Daily Reads

Monday, July 27, 2009

Why I don't favor a rush to "fix" health care

I spent several years on Tricare (it's still my secondary), and rather longer before that in Ireland in their NHS system. Which is why I worked hard to get a good job so I would have something NOT run by a gov't. The Navy tried quite hard to kill my eldest child, and I still have occasional problems stemming from the post-appendectomy abscess in Galway ("Oh, but 10% to 20% of all appendectomies get post-op abscesses!")

At least HR 3200 is currently not quite as bad as HR 676 - Medicare for all! No co-pays, ever! No for-profits of any kind anywhere in the health care system (we'll buy them out forcibly)! The gov't will decide in advance how much they will allow a geographical region to spend on care for the year! (Ask the UK how that's doing - no money for cleaning and other basic supplies.) A rather Orwellian/Soviet-sounding "National Board of Universal Quality and Access"! What could go wrong?

Yes, the current system needs some fixing. But handing it over to gov't bean counters to decide whether the only treatment that will cure me is "cost-effective" or if I’m far enough up the queue is not something I ever want to deal with again.

One place to start reform is letting the uninsured pay the same as is accepted from insurance. I've been charged $70 for an inhaler when Tricare's computers were down and there was no proof that I was still insured. Two days later when they were back up, the pharmacy accepted a total of $40 between insurance and co-pay for the same med. But federal law requires that they charge the uninsured full freight, even though they must accept the lower amount from the feds. Why should a lack of insurance mean you have to pay 50-100% more for all your medical care? I'd like to see a provider being allowed to recieve the same amount for the same service, no matter who pays. The feds are responsible for that, so they could fix it pretty fast, if they were willing to. However, if they did, they'd have to up what they pay, since providers tend to lose money on the federal patients, and have to make it up on privately insured, and uninsured.

We could also buy basic private insurance for all the legally-here uninsured for far less over the next 10 years than the projected costs of HR 3200.

I just worry that if we get system which divorces end users even more from the costs, inspite of gov't rhetoric, the only way to contain costs will be rationing, and then we'll end up with folks dying of curable diseases, simply because it costs too much to do detection testing, such as pap smears on women under 25, because we know that they never get cervical cancer, or because at 80 how much use will you really get out of that pace-maker?

The problems with our current delivery of quality health care and - perhaps even more so - sick care are complex, and to ram through a fix on a rapid time frame, designed by who-knows-who, and voted on by legislators who don't even read, much less understand, what they vote on, just so we can say we "fixed health care!" will create even more problems.

Utah has what looks to be a distinct possibility in improving access to health care, MA's system is going (gone?) broke, Hawai'i tried something for kids which they had to stop within 7 months, because they didn't account for human nature and it cost way more than expected. Let's see how all these experiments work before we rush into fixing a damaged, but still functional-for-the-majority system.

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