If I Only Read One Article On The Health Care Issue This Year …
http://www.theatlantic.com/doc/200909/health-care
I would want this one to be it. Ignore the title. It is thoughtful piece that avoids the verbal food fight that we’ve watched (from both sides) for the past six months.
In 1960 health care cost Americans one dollar out of every twenty that they earned. Today it is close to one dollar out of every five (18% of GDP, to be exact). Since we don’t live four times as long, or are four times as healthy, it is reasonable to investigate why health care costs us almost four times as much, in terms of proportion of income, as it did in 1960.
Mr. Goldhill, a business executive (and Democrat, by the way) lost his father to an infection contracted in a hospital (when he reveals the bill incurred as a result of this hospital-contracted infection it will make your jaw drop) embarked on such an investigation and presents his findings and conclusions.
Much of what he has to say resonates with me, as a head of a family which has experienced tuberculosis, spinal bifida, and a cancer scare in the past two years, as well as being a company president who has to agonize over health insurance purchases every year in for an aging workforce with more than its share of expensive cancer cases (So, do I cut back benefits, or do I lay off employees …hmm – decisions, decisions)
He avoids villainizing anyone, although members of the health care profession may wince a bit when he analyzes the current economic distortions in the industry (which, he points out, are to some degree a product of past government actions). However, is tone is not adversarial towards any profession – I have given it to my daughter who has her sights on medical school and she likes the article.
A theme which resurfaces throughout the article is that much of the dysfunction in our current system has been generated by the perception among patients is that, when selecting health care options, they are being paid for with other people’s money, whether the government’s (as in the case of Medicare/Medicaid), or the employer’s (as in the case of private insurance most of us receive as a benefit). Ultimately, though, these costs are borne by all of us – reminiscent Mrs. Thatcher’s famous aphorism (paraphrased) that, the problem with using other people’s money is that eventually you run out of it.
It’s a very thorough discussion of the industry today, why it isn’t working, and why so many are unhappy with it. Tea Party members will be heartened by his strong bias towards the free markets, as well as his revelation that in nationalized health care systems (such as exist in Europe) costs are increasing just as fast as they are here in the USA. However, he is hardly a Libertarian purist, and sees value in the government promoting transparency, competition, and (take a deep breath, fellow conservatives!) a safety net for the less fortunate, albeit a much more restricted one that the option the current administration has in mind (now, exhale …).
A lot of folks claim to be promoting non-partisan discussion – this guy’s the real deal. You’ll be more educated after a half hour of reading this than you will after 10 hours of watching news programs devoted to the same topic.
August 19th, 2009 at 6:31 am
Thanks for the refreshing post. I don’t agree with everything he is arguing, but he does bring up a number of fundamental flaws in the current Medicare structure that I know many of my fellow liberals also see.
We may not see the solution as being to completely throw away Medicare, but hopefully more articles and discussions like this can help us revive the discussion that Medicare’s current structure is unmaintainable in the long run, and we need to come up with solutions that address that.
I feel that the author focuses considerably more upon the failures in the current health insurance and subsidy system where it comes to personal wellness, injury treatment, etc….
One point where the system in this country seems to work (for better or worse) is in prevention and treatment of communicable disease. Some of the “over treatment”, “over testing”, and artificially-inflated demand that gets criticized for cost inflation has been helpful in identifying and treating communicable risks (such as viruses) in this country. Much of this work does get subsidized by the government, which itself spends considerable amounts of money on a top-notch CDC. Even the recent H1N1 “outbreak” has had a rather muted effect so far (fingers crossed), with isolated cases being detected long enough in advance in order to get isolated and treated prior to widespread transmission.
I don’t think that this should come as a surprise to anyone, though. It has been well known that this country is very obsessive regarding germs and communicable disease. In some recent cases, there has been considerable evidence indicating the over-use of cleaning agents and germ prevention, to the point that some children grow up without the trace amounts of infectious organisms that would normally help exercise and stimulate healthy immune system development through “practice” and “experience”. In essence, many parents are over-spending on germ-fighting measures to the point that it can be detrimental to natural development.
It should not be surprising that the current focus on the health care system mirrors these same habits.
August 19th, 2009 at 11:27 am
I believe that our system of co-pays is very flawed. I am a very frugal person. I very rarely purchase a grocery item without a coupon or a rebate.
I do not have an incentive to shop for the best price on my prescriptions since I pay a co-pay.
I base my purchase solely on which pharmacy will pay me the most (via gift card) to fill my prescription.
I believe we need to make the cost of prescriptions more competitive so we can reduce the cost of healthcare.
August 19th, 2009 at 3:28 pm
Hi Coleman –
On my way to catch a flight but wanted to make some quick comments. Yes, there are a couple of dimensions he leaves out of a generally complete treatment of the topic. Of course, there is only so much we will read at one sitting!
The communicable disease issue is one that I have not thought of, although I am not sure one model necessarily has an advantage over another. A couple of other dimenssion which were missing were -
1. The role of malpractice – is it or is it not a factor? Direct costs seem to be about 1% of the total healthcare bill, but there are folks who think that the indirect costs (through defensive testing) could be much higher.
2. Also, if we were to (hypothetically) lower health care costs by 1/2, economics mean that we would lose a lot of jobs in the the sector. Agribusiness is a good precedent here – as farms got more efficient, less people were needed on the farms, resulting in human misery in the short term, but in the long term meaning we all have to work a lot less hours (compared to our forefathers) to get something to eat.
Cheers –
Ken
August 21st, 2009 at 12:32 pm
For your point #2:
I think that the job loss in the farming sector was mostly related to the jobs themselves being considered the “economic weak-link” in the system.
It’s not necessarily conclusive that a 1/2 cost cut in the health care industry will actually lead to 1/2 the jobs being cut. Health care and insurance may be two industries where a greater amount of efficiency might be gained elsewhere (one example: perhaps transitioning to an electronic record-keeping system from a paper-and-pencil one).
I think that it is also reasonable to recognize the effect that a sudden unemployment spike from a specific sector might have on the economy and all of us. It could be helpful if public programs were enacted, in conjunction with this purge, it could help stem the shock to the economy and perhaps help to move people toward other parts of the economy that could use the people-power.
August 21st, 2009 at 2:59 pm
My monthly cost to cover my family (medical/dental/vision) is about $220.
As I see it, my cost is inflated because of Americans receiving medical care without coverage (without paying).
Any way you slice it medical care will be paid for by working Americans and provided to unemployed Americans at no cost.
I just have a few questions for all the Democratic Health Care Reform advocates.
Explain how medical coverage will fall when you add millions of individuals to the system that aren’t working now & don’t plan on working in the future?
I say, “reduce Welfare program so employment income is better over Government poverty.”
As I see it, “eliminating private health care insurers will put another million individuals out of work . . . that will lead to more property foreclosures.”
When will someone discuss Welfare Reform and elimination of wasteful Welfare programs?
When will Obama say, “pull up your pants & go to school. Pull up your pants & get a real job!”
( A real job only includes business activity that’s legal in the US . . . not dog fighting, drug dealing or mail theft . . . go to school and get a job.)
When will someone begin associating FREE FOOD with Fat Fannies!
Democrats assume working Republicans will continue working & paying taxes. Imagine if employed people took a 3 year vacation? I say, “don’t pay a dime into the administrations corrupt system.”
How’s your Chinese?
August 25th, 2009 at 5:11 am
I currently have the catastrophic coverage he proposes and I have to agree that it would change everything dramatically for the better. I’ve had doctors order tests and when I tell them I’m basically self-pay, their treatment plan usually changes. I don’t think I’m getting worse care, just more cost-effective because the doctors are sitting across from the person paying the bills. In the beginning I didn’t tell docs about my situation because I didn’t want inferior care. One ordered a very expensive blood test (though we had no idea it was expensive until we received the $1600 bill) for my daughter. When I called the doc later she said, if I had known you were paying I’d never have ordered that!
We switched because the small business my husband works at had two workers with serious illnesses, which meant our premiums became impossibly high. We now pay $235/mo. for a family of four, have a $10,000 deductible and, minus the $1600 blood test, we’ve never had expenses over about $2,500 a year (and usually less). At some point someone will need surgery, but we’re working toward having our deductible saved up in our HSA.
It would be hard to change people’s mindsets–for providers and especially for consumers, it’s hard to start charging people for things like office visits and dental cleanings that have always been free or very low-cost–but in my experience it’s the best possible type of reform we could make.
August 26th, 2009 at 8:04 pm
My apologies for those who had to wait a long time to see their comments appear. We have had a tremendous volume of spam to work through and very limited time. We’re all caught up as of now.
August 27th, 2009 at 5:42 am
Vinnie:
I worked hard and paid my taxes when George W. Bush was in the white house torturing others and invading a sovereign country that never attacked us, the corrupt Bob Taft administration ran Ohio into the ground, and Phil Heimlich, Pat DeWine, and John Downlin ran the Hamilton County Commission. I didn’t childishly threaten to “go on vacation” because the people that I actually voted for didn’t win, or because I was not in favor of their policies.
To say that you don’t want to pay your taxes into the federal system merely because you disagree with the policy decisions that were decided by our democratically elected leadership is offensive, in my opinion.
I say that you are wholly un-American and you are a true “sore loser”. It is because of people such as yourself that we cannot have a reasonable debate about policy and issues in this country that is based on fact and evidence.
You and your “more important than everyone else” mentality are destroying America, not those who were elected to govern it, and definitely not “the Democrats” you refer to.
Fine. Go on your silly three-year vacation. Your job will just be replaced by someone who actually gives a damn.
August 27th, 2009 at 1:13 pm
Amen, Coleman.
September 1st, 2009 at 12:43 pm
Patriots,
I believe I can sum up the UC rally in two words “obamanation”. Ok, that’s one word. ON 9/1/2009 AT the Tangeman Great Hall in Cincinnati, Ohio, USA….
Forum format was set forth by the host UC. There was opening prayer by a local pastor, who invoked “political praying for “Obamacare”.
Sen. Brown, opened with remarks about going to Afganistan seeing the ink stained fingers of Afganis, who because of OUR great democratic nation, had been able to vote. Sans, their fingers being cut off by local militants-that’s what Brown said. What the had to do with obamacare, I don’t know.
Then there was a panel of four, two men, two women, who all told their “stories” of health insurance bias denying coverage or for the older man, his company had to reduce the number of employees on his business group plan.
I was very stunned by one story of the lady who has breast cancer, relating that she could not find “insurance” coverage, because of her pre-existing condition.
I would swear, she told several of us at the Dreihaus, “ticketed”event at the First Unitarian Church, the very same “story”.
Then the CEO of Childrens Hosptial of Cincinnati, who at first spoke of some “objectively plausible solutions” to the rising costs of health care, which Childrens had implemented, which of course garnered applaud.
Then he went on to long into “bologna” speech…
and the crowd chanted, 60% of the crowd chanted “Time” “Time”.
So, he stopped after Brown leaned over and ok’d it.
Now the Q and A. There was a sheet of paper and an index card on each seat upong entering. Honestly, I did not read the sheet, 1. because I did not have my readers and secondly at the front of the UC Great Hall was a huge projection screen listing the “myths” and propagandic “facts” as they relate to “govt health care reform” which showed the entire hour from 9:30 to 10:30.
Brown’s pitch for, reformed health care reform COULD be written in to the bill, not as the bill stands today. After 45 minutes into the event, finally….
Brown, calls out the names which had been written on the index cards and the first group of five went to the microphone.
Some of the questions were pro and some questions were anti-govt healthcare/insurance reform. High costs of insurance and the
removal of choice in an individuals “health care decisions” dominated the questions.
Brown, reponsded to one question by saying the American taxpayers pay 2 trillion dollars
out of pocket every year for health care.(my ihought here [u]WHO[/u] loaded up the HMOS to begin with/ IT WAS NOT the American people???)
Brown’s position is that the government would do a more cost effective job supplying Americans health care than those Americans, some 87% now, who can obtain their own private “health insurance”.
There were perhaps 3 or 4 folks who were on the facts, best questioner Mrs.J.C., was a lady who told Brown, [b]“Soc.Sec. and Medicare/caid is broke, Fix those first.” [/b]
IF The govt pays for over half of the nations health care costs so why are costs soaring?? She asked????
She also asked how to reduce costs??? Without hesitation she said, “Reduce [color=crimson]‘RED TAPE”[/color]“, was her reply for Brown.
She also went on to state that “Brown” and the government should fix the Waste, fraud and abuse in the Medicare/caid programs that the government runs. Leave her HEATHCARE ALONE!!!
Then she asked.. Does the government really think we are that [color=darkred]stupid and gullable?[/color] Mrs. J. C., did not want a reply from Brown.
Mrs. J. C., told Brown that she pays for her own health care, her doctor, her prescriptions and she likes her health care that way because she can save money. She wants the right to choice her own health care plan.
And she wanted to know -to Brown- she will await his next magic act.
I was there and I saw what you did. The shuttled in students from a dot.org a couple of high schoolers and a handful of “very disinterested UC students”, the union workers in their colored Tees, the “staffers” absolutely mindless, minions who God forbid, bow to the “tyrannt”.
OH. least I forget of the numbers of “chosen ones” who did not have to be searched, and shuttled through the metal detectors!
Patriots I am not a paid “person”. I am an American, who is trying to stop my
sons from having to “fight for their Freedoms” right here on American Soil!
So, there is no disclaimer, no funds to disclose. Just a red-blooded heart, which aches, that MY/OUR Country is at odds, because of
Greed, Power hungry, insane, “public servants” who have not fulfilled their
commitment to “WE THE PEOPLE!”
SEE YOU AT VOA!
GOD BLESS US AND GOD BLESS THE UNITED STATES OF AMERICA!
PATRIOTS UNITE!
October 14th, 2009 at 6:01 am
Its just sometimes people seem to get themselves tied up in unnecessary knots over something that