An editorial in today’s New York Times, discussing health care, at least takes the conversation beyond providing health insurance to all Americans. It discusses reducing costs, but offers no comprehensive scope for the discussion. It talks about the cost to government, mentions lowering Medicare payments to the most costly hospitals and doctors for instance, but doesn't have much to say about the costs to individuals, failing to mention the 60% of personal bankruptcies that are due to medical crisis.
While it does mention the possibility of changing the present fee-for-service method of payment, it merely comments, “The problem is that nobody is sure of the best way to do that.” And so we pass a bill insuring everyone and drop the ball in reducing cost.
What it does not do, of course, is suggest looking at the ways that other nations deliver health care to their citizens and asking how those nations deliver equal results for half of what we spend. That little fact is always left out of the discussion; we spend twice as much as any other nation, and we do not get better results.
It does not bring up the impact of the legal system on the practice of medicine; neither the frequency of medical malpractice lawsuits, nor the staggering size of awards. I do not know how we rank internationally in either regard, because that issue never enters the discussion of health care costs. I do know that the subject has an effect, and not a small one, and that it is twofold; the insurance premiums paid by medical providers, and the practice of “defensive medicine” in the form of ordering marginally justifiable tests and procedures.
What is that effect in other countries? Well, that issue will have to become part of the conversation before we can know much about it.
Mostly the discussion is about how to raise money to pay for more insurance. If you give that a moment’s thought you will realize that is a plan to pay more for what we are already paying too much for. We have just got to take the stupidity out of this discussion.