You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010


Sunday, July 18, 2010

Health Care Reform Triangulation

Today on the front page of the NY Times was a feature article about an effort by health insurance companies to offer more restricted plans for less money. As consumers we are silent bystanders to these negotiations, since the insurers deal mostly with employers. Companies large and small are struggling with the cost of providing health insurance for their workers. These newer insurance products present lower costs, or at least lower increases in cost in exchange for offering companies (and workers) fewer choices.

One of the selling points repeated loudly and often by the President was that with the health care reform package no one would lose their insurance; they could keep the coverage they had or opt into something better. The President was right to a degree. The government won't force these decisions, but the health care market is spiraling out of control; this would have been true even if Obama had never uttered the words "health care reform." Our current system is unsustainable. No segment of society, not government, not corporations, not individuals (except the very wealthy) will be able to afford our health care system going forward. This is not even addressing the serious failures of our system in protecting and promoting health. We have a lousy system now, but we can't afford it much longer. Though much maligned by Obama’s opponents, the European systems are wildly popular with their citizens, less costly, and get better results.

As the Times article illustrates, many people may lose their current health insurance plans, not because of health care reform, but because employers can no longer afford plans we've taken for granted in the past. This would be true even if Obama had never come on the scene.

The focal point of what we value can be visualized by a triangle, with cost, access, and choice at the points. Up until now, choice has been in the ascendancy. Americans want to choose their doctors, their drugs, their hospital. Of course most consumers' choices in this regard are not guided by evidence of value. Data to guide these choices has not been available, and so we are persuaded by marketing ploys and superficial indicators. This is beginning to change, but slowly.

The primary driver of this year's health care reform legislation has been to increase access, bringing in the 40 million Americans with no health insurance, and therefore no choice except emergency room medicine. While universal access is a worthy goal, and something demanded by social justice, it will increase cost unless adjustments are made elsewhere in the system. If we want to increase access without increasing cost, we have to limit choice.

Some of the most vocal opponents of the health care reform proposals which passed this year claim that we will have to ration care. What they really mean is "I have good care now, and don't want to sacrifice so that those shut out of the system can be served." Of course we ration now, but those excluded, by and large, have no voice in the political system. In order to hold down cost while maintaining choice, we limit access.

Researchers at Dartmouth Medical School have clearly shown that unlimited access is not really a good thing. Not only does it drive up cost, it also drives up waste. Those researchers (Google Dartmouth Atlas) estimate that somewhere in the neighborhood of $700 billion per year is wasted. This expense might enrich providers, but does nothing for individual or public health. This represents a fourth to a third of the nation's health care expense. Costs come from duplication of services, or providing services which do not benefit patients. In other words, we are victims of inefficiency and gaming the system, charging for things that shouldn't be provided in the first place. This latter practice is so common it is a standard of care in some places. It is theft in plain sight.

It is clear that there is much to be done to reach the potential we have as a nation, finding a better balance between the best of open markets and private enterprise and being sure that health protection and promotion is the goal, not just a business plan.


Anonymous said...

All you require is to adhere to the directions cautiously.

Coupled with the achievement of the iPhone 4S, it is most likely that Apple will promote 200 million in 2012.

Most importantly, although, make certain iTunes performs a backup.

my web site: pligglink.info

Anonymous said...

I'm not sure why but this blog is loading extremely slow
for me. Is anyone else having this problem or is it a issue on my end?
I'll check back later and see if the problem still exists.

my homepage; auto repair shop Sacramento

Anonymous said...

The game found immediate acceptance after its release and subsequently, the day.

The playing field, in precisely the same level
of challenges before you reach your potential audience.
Here we will tell you dungeon hunter 4 hack how!

It has similar kind of online shopping was earlier restricted with
the APIs offered by the blue balls, which runs a version for Facebook.

Plants Vs ZombiesIn this game can be a very nice way.

Anonymous said...

Does your blog have a contact page? I'm having a tough time locating it but, I'd like to shoot you an e-mail.
I've got some creative ideas for your blog you might
be interested in hearing. Either way, great site and I look forward to seeing it improve over time.

Also visit my weblog: cna classes in rochester mn

Anonymous said...

You really make it seem so easy with your presentation but I find this topic to be really something that I think I
would never understand. It seems too complex and extremely broad for me.
I'm looking forward for your next post, I'll try to get
the hang of it!

Also visit my website :: Real Flame fires (Urbanhyderabad.com)

Anonymous said...

Excellent article. I am facing a few of these issues as

my blog post; head gasket replacement cost

Anonymous said...

Everything is very open with a clear description of
the challenges. It was truly informative. Your website is extremely helpful.
Many thanks for sharing!

Also visit my blog ... google

Unknown said...

Health care is simply what people need..

About Sciatica

Anonymous said...

Lots of information and benefits that I can take from your writing.
I hope that in the future it will get even better and better, so that everyone can get a lot of information here.

Visit the best Website health and information

Lots of information and benefits that I can take from your writing.
I hope that in the future it will get even better and better, so that everyone can get a lot of information here.

Visit the best Website health and information

ziaadesty said...

I really like all of your writing. I hope you don't get bored to always share your experiences with me. Don't forget to visit my website below:





yanmaneee said...

kyrie 6 shoes
yeezy boost 350
yeezy boost 350 v2
supreme clothing
supreme t shirt
stone island
off white x jordan 1
kevin durant
supreme hoodie
supreme shirt