HEALTH CARE
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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