Random Thoughts About Healthcare
Since healthcare will undoubtedly be in the news for the next several weeks, I thought I would list some random thoughts.
-healthcare, medical care, and health insurance are 3 different concerns with some overlap between them. When those that bad mouth our medical care site the decrease in life expectancy of US and other “health” measures, they clearly don’t know the difference. Attempts to solve all 3 at once thru one sweeping legislative is a little naive in my opinion.
-while I can find a lot of valid arguments against a gov’t run single payors system, the oft cited “we don’t want beaurocrats making medical decisions” shouldn’t be one of them. We already have that with every major private payor in the U.S.
-I don’t understand the logical deduction that many are making when they state “comparative effectiveness means rationing of healthcare”. If we don’t have some analysis, we might continue to have some chiro’s continuing to treat kids for bed wetting.
-The idea of mandating employer coverage for health insurance is completely unfounded. When are we going to realize that the employer model of health insurance hasn’t worked and won’t work as business challenges are daunting enough. Employer model has been around for a long time and has essentially made big companies financially vulnerable and contributes significantly to increased cost of products/services and lack of companies being able to expand. The vast majority of new jobs are created by small business-mandating insurance coverage might stop a new business in its tracks before it starts.
-There is plenty of money in the system to take on the 50 million without coverage but there isn’t enough providers. Therefore, without force multipliers and deregulation around those that can provide services, there will be long lines and general angst. The military healthcare system has been dealing with these issues for years and its system should strongly be considered as a model.
-given the hi percent of GDP on medical care, I do believe that a catastrophic health benefit should be a birthright and affordable primary care should be available. The one thing you can say about medical care-even at its worst-there are true economic transactions and people performing services which is good for the economy as those employed do pay taxes (will avoid commentary about the failed bank crises and their number of employees by comparison).
-You can’t have healthcare reform without legal reform and business reform. Significant cost drivers include “defensive” medicine and fee for service in “conflict of interest” business arrangements. The hidden cost of regulation contributes to to the problem.
-Consumers already exhibit a strong voice in their care. Per FDA data, 70% of the time a patient requests a certain type of drug from their doc, they get it. The idea that individuals can make complicated decisions about spending their dollars makes no sense at all. Increased co-pays have not solved the problem and in many cases are counter-productive towards savings.
-There are generational differences in medical care. Older baby boomers generally trust their doc, younger generations are skeptical about their medical providers and they are comfortable doing searches on the internet to help them determine their best care. They also want a CNET style of healthcare which will show them number of choices, lowest cost, and provider ratings.
-Anybody who believes the gov’t knows how to implement “quality standards” ought to read about the adoption rate of PQRI by MD’s and PT’s.
-Not sure I understand why we aren’t looking at the success of mandating individual auto insurance as a model. This substantially opened the market to individual underwriting and competition which is something we don’t have in the health insurance marketplace. Many employers would be happy allocating to an individual an amount of money for them to choose their own policy outside of their employer.
Thoughts?
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