Addressing Myths of Our Health Care System
Jason over at The Sidetrack linked to an interesting article on 5 myths about our health care system. I've already written many times about health care, but I thought I could propose some solutions to the problems that this article points out. Because I knew I'd end up writing so much, I'm going to respond to his post here.
The first point is that despite spending lavishly on health care (more than any other nation on a per capita basis), we have poor uniformity of care and some key health indicators are worse. The article blames this on higher rates of obesity, yet it doesn't delve into how federal spending causes it. Because corn (#1) gets more subsidies than wheat (#2) and cotton (#3) combined, it's used to make all kinds of inexpensive and unhealthful foods. We also spend lavishly on subsidies for rice, soybeans, diary and many other foodstuffs. These subsidies lead to us being overfed and undernourished. Killing them would be a big step towards solving the obesity issue and save billions of dollars per year.
The second point is that we always pay for our own insurance and that this climbing cost is contributing to stagnant wages. If only this were entirely true. In fact, we have little power over health care purchasing decisions from the get-go. Our employer chooses the plan, and then the insurer and care provider haggle endlessly over the price without giving us the ability to make smart purchasing decisions. If we really want to see a change, we need to be put behind the wheel of picking our own plans.
The third point is that administrative costs are but a small fraction of the total cost of care and that exotic new drugs and procedures are the real culprit. On this point I agree entirely and we certainly need a sweeping overhaul of our patent system to aid in this. Figuring out how to drop the frequency of dosage of a medication from twice a day to once does not warrant a patent extension.In essence, our patent system has been turned into a system of government-granted perpetual monopolies, an affront to free-market principles. There's also a significant lack of transparency in price/performance ratios with drugs and medical procedures which hampers our ability to make smarter choices. We again see the hand of insurers pushing us aside as they dictate prices.
The fourth point bring up how unnecessary care is eating up about 20-30% of all medical spending, much of it on preventable medical accidents. It's no secret that medical record-keeping is archaic at best and PCs seem to exist in hospitals as a way to conveniently rack up more and more paper records. There's no easy fix either. The tech industry has spent decades trying to bring better data storage solutions to the medical field without much in the way of results. The key problem is that there is no set of medical data standards, no interchangable data formats, no protocol for electronic record sharing. There's also no incentive for heath care providers to form or join a working group to hammer all of these things out. It isn't helped that large companies such as Oracle, IBM and Microsoft all want to make sure that they poison any standards with their own "embrace, extend, exterminate" business philosophies. This is something that will have to be driven by engineers and gearheads with the full support of the biggest names in the medical industry.
The fifth point is that Americans are ready for sweeping changes to the way medical care is handled. They cite opinion polls in which 70% of Americans believe the system needs major changes. This is an area where I think we need to step back and move cautiously. There are a lot of hare-brained schemes to "fix" medical care out there that would love to claim a mandate to do so, but we need to only focus on one thing: identifying what makes health care expensive and doing everything in our power to drop that cost. This means radical pricing and effectiveness transparency for medicines and procedures so that patients can make better choices. It means removing the pricing incentives to eat Twinkies instead of carrots. It means making strong tech standards for medical records and finding ways to securely share them between all authorized medical providers. It will take a lot of radical changes to fix; socializing medical care, which seems to be the hinted aim of this article, is not one of them.