Monday, April 18, 2005

What to do about health care?

First, as we considered last time, the problem is fundamentally insoluble. People want more health care than they can afford. The whole country wants more health care than we can afford, we want to live as long as we can, as healthy as we can, and we want somebody else to pay for it. There's no general solution, either we accept that rich people can afford very expensive treatment while poor people can hardly afford any medical care at all, or we take money from rich people to give poor people some small fraction of what they want, or we do something else along those lines. In every case except the first, somebody has to decide who lives and who dies. Nobody wants to be blamed for that decision.

We don't want a single-payer system for medical care. It would probably be considerably cheaper, but it would mean that citizens had no recourse. As it is, if you need expensive care and your insurance doesn't cover it, you have the consolation that you could have chosen some other insurance carrier. You can ask your employer to switch carriers so the next guy will have a better chance. You have gambled and lost, but at least there's the chance that somebody is winning. With a single-payer system there's no such chance, everybody is subject to the same system.

The best we can do is muddle through to some kind of system that doesn't cost too much and that nobody likes but nobody will rebel against.

Meanwhile, it would be nice if we could cut costs. Every medical test or other procedure that was done cheaper at the same quality would allow us to get more medical care for the same money. One obvious way to encourage that is to arrange for the testing to be cheap for new technology that's designed to do the same jobs as older technology but cheaper. Given a choice between spending a tremendous amount of money to test something new that will fill an unmet need at a high price, versus spending the money to test something that can out compete an existing product on price, which would you choose? There's no profit cap on the new thing.


Here is an alternative that I think is worth following up, that would distract some from the insoluble problem. The federal government could put more money into public health. Public health is a legitimate venue for government. Some of it can't be done without government coercion. Most of it can't be done for profit. To the extent that a strong public health program improved the health of the public, our health insurance money would go further.

Various public health initiatives are currently stalled because people don't like them. We could cut unnecessary health costs by reducing tobacco use. But most tobacco addicts are unable to quit, and many don't want to, and the tobacco lobby is quite strong. Fast foods are generally recognised as rather unhealthy, they provide too-large portions of fats and starches and in some cases carcinogens. The fast food corporations tried providing healthier foods in healthier portions but found that past the first fad they didn't sell well. Etc.

Public health diagonostics are potentially cheaper than ever before. The big cost was record-keeping. Start a trial with 1000 people, in 4 years more than half of them would move and would need to be tracked down. But it's far easier now to track people who don't mind being tracked. And there's more insurance etc information available to qualified researchers.

Imagine that the thing went superbly well. Tobacco use was cut to insignificant amounts, and tobacco-related diseases went way down. Obesity went way down along with obesity-related diseases. Simple sugars got used much less, so fewer diabetic symptoms. Environmental carcinogens were strongly cut and so age-adjusted cancer rates dropped 80%. Health care costs would not drop at all. We would spend the same money to get lots of new medical care, things we couldn't afford and don't even know about today. It would be a good thing even though it would not help the health-care crisis at all. We would be healthier, we would live longer and get more of our expensive health care at older ages than currently.

4 Comments:

Blogger Basket said...

Bon jour. Le temps amer que je vois.

Chercher le temps et quelques comment terrien ici.

Blog agréable.

Je devrai revenir plus tard.

5:53 PM, October 25, 2005  
Anonymous Blue Cross of California said...

Great blog and information on health care. I hope one day health care can be improved and everyone could be covered.

2:07 PM, November 29, 2005  
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6:10 AM, December 20, 2005  
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1:45 PM, December 20, 2005  

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