July 28, 2009

Health Care Reform











I've been getting a lot of email from folks who are concerned about the proposed health care reform package.

When I hear people's emotional appeals about how bad our health care is going to be under the new plan, I can't help thinking that while that may be true, our current health care system is broken. So staying the course really doesn’t seem to be a very good option. We need a change. Therein lies the problem.

When the current health care system is costing us something like 18 to 20% of GDP, there will be a lot of people and corporations with vested interests who will oppose any effort to change the system.

As our health care system affects each and everyone of us so personally, there will be a lot of people who will oppose any change from the status quo for fear of losing something they think they have.

So if vested interests and individuals are averse to changing the system, I’m not sure how we’ll get any reform passed.

On top of that, the performance of our health care system seems so entangled with so many other mega trends in our society that I wonder if even the best legislation will have any measurable affect.

Here are a few of the factors I'd suggest would need to be addressed for effective reform. (Let me know if you have others.)

Lawyers

We live in a litigious society. More and more doctors are consulting their lawyers before prescribing a course of action.

* When the doctor says “Why don’t you have a $3000 MRI just to be safe?” many times that safety is about his economic well being, not yours.

* Who pays for unnecessary MRIs?

* Who pays for the cost of malpractice insurance?

Advertising

We live in an advertising culture. When drug companies can generate billions of dollars of demand just by saying “Ask your doctor about the purple pill”. There really is something wrong. These drugs have side effects. Then there is a drug we can take to manage the side effects of the purple pill.

* Who pays for advertising generated drug costs?

Diet

A major part of our soaring health care costs is related to our lousy diet of junk food. You are what you eat.

* High fat diets are directly linked to high rates of cancer, heart disease, and diabetes.

* Who pays the cost of our junk food diet?

Pollution

Another major increase in our soaring health care costs is related to pollution, toxic chemicals from coal plants, smog from our cars.

* We have skyrocketing rates of lung disease that is related to the quality of the air we breathe.

* Who pays for the health care costs of coal plant pollution and inefficient cars?

Specialization

We live in an age of specialization. (Maybe this is a good thing.) There are even specialists within specialization areas. They are really expensive and don’t tend to see the whole picture. (I’m a knee doctor, you’ll have to talk to someone else about your hip.) It seems that the primary purpose of our primary care physician is to refer us to specialists. Were we a lot worse off when we had a family doctor who actually provided most of our care? (Maybe we were, I really don’t know.)

Lack of Individual Power

Most folks can’t change health insurance without changing jobs. And when you change jobs, you have to change health insurance… So the health insurance companies know that the individual has no say, no power over them. I can switch my car insurance or house insurance anytime I want if I don’t like how they are performing. Why am I locked in to the plan chosen by the HR department? I have very different health needs from my co-workers.

FDA Monopolies

The FDA effectively protects the health care industry from price competition. Why do drugs cost so much less in Canada?

* Hint: It isn’t related to costs.

Our Choices

Finally, there is our behavior, our choices. If an x-ray can provide 95% confidence in a diagnosis, but an MRI can provide 98% confidence and both cost you the same amount out of pocket, of course you go for the MRI. But one procedure costs the insurance company 5 times as much the other.

* Would you make the same decision if the MRI cost you 5 times as much as the x-ray? Maybe, maybe not.

Are any of these topics effectively addressed as part of the proposed health care reform plan? Let me know your thoughts.

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