Tuesday, September 8, 2009

Some actual thinking about health care

If you’re tired of the shouting and the superficial sound bytes passing for discussion of health care reform in the United States, you might want to check out the latest issue of The Atlantic magazine.

David Goldhill writes a piece titled “How American Health Care Killed My Father.”

It’s too long and detailed an exploration of the flaws and potentials of American health care to summarize here. The gist is this.: Goldhill argues that the only way that costs can be tamed and quality ensured is by converting to a consumer-driven model for health care.

Right now, patients and their families are not the customers — insurance companies and the government are. Goldhill argues that any reform that does not address that fundamental distortion is bound to fail.

It’s a refreshingly nonpartisan, non-ideological approach — Health Savings Account; government-pooled catastrophic insurance; greater transparency.

No shouting, no spinning. It's long, it's detailed, it's dense with ideas and information. Worth a read.

Jim Cornelius, Editor


  1. I have long maintained that the single best step that could be taken to control the cost and quality of health care is to make health insurance illegal. By forcing health care providers to deal directly with the patients not just in treatment but also the cost of treatment, you will find that a huge amount of waste will be removed from the system, both in terms of the cost of specific treatments and in terms of the types of treatment provided.

    Since most people cannot afford $200k to have the battery in their pacemaker replaced (from a real live story!) the cost of this procedure would drop to a reasonable range over night.

    When all the cash in our system that is currently tied up in the insurance bureaucracy (whose only purpose is to deny benefits to as many people as often as they can) is freed up, then there will be a nondistorted view of what it really takes to deliver quality health care and who really needs help the most.

    Right now, the combination of forces that are pushing hardest to preserve status quo (providers like Big Pharma, BIg HMO, Big Insurance) to perserve an ever escalating river of profits derived from bankrupting people who the most vulnerable (IE the critically ill) or denying them treatment altogether in the name of cost containment.. thus causing their deaths in the most extreme cases.

    When you look at how it actually operates in this country, Health Insurance is a moral abomination.

    Make health insurance illegal,
    Force health care providers to deal directly with their patients,
    Market forces will purge the system of the greed that currently infects health care delivery.

    In this respect Health Insurers have something in common with cigarette companies: they are more than willing to kill their customers to get the customer's money.

  2. I liked a lot of what the President said to the joint session of congress. But I still have some unanswered questions:

    1) If the government knows that there is $80-100B in waste in MediCare & Medicaid, then why don't they eliminate it right now - today - and not wait for an act of Congress? And why should we expect a new government insurance program to be run more efficiently than the one we have now?
    2)If less than 5% of the population will go into the 'public option' - how is it going to be self funding like Obama says? Remember that many of these are people that can't qualify for insurance, so they will cost more to provide coverage for.
    3) If you take out the illegal population (which Obama promised to do) then there are 37M without insurance. How is he going to cover them, lower our premiums, and reduce the deficit all at the same time? Would love to see the math on that one!

    We definetly need to revamp the health care system, but Hope & Change isn't going to get it when 85% of the populaton has coverage. Congress is obviously incapable of putting together legislation to fix this, so Obama needs to write the legislation and present it to Congress - and that means getting down to the details even if it pisses off the insurance companies and the trial lawyers!.