Health Care Fundamentals

September 5th, 2009

I’ve been thinking about what the President is going to say to Congress in his speech next week about health care reform — or health insurance reform, as he’s begun to call it.

The Democrats obviously aren’t going to get anything close to the sweeping plans they’ve been grinding out.  I’m concerned that they, at the President’s urging, will come up with some half-way mix of various ideas now in the draft plans just to get a bill passed.  Then they can declare victory and move on. 

I think this would be a disaster because it will be years before the real problems are looked at again.  What are the real problems?  Costs are too high and the rate of increase grows increasingly absurd; current insurance programs are highly complex and confusing, working to ration care in realistic terms; tort reform, which could have a positive impact on controlling costs, isn’t even under discussion; and among those 47 million people who have no health insurance, there are some who really do need access to health care.

David Brooks says it well in Let’s Get Fundamental in The New York Times:

If I were magically given an hour to help Barack Obama prepare for his health care speech next week, the first thing I’d do is ask him to read David Goldhill’s essay, How American Health Care Killed My Father, in the current issue of The Atlantic. That essay would lift Obama out of the distracting sideshows about this public plan or that cooperative option. It would remind him why he got into this issue in the first place.

Goldhill’s main message is that the American health care system is dysfunctional at the core. He vividly describes how the system hides information, muddies choices, encourages more treatment instead of better care, neglects cheap innovation, inflates costs and unintentionally increases suffering.

The essay is about the real problem: the insane incentives. Goldhill is especially good on the way the voracious health care system soaks up money that could go to education, the environment, economic development and a thousand other priorities. Health care, he writes, “simply keeps gobbling up national resources, seemingly without regard to other societal needs.” …

Instead of true reform we got a series of bills that essentially cement the present system in place. The proposals do not fundamentally challenge the fee-for-service system. They don’t make Americans more accountable for their own health care spending. They don’t reduce costs. They just add more people into the mess we’ve got. …

If I had a magic hour with the president, I’d tell him this is his ninth-inning chance. He can stay on the current path. He might be able to pass some incremental bill that extends coverage. But he won’t have tackled the fundamental problems that first drove him to this issue. He won’t have cut health care inflation. He won’t have prevented a voracious system from bankrupting the nation, defunding the schools, pushing down wages and impoverishing the young.


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8 Responses to “Health Care Fundamentals”



  1. Brian Bagent |

    Tom, that was a pretty good essay. As I have pointed out before, government involvement in activities best left in private hands always entails unintended consequences, and the consequences in health care have been very expensive.

    One of the problems I see with his argument, though, is that many health care workers are technophobes. That certainly isn’t justification for not transitioning to electronic documentation, but it is a major hurdle that must be overcome and will probably need to end up being another course in medical and nursing schools.

    As to hand-washing, I probably spend nearly an hour out of every shift washing my hands. It is one of those things that must be done by everyone that delivers health care, but it is time-consuming. If someone is sinking fast, we frequently don’t bother with hand-washing, and I suspect that may be what happened with his father. If someone starts to sink with septic shock, they need work done NOW, not in 30 or 45 seconds. The general rule is “if we don’t do something now to keep this patient alive right now, the issue of a secondary infection will be obviated by death.”

    I read a book years ago called Unintended Consequences. It is a historical novel aimed at guns and gun control, but the author demonstrates the folly of government involvement in just about everything. I strongly recommend that you read it, though you may find much of it very distasteful.


  2. Amlicar |

    Its folly to think that the government is an alien immigrant making decisions for Americans. In fact America is the FIRST COUNTRY A TO SUBMIT TO THE WORLD , THE CONCEPT OF THE PEOPLE HAVING MODERN COLLECTIVE OF OUR PEOPLE TO TAKE CARE OF NATIONAL OR REGIONAL OR COMMUNITY ACTIVITIES THAT 360 MILLION CANNOT DO INDIVIDUALLY….. It was presented a Capitalist political Gov’t structure as opposed to the Feudalistic political, of the King of England and his concubines and Staff.

    So to oppose “the Government” because they are doing the work of a collective of people, chosen by the collective of people..is like braying thru your Ass…..It makes no sense..and makes you a mouth pieace for someone with an agenda…….Sorry I had to be so blunt. A good whack on your Butt always gets your attention…

    So buddy read my blog spend some days reading all my posts..if you don’t understand some outlooks and analysis drop me a line….

    Good luck with being smart….This is the 21st century.


  3. doris |

    Yes, Amlicar, right on. We elected them and need to give them the benefit of the doubt or vote them out next time, your choice. If you do not vote, well, your loss.

    Brian, I have been in your and other hospitals and seen with my very own eyes doctors and nurses, not you or mine, not washing their hands and not caring. I asked a doctor to wash his hands once, and he got angry and left the hospital room, so, not fixed yet, contrary to current belief. Doctors still think they are God, and you have no right to question them or their cleanliness. My own experience, not hearsay.


  4. Brian Bagent |

    Amlicar, I am not your buddy, and I can only suppose that your thinking is as primitive and unsophisticated as your prose.

    Speaking of braying through your ass, you should take your Trotsky-esque agitprop and peddle it some place else.

    Let me ask you something, since you are such a genius and all. The collective in Germany decided, or at least acquiesced, to the murder of Jews, Gypsies, Catholics, homosexuals, and the handicapped. Is it your position that since it was the “will of the collective” that this was acceptable?

    People that actually understand abstract thinking also understand that the purpose of government is to protect the rights of the minority, and the smallest minority in the world is the individual.

    I have no more right to impose my will on the masses than the masses do to impose theirs on me. What you speak of is power, and the way you speak of it makes you a thug.


  5. doris |

    Harsh, Brian.


  6. doris |

    I suppose I should be happy you didn’t say Doris, huh? I better stop while I am ahead, or behind, as the case may be.


  7. Brian Bagent |

    Doris, I will agree that SOME doctors behave that way, but certainly not all or even most of them. I can think of 3 up there that I wouldn’t permit to touch my pigs, let alone me or my family. But bear in mind that they are the exception, not the rule. My sister (a pediatrician) and her husband (a pulmonologist) I know for certain do not behave that way.

    Your daughter’s primary care doc is wonderful. I think the world of my surgeon, my cardiologist, and my orthopedist. The other orthopod at our hospital is kind of an ass much of the time, but he is a first-rate surgeon with an insanely low post-op infection rate. And, he treats his patients very well. He’s even had words with one of “the three” about the way he treats us nurses.

    The broad brush with which you paint doctors is the same brush used by the Klan and the Arryan Nation to paint blacks, Jews, and Catholics.


  8. doris |

    Sorry, of course not all doctors, just ones I seem to pick. I know there are good Dr.s and great nurses, but there are also not so good ones. Don’t associate me with those guys, I am the last person on earth to be compared to them. I despise all they stand for. I have just had some bad experiences with doctors, maybe I am hard to get along with [especially if you don’t do your job], naaaaaa.


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