Friday, July 17, 2009

The Cost of Health Care

The Congressional Budget Office is now saying that, while extending health care to more people, the plans being offered by Congress do not reduce the cost of health care, and may even increase it. That comes as no surprise to me, since the so-called reform is nothing more than a plan to extend health insurance to more people. Praiseworthy that may be, but it is not reform, and to change the cost of something you need to reform the way it is done.

Why is our health care system so much more expensive than any other nation? No answer than I have seen presented has really seemed entirely reasonable to me.

Some suggest it is because we have the most modern and expensive technology, but several arguments mitigate against that. Modern technology has driven the cost of pretty much everything else down; compare the cost of a computer from 30 years ago to what you can buy today, to name but one example. What part of our technology is not being used by other nations? Even given that we have it, that it is actually that costly, and that it is unique to us, why do we need to use it so extensively? It doesn’t seem to be producing very good results, since our health results are pretty poor.

Anecdotally, all of this modern technology has not been able to pin down my cardiac arrhythmia firmly enough to persuade the doctors to be able to deal with it. We know it was present at one time and was throwing blood clots into my brain, but since it isn’t now showing on their instruments they simply shrug and have me taking a blood thinner. Last week it threw another blood clot into my brain. My neurologist is furious and wants something done, but cardiology doesn’t see anything on the monitor because my heart doesn’t do it when the monitor is attached. This has been ongoing for more than four years, so I am not really sold on the modern technology thing.

To finish my anecdote, everybody is making lots of money during this process, of course, so the only one that’s really unhappy is me and my family.

One explanation I really enjoy is that the cost is due to people who don’t have insurance. These people, it is claimed, go to emergency rooms and then cannot pay the bill, and that cost is passed on to the paying customers. I’m not even going to bother with all of the ways in which that is a mixture of irrelevance and circular reasoning. Suffice it to say that we are talking about societal cost here, not about individual cost.

Obama is proposing a system of electronic medical records to reduce the cost of health care and, while I don’t oppose that, I don’t really think it will have significant impact even if it doesn’t wind up being a huge boondoggle. So far to date, every massive non-military computer system that the government has called for has cost the taxpayers billions and has been so poorly implemented that it has wound up being scrapped.

The bureaucratic overhead cost is certainly a factor and, of course, the proposed “reform” does nothing to address that issue as it leaves the existing insurance structure in place. There is some discussion of “standardized forms,” but don’t hold your breath waiting for that to happen.

Obama cites “savings” in Medicare and Medicaid as insurance covers more people and so those two programs are relieved of that burden, but that is smoke and mirrors; that cost is not eliminated, it is merely transferred to the private sector.

One cost that seldom to never gets mentioned, certainly not by politicians, is the impact of our legal system on the cost of health care. I have no statistics to verify it, but I will pretty much guarantee that no other nation has even close to as many health care-related lawsuits, or has judgements that even approach in size the awards that are routinely granted in this nation. Doctors not only have the cost of malpractice insurance premiums, but they constantly have to bear in mind the threat of lawsuit as they treat patients. Every patient is a potential lawsuit. It’s called “defensive medicine” and is doesn’t come cheap.

No one wants to tackle that issue, though, and not just because they don’t want to offend trial lawyers. No one wants to jeopardize the great American right of becoming immensely wealthy in a court of law.

To engage in “fundamental reform” of the healthcare system, something Obama claims to be doing, we need to do a lot more than extend health insurance to those who do not have it, which is what Obama is doing.

We need to change the way that the patient seeks healthcare, and his expectations of what he will receive when he gets it; not insanely wealthy by means of lawsuit, for instance, or an MRI because he has a head cold. We need to change the expectations of practitioners; doctors should be respected and very well paid, but should they expect to become multi-millionaires? We need to change the fundamental manner in which medical expenses are billed and paid.

I don’t know the ways and means that these changes need to be made. I am a former landscaper, for heaven’s sake. We have people who can figure these things out, but it won’t happen when we are beating the drum for a program of extending health insurance to those who don’t have it and labeling that as “fundamental reform.”

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