Health Care

How American medicine is destroying itself

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.

Can the government tell you what to eat?

Food is on the tip of everyone's tongue these days.  It even came up during Elena Kagan's Supreme Court hearings today.  You can watch the video below.  Senator Tom Coburn of Oklahoma asked if the government could pass a law mandating that people eat three fruits and three vegetables a day.

 
Coburn's question really was about the Commerce Clause, not food.  The Constitution gives Congress the power "To regulate Commerce with foreign Nations, and among the several States, and with the Indian tribes".  Despite the fact that the word "regulate" did not have the same meaning when it was written as it does today, the interstate portion of the clause has been interpreted by the Supreme Court (most definitively during the New Deal) to mean that the Federal Government can regulate anything that might possibly impact interstate trade.  Essentially, anything and everything.  Even what we eat, is Coburn's point.
 
Health care and food taxes/regulations are deeply intertwined.  (Health and food are deeply intertwined.)  We're increasingly seeing calls for soda taxes here in New York City.  It's in line with other "sin taxes" (smoking, gambling), which politicians find easier to levy.  Congress definitely has the power to tax.   But the public willingness to accept food taxes and eventually, more restrictive federal regulations, will only increase as people feel that they are paying for other people's healthcare.
 
To a large extent we already do pay for other people's healthcare via Medicaid and Medicare -- and even through private health insurance (where I am pooled with others, many less healthy than I, to arrive at a group rate).  But the perception and reality of Peter paying for Paul's healthcare will only increase under the new health care legislation.  And the implications are pretty easy to follow: If I'm paying for your healthcare, you better believe I'm going to tell you how to eat.  This certainly won't come through prohibitions and mandates (no politician is that stupid), but through taxes and incentives.
 
What really scares me is that the long-time foundation of the USDA food pyramid has been a food group, grains, that humans basically did not eat prior to the Agricultural Revolution.  And don't forget the decades long and deeply misguided War on Fat.  Doesn't exactly inspire confidence!

The beauty of a system based more on individual responsibility is that people have the freedom to live as they please: healthy or unhealthy.  Of course, then you have to let people face the consequences of their decisions, as if they were fully capable adults.

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