| Wednesday,
May 13, 2009 This is typical (although that implies that
there are many more people sending me these sentiments than there really
are) of response to yesterday's notes:
Why is it, of all the
industrialized nations in the world, we are the only country that cannot
tackle health care reform? You of all people should be its strongest
champion, for at the heart of the debate is realizing the ideal that Henry
Kaiser had when he founded his program, providing low cost health care for
his employees. Why cannot we, the richest nation in the world provide
affordable health care for all citizens? Why is it that Medicare, a
government run program, has such a lower overhead than private insurers
and healthcare providers?
If you looked at a detailed
analysis of where cost go in the insurance and pharmaceutical industries,
you would be completely shocked and dumbfounded.
In some cases, 60% of the cost
of prescription drugs goes to advertising and promotion. Big Pharma
negotiated a deal with the last Administration to remove the cost of drugs
from any future Medicare negotiations, allowing them to sell Canadians
prescription drugs at a lower cost than they do Americans, then banning
the import of “Canadian pharmaceuticals” on safety grounds.
I have a few questions. First, I would like to know
which countries have so much better systems. Secondly, I believe that
Medicare is in dire need of new funding: they'll have to raise taxes to
sustain it.
My own view on all this is that health care is
nowhere mentioned in the Constitution, and is thus a matter for the states.
If there is some wonderful solution to the health care mess, Congress has
the absolute power to try the experiment in the District of Columbia, and
should implement something that everyone would want to emulate. It's like
education: if they can't do it in DC where they are sovereign, why do we
assume they can do things from Washington that will work in Iowa and
Arizona?
One reason for the high costs is, I am told, the
enormous cost of malpractice insurance, and one way to reduce the costs
would be to make changes in the legal system. That's far outside my area of
expertise, but I can safely say that nothing will be done that reduces the
amounts paid to the trial lawyers,
Great heavens, if there were a simple system whereby
we would all put up a small percentage of our income in return for universal
membership in something that works as well as Kaiser has worked for me, I
would be among the first to advocate it; but I have seen nothing offered
that looks like that, and I suspect that if we have open borders and free
health care, not even the productivity of a booming economy could support
it. The demand for a valuable free good is infinite. the only way to limit
costs of health care is to limit benefits: now who gets to set those limits?
So which industrialized country has the system we
ought to emulate?
==================
I returned from my walk with more thoughts on this, but I also found
mail about the
Japanese health care system.
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Think of this model. A gated community decides to build its own
clinic/hospital for those who live in the community. There are a number of
doctors there who are going mad with forms and other such stuff, and they
agree: they will accept a fixed salary, dues for the homeowner association
are set to a certain amount that will pay for the operating expenses
including salaries and retirement of the loans taken out to build and
equip the clinic. If you buy a house in that community you will have both
the privilege and obligation of paying the dues which include the health
care facility. If you need something the clinic doesn't provide you are on
your own, but otherwise you can go to the Indian Sunset Homeowners Clinic
and Hospital and pay some nominal copayment (just enough to discourage
bored retired people from going in just to have something to do) and all's
well.
Now a gardener is injured. He's taken to the clinic, where they take
care of him. He goes home and tells his wife. Soon his family begins to
show up. So does his brother's family. And others. The doctors find they
are working overtime. They tell the homeowner association that they'll
have to provide more staff, which will mean a raise in dues, because they
can't legally turn anyone away just because they can't pay and aren't
members of the association.
If the association won't raise dues they can't hire more doctors. Some
doctors quit. The others are now even more overworked. And the lawyers
tell the owners they can't legally close down the clinic...
That began as an analogy and became something that might end up as an
incident in a story...
==========
malpractice costs
are something like 2% of total medical spending in
this country. see
http://www.cbo.gov/ftpdocs/
49xx/doc4968/01-08-
MedicalMalpractice.pdf , congressional budget office.
Gregory Cochran
I find that hard to believe. I know that our pediatrician gave up doing
tonsils and minor surgery because of the cost of malpractice insurance,
and my physician friends all point to the enormous costs of malpractice
insurance; surely more than 2%. There are also the costs of
defensive medicine. I would really be astonished if the legal costs were
2% or under.
More of this
in mail. Dr. Cochran is right, but there are considerations.
==============
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