physician-patient relationship, it will ration care from a top-down approach, it will not limit malpractice, etc. We should and do support reform. But we should not pass a crap bill for the sake of saying we want to “do something.” That’s sloppy reasoning.
Dr. Centor,
I do not follow the logic of supporting a bill ( the house bill) whose 1000 plus pages of arcane, self referential wording remains unread and a mystery to many of its supporters .I cannot buy the rationale of supporting such a bill because we ” need to do something.”without really knowing what the bill proposes in all of its details translated from its current bureaucratic legalese into plain English. If health care reform is to improve the “health” of American industry because businesses have such high health care costs I remain unconvinced that this will accomplished by forcing more employers to provide medical insurance. If we remove the health care costs for those without insurance from those whose pay who do you suppose will pay? The government who will still get the money from those who pay through taxes .
In the United States people don’t starve. How do they do that without food being a right? The free market supplies plentiful calories at low prices. Those that cannot work for their daily bread have private and government charity provided food. Systems that have food distributed universally as a right do not fare as well as we in the US do. Such government systems slowly or quickly pull down the economy and even under the best of circumstances find themselves unsustainable after a few generations, the next major embarrassing casualty being the EU’s Common Agricultural Policy or CAP. You haven’t heard about this Eurosocialist failure? Don’t blame yourself. It doesn’t fit the media narrative.
I too want everyone to get healthcare. But I’m not willing to accept the slow degradation of our health system and the ultimately wrenching disaster when we run out of money and it all comes crashing down around us. I would much prefer to approach universal coverage in as free market way as possible, leavened by the Hippocratic oath and good old fashioned charity for those who cannot make it.
President Bush’s proposal for associational healthcare would have led to an increase in coverage as people were able to join insurance pools through stable associations like their church or some other private affinity group. This step towards universal coverage was overwhelmingly rejected by those pressing for the current Democrat proposals today. Ever think why?
There are free market proposals out there. This is not the time for proposing them because they will be rejected out of partisan spite much as President Bush’s associational health insurance reform was rejected. Now is the time for ‘first do no harm’ which is why you find the GOP in a very rejectionist mood.