Threads from Henry's Web

Category: Health Care

  • Health Care Must be Produced

    I read this article on CQPolitics.com that deals with some of the issues of handling health care costs, and also suggests to me that my feeling may be right that the types of savings claimed by the candidates as part of their health care programs may be much more complicated to attain than they would have us believe.

    There’s a fundamental qualitative difference between saying that someone has the right to life, liberty, and the pursuit of happiness, and saying that someone has the right to free health care. While there are costs for life, liberty, and the pursuit of happiness, once won, they impact very broadly. In the case of medical care, someone has to produce the care, in fact, many someones. There are physicians who spend huge amounts on their training and go into massive amounts of debt for the privilege of treating us. Drug companies do make profits, but they also must expend a great deal of time and energy on research and development. Those who produce medical equipment again have huge investments. Then we turn around and say that everyone has a right to their services.

    Now those who have been around this blog for some time may want to remind me that I have called for universal health care, and this post sounds like I’m arguing against it. But I hope you’ll also recall that I have mentioned the contradiction. The problem is simply this: We’re not going to deny people treatment at the emergency room door. What happens as a result? We do cover those least able to pay but in one of the most expensive and least effective ways possible.

    Since we’re going to spend money here–and as a Christian I believe I should do what I can to see that these people are cared for–the question is how are we going to do so more effectively. The article I cited at the beginning lists a number of excellent points. I’m not going to try to reiterate them or argue with them. I confess that I am finding the details confusing, and I don’t think I’m that easily confused.

    Here’s the direction my thinking is going. I think we need to define basic medical care that will be universal, and provide the necessary subsidies for that care, possibly through a type of credit on taxes. Then we need to leave the more advanced and experimental care ideas in private hands to be developed over time. As a technique becomes ready for the mainstream, we could change the boundaries of basic medical care.

    I believe Nurse Practitioners are one way into the future. I often wonder how people from non-medical families do it. I can call my wife, sister, mother, all RNs, or my brother the cardiologist, and say, “Here are my symptoms, do I need to go see the doctor?” Generally the answer is no. A little sensible care at home and I’m up and running again. Just consider this: Friday was probably the most miserable day I’ve ever experienced in terms of illness, and today I’m sitting here typing, no visit to the doctor involved.

    People are concerned with lawsuits, but that is something that could be managed legally as well. Preventative care would be important and could be pursued through more accessible primary care.

    But health care plans that simply deal with distributing care won’t provide a long term answer. We need to keep in mind how good health care is produced, and what any new plan will do to that production. Medical practitioners are not merely distributors of an existing good, like water. They are producers, and if we want them to produce we’ll need to deal fairly with them as well.

  • What I Want for Election Day: A Health Care Plan

    I haven’t seen any results from New Hampshire yet, so this is probably a good thing to write about politics. I’m going to try really, really hard to keep this short. I am very much encouraged by the increased voter turnout thus far, both in Iowa and New Hampshire. I hope it is a trend that continues. More involvement and less apathy will be good for all of us.

    What do I want to see in a health care plan? I’d like to see health care:

    • Universal
    • Free Market
    • Limited Regulation and Bureaucracy

    Of course, anyone with any knowledge of politics and economics can tell me I’m not going to get all three of those, as there are contradictions in them. So what do I think I can get?

    It’s something like the little Marilyn Monroe song (later by Madonna as well, I believe) in which we find the lines:

    a yacht
    that’s not
    a lot

    The yacht is a lot, but we’d like to think otherwise. It’s the function of a candidate to convince us we can have the yacht without paying for it; once elected, he’ll make us pay for it, but never provide the yacht. This occurred to me as I was reading the few health care plans that the candidates have put forward. For what it’s worth, I congratulate those campaigns that have gotten specific on this issue.

    First, I think it’s time for us to have some kind of universal coverage, or at least to head that way in this country. At the moment we have too many people using emergency rooms for primary care, and guess who pays for that. You and I do, sometimes in taxes, sometimes in our medical bills. Further, emergency room care is excessively expensive. But I’m not here to get into the details of emergency room care.

    What emergency rooms tell me is something simple. When we are confronted with someone in dire need of medical care, we are not willing to just let that person die. That’s why emergency rooms have to take people in who can’t pay and provide them with a minimum of care. Unfortunately, the same moral compass that leads us to expect care for these people doesn’t seem to lead us to pay for it.

    Second, however, and conflicting with the first, medical care is an economic good. It’s not in unlimited supply, it doesn’t just happen. Somebody has to produce it. When we declare that someone has a right to medical care, we’re also by nature implying a duty by someone else to produce that care. When the issue is someone dying of fatal injuries, however, we want to ignore the issue of precisely how the thing to which that person has a right is produced.

    This leads me to suggest that we build a system that is as private as possible and use a minimum of government intervention. There are certainly some ways to reduce costs. These include moving more primary care to providers such as nurse practitioners. I don’t have statistics on it (I’m going to do more research) but I believe it will also be valuable to put some kind of restraints on malpractice lawsuits to alleviate fear of using people with less than a medical degree plus a specialty to actually see patients. Personally I think we will be better off, on average with the nurse practitioners providing primary care.

    Those items, however, are going to be minor. One thing I noticed in the health care plans I read was a great deal of optimism about saving money. It is very rare that government regulations can be set up to enter an industry and reduce overall costs. Again, it’s a topic for more research, but I am extremely suspicious of the savings numbers given by any of the candidates. It seems to me that the promise of large monetary savings and no new bureaucracy is a bit like “the yacht is not a lot” but yet the time will come when folks have to pay.

    Further, there is a good reason why savings don’t ever seem to accomplish what is promised for them. Even wasted money goes into the economy somewhere. If it is used more productively there will be an improvement, but fired government workers, for example, were buying groceries whether their work was productive or not. Overpaid executives put their money in banks where it can be used for investment. In general, when we state either losses from fraud and waste, or savings from eliminating it, we get the idea that more will be accomplished than will actually happen.

    So where do I end up? With a compromise. I’d be pretty happy with a private system that nonetheless mandated some level of health care coverage with a safety net program for those who are unable to pay for it. I know that safety net programs tend to become entitlements, but I do not want to see anyone left without basic (that needs to be defined, but not today) coverage, or anyone forced to provide free service. I think this one needs to be taken care of nationally.

    PS: To find out why I’m almost certain to be disappointed, read Bureaucracy, by Ludwig von Mises. If you’ve read (or tried to read) Human Action, don’t worry. Bureaucracy is an easy read.

  • Medical Conspiracy?

    This is a good post. Not only is it true, but it’s fun. More of us should dissect certain advertising claims in this way.

  • Lybia 6 Freed

    according to ABC News. These are the folks who were wrongfully jailed for 8 years. I rejoice, but continue to regard with horror the fact that humanitarians such as this could be imprisoned because of ignorance that ought to be criminal. People stupid enough to jail these folks shouldn’t be allowed to drive cars, much less have guns and run countries.

    I blogged about this before here.

  • The Real Cost of Health Care

    Hmm! I don’t really know what that is! But Robert J. Samuelson has an excellent column on Newsweek (via MSNBC) that discusses the issue. He makes a number of excellent points, including pointing out that we’ve hidden the actual cost of health care, though I suspect not nearly so successfully in this country as in some others.

    One thing he points out is this:

    Our health-care system will inevitably combine government regulation and private enterprise. But what should the mix be? Which patients, providers and technologies should be subsidized and why? How important is health care compared with other public and private goals? Will an expanding health-care sector spur the economy

  • Excellent Health Article

    Those of you who read this blog regularly know that I pretty regularly lash out at the news media. It’s not that I think they’re biassed to one end or the other of the political spectrum. I just think they’re biassed stupid.

    Well, I just want to point out an article today in Newsweek that I think exemplifies how information should be presented, especially on the internet. There should be this type of research behind every news story, and even if you present a short, idiot friendly version on the front page, it would be nice to get a well written, extended article such as this column.

    I refer to Drugs Aren’t the Only Option, a column by Dean Ornish, M.D. This article is well-written, it doesn’t prescribe what I’m supposed to want in my life, it doesn’t run anybody down, but it does provide useful information on diet and lifestyle, particularly with reference to cholesterol.

    I happen to be interested in that subject, but the only reason I’m bringing my personal interest to the blog is simply to point out the excellent style and balance of this article. I wish we would see more articles of about that length printed in the online news media. We may be subject to excessive time and space constraints on television, but the internet provides opportunities for more solid, informational content.

  • Innovative Health Care Option

    For years, ever since I first heard of nurse practitioners and physician’s assistants, I have thought that our health care profession could be improved by using less expensive–but not necessarily less effective–professionals to provide primary care. Now, in an article Want Treatment With Those Pills?, Newsweek is describing just such a revolution in progress. Small, walk-in clinics staffed mostly by nurse-practitioners, are popping up all over the place. What they provide is more consumer oriented medicine, including greater convenience, better service, and lower prices.

    Right now the target is primarily those without insurance, for whom the lower cost is the focus. But one clinic, according to Newsweek, reports that more than half of its patients are insured. Quoting the article:

    “The time for this concept has come,” says Brian Jones, CEO of MedXpress, which is opening its first clinic this summer in Texas and expects to have 500 locations nationwide by 2010. “We expect this to be almost a revolution in terms of the delivery-care model,” he adds.

    I agree! I certainly hope that this will be a revolution in how health care is provided. Medical science continues to advance, so that physicians have to have more and more training just to get past the starting gate, and must spend a good deal of their time in maintaining their skills. A good thing, the improvement of medical treatment, becomes a negative because it makes simple treatment much more expensive. If I have a cold that seems a little more persistent than normal I have two options–delay treatment, or bite the bullet and pay the price, most likely just to be told that I have a cold, and have to wait it out.

    Now in my household, with a wife who is a Registered Nurse, and MD/RN parents who are a phone call away, I can often avoid the dilemna. But others don’t have the family resources I do. Because of high cost, they may delay treatment until things become much worse. With a nurse practitioner available, someone surely well-equipped to tell the patient whether their condition is routine or requires more complex handling, anyone can avoid these extra expenses. Most medical conditions don’t require the time of a specialist, and these can be handled much more effectively.

    With standards established for electronic medical records and the means of sending them quickly to a primary care physician’s office, referral can be quick and efficient. There is some discussion in the article of consultation and supervision by physicians, and that would provide an additional layer of safety, again using quick transfer of medical records and test results.

    I think this is a wonderful innovation, and I’m glad to see that it’s catching on in a big way. It doesn’t solve the problems of health care, especially for the uninsured, but it certainly helps. It will not only reduce the total bill for health care, but allow resources to be shifted from routine care to case where more complex care is needed.