If you’re a staunch single payer supporter or a free market advocate, you’re likely going to be disappointed with how health reform is going to play out.
In an excellent piece, Atul Gawande discusses the history of health reform (via Ezra Klein) in other countries that have universal care, like Canada, the UK, France and Switzerland, and how those systems came to be.
Completely scrapping our health care system to implement the ideal of the left or right is simply not feasible, as Dr. Gawande points out that “the system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die.”
He notes that we already have three established systems in this country of varying effectiveness, the VA, Medicare, and the private insurers. Predictably, there is an inverse correlation between patients’ freedom of choice and cost control, with the VA controlling costs and restricting choice the most, and private insurers, the least. Medicare falls somewhere in between.
A pragmatic approach is needed to bridge the differences between the left and right, hospitals and economists, physicians and health policy wonks. Doing so means supporting the center and building upon what we already have, leaving those who advocate on either extreme increasingly irrelevant in the health care reform debate going forward.
Related posts:
- Should private insurers be kept in the health reform mix?
- Physician payment reform is the key to fixing the health care system
- Why controlling health care costs is so difficult
- Rationing health care by waiting times, or by cost
- Health care equality is an oxymoron
- Convincing doctors to accept a public health care plan option
- Do we almost have universal health care already?
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Thanks for pointing out this article; I thought it was excellent. It addresses a problem that really bothers me as I speak with people and read blog comments. Many people are so invested in wanting to see their vision of a perfect system come to pass that they would actively oppose incremental change, even if that change would benefit a lot of patients. It just makes sense to me that change which builds on what is already familiar to the public is a much easier sell than something brand new and untested.
Dr Gawande’s article is excellent-thank you for linking to it. Although it is painfully obvious to most Americans that the current system cannot continue, it is also obvious that you can’t please all the people all of the time. We will all have to accept some compromise somewhere in order for all Americans to have access to good quality, affordable health care. Maybe that will mean some technologies are used less frequently (e.g.not getting a CT or MRI for a sprained ankle). Maybe that will mean paying primary care physicians (and those who don’t do procedures) more reasonably for the services they provide (e.g. the redistribution of income medical specialists seem to dread). Maybe that means regulation or revamping of the health insurance industry to decrease things like administrative costs (both theirs and the administrative costs borne by providers to deal with the insurance companies), executive compensation, creating venture capital funds/financial institutions. Maybe it means that some laws – like EMTALA – need to change. Maybe it means we will take more generic drugs rather than brand name drugs. Maybe we will all have to work together to reach consensus, accept compromise, and put away our selfishnessso we all can have health care without worries.
Dr. Gawande erroneously assumes that those of us with health insurance have decent health care. With drive-by appointments and doctors who would rather do procedures, it’s no wonder we rank 37th in quality care.
As doctors squabble over who gets the biggest pieces of the health care pie, I suppose I will continue to rot at the bottom of the boat.
There is nothing wrong with our system, except cost. Most of the excess cost is caused by lawyers.
White people here are doing better than their relatives in Europe, and we would rank at the top or near the top if only white health outcomes were counted.
Patients can do their own pre-authorizations and limitation of procedures by the promotion of medical savings accounts. We need health insurance only for catastrophic care. Lesser care and medications should be paid for from the personal asset of the medical savings account. The patient is the best judge of medical necessity, after the pros and cons are reviewed by the doctor, and supplemented by personal internet research.
Supremacy Claus said, “There is nothing wrong with our system, except cost.”
From “America’s Healthcare System is the Third Leading Cause of Death”
Barbara Starfield, M.D. (2000)
Summary by Kah Ying Choo
• 12,000 deaths per year due to unnecessary surgery
• 7000 deaths per year due to medication errors in hospitals
• 20,000 deaths per year due to other errors in hospitals
• 80,000 deaths per year due to infections in hospitals
• 106,000 deaths per year due to negative effects of drugs
“The traditional medical paradigm that emphasizes the use of prescription medicine and medical treatment has not only failed to improve the health of Americans, but also led to the decline in the overall well-being of Americans.”
Those statistics were extrapolated by left wing ideologues from a Harvard study that was biased, left wing, and invalid garbage science. I would be shocked if the real rates were one tenth those listed.
Some authors had JD’s. They indoctrinated trainees for hours. Those trainees still had totally unacceptable inter-rater reliabilities, making all findings garbage.
Next, they had the trainees rate the charts of clinicians. Ignorant, lawyer indoctrination victims, trainees with unacceptable inter-rater reliabilities rated the work of experienced clinicians.
What this study proves is that clinicians will get scapegoated by left wing ideologues from Harvard, for bad outcomes in moribund old people, expressing outcome bias at best, and vengeful, left wing Harvard hatred of clinicians, more likely.
You had to read the Methods section in tiny print to learn that.
I have one word rebuttal for Commie Care, which this study was meant to promote. Princess Diana.
No EMT’s. No supervisor. No telemetry. No helicopter. No trauma center. No waiting operating room with a thoracic surgeon. No. In Commie Care, you get futzing for 45 minutes at the scene, with the Princess talking. Then you get a ride to the academic medical center 4 miles away for one and half hours, with stops to do street resuscitation on a trauma victim bleed from an arterial tear in her chest. Go ahead compress the chest. See what happens in Commie Care. The Princess could have survived her injuries in the worst slums of the United States.
What chance do ordinary, seriously ill people have, once Obama enacts Commie Care?
“Commie Care”
I see your ideology distorts your view.
I currently wait 2 months for a 10 minute appointment with a doctor who would rather write a prescription than listen to my issues, make a accurate diagnosis and devise an appropriate treatment plan. I have been misdiagnosed 5 times, 3 times with the same wrong diagnosis because the doctor didn’t read the chart. This is great health care?
Perhaps univeral “commie care” isn’t the best option what we hav e now certainly isn’t working. Do I have to have a tramatic injury to get decent care? I would rather live a quality healthy life with everyday health care than survive that tramatic crash. Instead, I live with chronic illness that doctors don’t have time to diagnose and treat appropriately.
You sound like Ann Coulter with your conspiracy theories. Instead of engaging in real conversation on how to deal with our health care crisis, you use fear and insults to get your point across.
Fine. Do health care reform at the state level. Pick a state. Just so long as it’s not my state. Massachusetts is doing that right now. Let’s see how they do.
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