A few years ago, I was your typical office-worker: stressed out, uneven energy, overweight, and inconsistent complexion. Now I'm just your typical 28-year old urban hunter-gatherer on a quest to be healthy, and having a few adventures along the way. See my full bio.
From The New Republic:
"Among the elderly, the struggle against disease has begun to look like the trench warfare of World War I: little real progress in taking enemy territory but enormous economic and human cost in trying to do so.
The article is called The Quagmire: How American medicine is destroying itself, and the first half describes our expensive lack of progress in health, life expectancy, and medicine.
But I can't say I agree with their prescription:
"The only reliable way of controlling costs has been the method used by most other developed countries: a centrally directed and budgeted system, oversight in the use of new and old technologies, and price controls. Medicine cannot continue trying to serve two masters, that of providing affordable health care and turning a handsome profit for its middlemen and providers."
It seems to me that industries which have the most difficulty controlling costs -- in the United States of America, where this policy would be put in place -- also tend to have the most government involvement (education, health care, defense spending, pensions), often in hock with special interests (big business, unions) who profit off of government largesse at the expense of tax-payers.
Oddly, after the authors have already arrived at their conclusion of how to fix the system, they suggest a method to....figure out how to fix the system. The answer: a big study!
But there is, in fact, a solution: a top-down, bottom-up study of the entire U.S. health system, with a view toward taking it apart and reconstructing it in a manner adapted to our nation’s needs—a multiyear, multidisciplinary project whose aim would be to change the very culture of American medicine. The inadequate, inequitable, and financially insupportable system that has been jerry-built and constantly band-aided during recent decades will no longer do. Nor will incremental policy reforms, no matter how well-intentioned.
Top-down AND bottom-up?!? Sounds like The Best Study Ever.
You know what else big studies are good for? Finding a cure for heart disease. OH WAIT. No they aren't. The authors never stop to think that re-designing and implementing a health care system from scratch might be just as difficult and intractable a problem as finding a cure for heart disease.
They are skeptical about medical interventions in one complex system (the body), but brim with confidence about economic interventions in another complex system (the economy). Note that being skeptical of their proposed re-engineering is not a defense of the flaws in our current health care system, just as being skeptical of finding a high-tech cure for heart disease is not a defense of heart disease.
Both problems might benefit from taking an evolutionary approach.
Comments
After World War II, despite
After World War II, despite having their cities bombed to rubble and their hold on empire collapsing around the world, Britain managed to cobble together a nationalized healthcare system which is now the largest of its kind. Given our current relative prosperity it seems like the United States ought to be able to do the same, but I guess that's just beyond the capacity of the three-ring circus our government has become.
Whatever way you do DO NOT
Whatever way you do DO NOT FOLLOW OUR EXAMPLE. A large bureaucratic system with a single provider of healthcare is not the ideal solution.If you look at league tables of health care the UK usually comes high up because of "access" i.e. everyone can theoretically get treated. The thing to look at is health outcomes where the UK really lags behind, particularly in things like cancer survival rates.
Whatever way you do DO NOT
Whatever way you do DO NOT FOLLOW OUR EXAMPLE. A large bureaucratic system with a single provider of healthcare is not the ideal solution.If you look at league tables of health care the UK usually comes high up because of "access" i.e. everyone can theoretically get treated. The thing to look at is health outcomes where the UK really lags behind, particularly in things like cancer survival rates.
They speak of "taking [the
They speak of "taking [the healthcare system] apart and reconstructing it in a manner adapted to our nation’s needs", and "chang[ing] the very culture of American medicine." This reminds me of Adam Smith's "Man of System," in that the author(s) seem to view the health care system as consisting of inanimate matter which can be shifted around, instead of flesh and blood human agents. The Quote from Theory of Moral Sentiments: "The man of system...is apt to be very wise in his own conceit...He seems to imagine that he can arrange the different members of a great society with as much ease as the hand arranges the different pieces upon a chess-board. He does not consider that the pieces upon the chess-board have no other principle of motion besides that which the hand impresses upon them; but that, in the great chess-board of human society, every single piece has a principle of motion of its own, altogether different from that which the legislature might chuse to impress upon it. If those two principles coincide and act in the same direction, the game of human society will go on easily and harmoniously, and is very likely to be happy and successful. If they are opposite or different, the game will go on miserably, and the society must be at all times in the highest degree of disorder."
John, don't be too hard on
John, don't be too hard on them. They're just trying to keep themselves in business for the rest of their lives. They're just following the conventional business model. I mean, don't begrudge another man his right to earn a living. So what if it's at everyone else's expense.
Great thoughts John, thanks
Great thoughts John, thanks for sharing :)
Amen John!I don't need a
Amen John!I don't need a major government study to tell me how to fix a very expensive health care system) I can do it in four easy steps!1) allow people to buy health insurance across state lines. This frees them from the burden of their own states' mandatory minimum coverage laws. People who want coverage for catastrophic injury or illiness only can then buy it.2)allow health savings accounts to accrue year-over-year. I can then save up for what my insurance doesn't cover3)provide health care vouchers to the poor to purchase insurance policies w/ remainder serving to shore up HSAs.4) allow people the same tax deduction for purchasing their own insurance policy that businesses get for buying them for their employeesautomatically doctor's prices will come down. They no longer have to staff five people to deal with insurance billing. They also will have to start posting their prices. People will naturally decide how much professional health care they need when they have to decide how much they are willing to pay for. (They may even be more inclined to work on nutrition first)both doctors and insurance companies will shift to please their new customer: The Health Care Consumer. currently,, doctor's customers were the insurance companies, Insurance company's customers are employers.
Agreed, but I don't think it
Agreed, but I don't think it will happen any time soon.I'm in the UK where the current government is trying to make some quite minor changes to the way healthcare is funded i.e. still all centrally funded with a gigantic NHS bureaucracy but the funding goes initially to general practitioners and they purchase services for their patients from hospitals etc. The screams of outrage and "won't somebody PLEASE think of the children" have been deafening.The more people who have direct interests in the current status quo the harder it is to change. There are too many people whose wealth and (more importantly in the UK) prestige and influence are tied up in the current systems to allow significant change.