Saturday, September 28, 2013

Primum Non Nocere……First Do No Harm

Fixing our healthcare system will require some combination of more money to provide the products and services some folks are not getting, reducing the cost of certain products and services and limiting the availability of certain products and services. I don’t think the Affordable Healthcare Act (aka Omabacare) gets us where we need to be. Furthermore, I’m not sure any politician has the guts to put forth a program that does. Providing healthcare for all, significantly reducing the cost of healthcare and determining what level of healthcare people are “entitled” to receive would seem to be way more than our government can handle. And then there is the question as to whether or not they should even be trying.

Certainly the government has a role to play in healthcare. We want and need certain controls, guidelines, certifications and oversight of healthcare related services. Rules and regulations are necessary up to a point. But we are headed in the wrong direction when the government mandates that everyone will have healthcare and then cobbles together a half-ass program and hopes that the people (especially the ones who vote) won’t get so pissed off that the political geniuses who came up the idea get run out of office.

The healthcare math is really simple. It still cost money to provide healthcare to people who do not have healthcare (or money). You can force young healthy uninsured people to pay for healthcare that they will not likely need at this point in their lives and cover some of the immediate costs. But it’s not going to come close to covering the overall cost of adding millions of uninsured, unhealthy people to the program. And the premiums you (and your employer) pay in when you are young will be needed to keep you upright and mobile when you get older. Trust me on this.

The cost of certain healthcare products and services can and should be reduced. The threat of litigation causes the industry to over test, over prescribe and over refer to specialists who over refer to other specialists. In many cases the process or sequence of tests and evaluations allowed by insurance providers ends up adding costs, not to mention delaying treatment. The “system” needs to be improved. The marketplace can do a pretty good job of driving down costs and improving service if it’s allowed to work. But, the healthcare, insurance and big pharmaceutical lobbyists have done a great job of stacking the deck in their favor. And, I predict that when it’s all said and done, they will do just fine under whatever sort of healthcare program we end up with. They will make sure that “the marketplace” works mostly to their benefit.

Which brings us to the third variable in the healthcare service and cost equation. What products and services will be available and who makes that determination? Interestingly, we are moving toward a hybrid healthcare system that is part public, non-profit, government entitlement program and part private sector, for-profit business. Perhaps the worst of all outcomes. The “for-profit” system which delivers the vast majority of healthcare related products and services cannot afford to lose money. Capital will evaporate and the businesses will go under. So this “for-profit” system will charge whatever they can and continue to lobby as hard they can. And, where they cannot figure out a way to make a profit, those products and services will become very difficult to access. Or they will only be available “outside” of the “affordable” system at prices few of us can afford.

There is no easy fix to our healthcare system. And it is indeed a shame that many people in this country do not have access to healthcare. We could improve that situation over time by upgrading our network of “public” healthcare services. But, there is no way to provide comprehensive healthcare for everyone without forcing some of us to pay for the healthcare of others while paying more for our own.

The real question is not are people entitled to healthcare. The real question is what sort of healthcare are people entitled to and what sort of healthcare should they pay for? And if they can’t pay for it, do they just live without it as best they can. For example, I had a total knee replacement back in December 2011. It has been a wonderful thing and I am thankful that I had insurance that covered most of the costs. But, should a person be “entitled” to a knee replacement? If you have no insurance and cannot afford a knee replacement, should the taxpayers pick up the tab? Tough question. No easy answers.

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