Summary
Health care has taken front row status with the Obama administration's push for immediate reform. The rhetoric has been cranked up to whip the public into a frenzy so they too will echo the same desires. Big numbers have been delivered in a dizzying array of unnecessary complexity to seem like the problem is running away from us and change is needed before the train derails. The players in medicine are a multitude but ultimately, consumers, providers, the insurance industry and coporate America are in a need of some alliance. Physicians must be at the forefront of this change-although they have been fairly absent. The degree of cost savings is hard to predict in such a complex system. President Obama apparently received a commitment to a 1.5% reduction from the major players all of which denied making the commitment immediately after it was announced. A sign that reducing expenditure is easier said than done
Analysis
Medicine is in trouble or so we are told. The numbers of uninsured, 46 million, is always trumpeted as a reason for health care reform. The rising expense being a close second. But numbers can be misleading. In the 1970 and 1980s we saw costs grow around 10% per year. Since the 1990s costs have actually slowed considerably and were 6.1% in 2007. The immediacy of the crisis has been exaggerated. The number 46 million is also interesting. In this number are included individuals who have the money for basic health care insurance but are not interested in paying for it such as young people just entering the workforce. These number around 5 million individuals. It also includes individuals here illegally; a number now thought to be closer to 20-25 million instead of the much touted 12 million. This brings the total number of truly uninsured down to 15-20 million individuals. So effectively about 95% percent of the population is insured. For this "crisis", we are willing to throw out our current system to usher in a new government run system.
Universal health care systems the world over are universally complete failures. While they manage to provide care for the entire populace, a laudable goal, they instantly create a two tiered system. One for the masses and one for the very affluent. The affluent universally seek care outside their system or pay to have better care provided to them within their system. Cost containment is also an aspect of these systems that is touted as beneficial. The cost of cost containment is decreased access, decreased quality and rationing. Stagnation in the advancement of medical care becomes an issue in these systems. As an example, Great Britain has the worst breast cancer survival rate in all of Europe. It is around 40% mainly because they save money by limiting the drugs they use for treatment. Most of the drugs they are using are outdated and less effective. While this accomplishes savings and everyone has access to them, patients suffer greater mortality and morbidity. Does this truly match our goals for health care reform?
The other fallacy is prevention will save money in a universal system. Most studies show that actually prevention is less utilized in a system where health care is free. This should not be much of surprise since when everything is free, it actually holds little value to the individual. Again this is borne out in preventable, lifestyle diseases like smoking, drug abuse, and sexually transmitted diseases. These are actually more prevalent and less likely to be treated in individuals who have free access to government health care. In fact some organizations that have been treating drug addiction for years, recognized long ago that if you charge everyone for treatment, even a nominal fee, the success of the treatment becomes much more likely.
All too often we have looked to systems such as Geisinger Health System in Pennsylvania and touted these systems as a solution for the entire country. This phenomena is not new. During the Clinton administration's push for reform, it was countries such as the Netherlands and their system that was the all the craze. The real problem with these sytems is their population base and size. Western Pennsylvia is not Los Angeles. Will this system actually work in a culturally and economically diverse area? Cultures and socio-ecenomic class bring very different variables to the health care table.
This article actually figures that by cutting expenditure, you will see increased monetary re imbursement for physicians. I am not sure how that is possible. It appears their assumption is savings will be directed back toward providers. I fear that will never be the case since government does not work that way. We have already seen the flight of primary physicians to "boutique" or cash only practices. Anymore reductions in physician compensation will only drive providers away from both government and third party payors. Any mandate by government to force physicians to take government insured patients will drive the best and the brightest away from medicine. All this will further erode quality and access.
Physicians need to drive the message that government reform is not actually in the public's best interest from both an access and quality point of view. It will be interesting to see how companies like General Electric(NYSE:GE), Microsoft(NASDAQ:MSFT), Google(NASDAQ:GOOG) and IBM(NYSE:IBM)'s investment in health care solutions play out in this arena. A better partnership bewteen doctors and industry might provide another solution-maybe even a better one. Physicians can bring the medical perspecitve to these companies and all its inherent complexities. These large companies can bring their years of experience streamlining processes and innovating solutions for complex problems. The hallmark of American advancement has been reward driven ingenuity. It should be no different for health care. In fact if cost containment is the goal, then government is not the answer. The SCHIP program, as an exmaple, has been grossly mismanaged in many areas. It was found in New Jersey, that families making over 280,000 dollars/year had their children enrolled in this program.
While health care for all and cost reduction are important issues. One needs to look carefully at the numbers being touted before jumping to conclusions. We also need to make hard decisions about what the true goals are for health care reform: access for all versus quality versus cost containment. Accomplsihing all at once is not possible. And are Americans really ready to give up their current access to most physicians, for long lines to a few government employed physicians? Are Americans willing to accept the rationing of their health care such as no dialysis after a certain age like they do in some countries? Are they willing to wait months or even a year for heart bypass and potentially die waiting? If they are then call Europe or Canada and ask how they did it. If not then be careful what you ask for, you might just get it.
