Monday, May 1, 2017



     As usual, our elected leaders are fighting over how to fix the wrong problem. They have their own reasons for doing this. I’ll come back to that later.

     Our starting condition, predating Obama care, is an enormously expensive ‘system’ coupled with lousy health. We spend 2 ½ times the average for developed countries, twice as much as the next two most expensive countries and, by any measure we are less healthy than most developed countries. We lag* in life expectancy, heart disease, infant mortality, obesity, diabetes, mental health, addiction, etc. None of the proposed ‘plans’ address these or other  sources of runaway costs.

     First, costs: In our government, inefficiencies protect special interests. Just look at our tax system—not the taxes—the system. Health care is loaded with protections for special interests—drug companies, trial lawyers, insurance companies. And I’m sure the paper companies are happy to produce the blizzard of paper for the forms I receive micro-informing me of the details of some procedure I had six months ago.

     The most simple test procedure at Lahey generates an itemized invoice—separate charges for minutia. Just like your electric bill. The cost of conforming to regulations and satisfying the government lawyers, the insurance lawyers, and Lahey’s lawyers does very little for the patients.

     Add to this the costs of liability insurance and the extra procedures resulting from fear of lawsuits. Most lawsuits seem to be aimed at getting a settlement, not winning in court. A loser pays system would, as it does in all other developed countries, eliminate this problem.

     Drugs: A quick fix would be to require companies to sell drugs here at a price no higher than charged in any other country.

     From personal experience, I know that tax-free, Cadillac, health plans drive up costs; employees see every new allowance as free money. Companies struggle to stay competitive in order to keep their employees. If the plans were taxed, employees would soon be interested in less plan and more pay. They’d probably be happy to seek out their own plans. The result would be fewer Cadillac procedures and a general downward pressure on health costs for all.

     A voucher system. Especially for the poor, with a built-in financial incentive for getting the right checkups and not spending all the vouchers might help.
     And, I believe that a strong anti-fraud system is important, not just for the savings, but to give the taxpayers faith in what we’re doing.

     What about our poor health? Much of it seems related to diet and lack of exercise (fat people don’t feel like exercising). We’ve done a pretty good job on tobacco. Why not try the same techniques on sugar and corn syrup?

     Addiction? Let’s stop playing ‘cops and robbers’ and put our money into education and treatment. Let’s also recognize that we can’t save everyone but sustain the afflicted with dignity.

     If you’ve been reading my stuff, you already know why none of the above will happen. The inefficiency people are paying up to maintain their paychecks, and they’ll pay even more if threatened. 

* ‘lag’ is intended to indicate behind—worse off.

Joe Bakewell,

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