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It costs too much


Fri, May 15th, 2009
Posted in Commentary



The conventional wisdom is that now is the time for healthcare reform. Of course, the Republicans are saying we cannot do it now because of the economic crisis. We couldn't do it before because of the economic boom and anyone that wanted to work could and could get their own insurance. The Republicans say we can't do it in time of war, or for that matter in time of peace. Healthcare takes up over l6% of our gross domestic product. It costs too much and delivers too little.

Never mind that it delivers too little and we are ranked 37th in the world. Never mind dozens of countries are better than we are in infant mortality, infant death before the age of five, amenable disease deaths (deaths caused by disease that would not have occurred if adequate care was given) and many other measures of care. You will hear those apposed to reform state we are the best at treating cancer of the breast and cherry pick a few other good results and give statistics on them. They won't quote statistics on cancer of the colon and lung. In any case, it costs too much.

There are all kinds of happy talk about improving the care given. Technology is going to make the medical record fly around the country on electrons in a secure way to alert the medical profession to all the nooks and crannies of our bodies along with the drugs and stitches jiggling around in them. Prescriptions will be printed in old English script and no pharmacist will give you quinidine instead of quinine.

There will be improved access. Everybody will have a "medical home" where your physician lives in your community and you can see him/her on weekends or nights when you get sick suddenly and feel all alone a scared. Well at least you can call him/her and not just talk to the nurse or his/her physicians assistant.

Surely after "reform" young doctors will look at rural areas, inner cities, Devils Island and think "boy that's the place for me." Reform will surely include incentives for this. When pigs fly. There would be no interest in healthcare reform if it didn't cost too much.

Improving care by comparing therapies is a good idea. Check and see which therapies make people well the most often and the soonest seems to be a no brainer. It is. It's been going on for decades. Really, since medical education was limited to the university systems. It weeds out most nutty practitioners pretty quickly. Continuing medical education is a joke but most physicians do not want to fall behind the curve and strive to keep up. It's still all about cost.

The politicians, the doctors, the insurance industry, the hospital associations, the pharmaceutical companies and all the other people who make a (lots of) buck(s) from healthcare will fight reform if it costs them 1% of their income. Worst of the lot and major causes of the mess we are in now and the defeat of other attempts at reform are the insurance companies and big pharma. Boy do they know its all about the cost.

I voted for Obama but he is starting to worry me. His forum on healthcare reform the first week in March included all of the "foxes" of healthcare and only enough of the hens to show they could get along and talk nice to each other for an afternoon.

The worst of the lot is America's Health Insurance Plans, the trade group for the insurance companies. They're the ones with the Harry and Louise TV blitz that helped torpedo Clinton's reform bid. Karen Ignangni, their chief executive is quoted as telling Obama, "you have our commitment to play, to contribute, and to help pass healthcare reform this year". That's almost as noncommittal as the statement of the board of AHIP with the misleading title, "Now Is the Time for Health Care Reform". It is a paragon of double speak promising nothing and touting the status quo except for making people buy health insurance (more customers for the insurance companies) and for the government providing an umbrella high risk pool for those people the insurance companies don't want to insure. You know who they are. They are the people who might really need and use insurance coverage and any self respecting insurance company wants to insure only young healthy people.

The insurance industry has forfeited any right to be at the table in these discussions.

When you see anyone attacking any part of reform efforts you should ask yourself if they have a personal financial incentive. Each dollar saved in healthcare reform will be a dollar lost in somebody's income. But that's the point. It costs too much.

There are lots of people who have been studying healthcare payment systems for decades. The healthcare ministers of a dozen European countries could contribute more ideas and solid advice in an afternoon than the cacophony of sclerotic ideas from the same Senators and Representatives that have been unable to produce anything over the last hundred years. These are the same guys that get literally in aggregate millions of dollars of campaign contributions over many electoral cycles from organized efforts of the insurance industry. Sick patients are too busy trying to pay their premiums and medical bills to match that because healthcare costs too much.

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