In its scramble to pass as much federal legislation as fast as possible, Congress should completely ignore health care reform. One reason, totally unrelated to the subject, is that hastily-conceived bills, rushed through at riot speed, provide an opportunity for the more devious members of congress to engage in very expensive targeted pork production. One of my favorite examples, in the emergency economic stimulus bill, is funding for a high-speed train to carry gamblers between Los Angeles and Las Vegas. Gambling is, of course, economically important to Las Vegas and Nevada; but few people outside of the Nevada congressional delegation believe that this should be addressed in a national emergency stimulus bill.
Besides congressional mischief, which is just a fact of life, there are at least four critical reasons why health care reform should not be addressed before the essential groundwork for it has been laid.
First, from what we see in the media on a daily basis it is apparent that the phrase “Health Care Reform” is almost universally interpreted as a single-payer health care system. Many envision a single-payer (U. S. Government) system as a Medicare-like national health insurance program. Others envision the single-payer system as a national health service like those of Canada or Great Britain.
But the requirement for a single-payer system, either insurance or actual health care delivery, is not the issue. The real problem is that this “forgone conclusion” mindset strongly indicates that there is no accepted definition of the health care problem that we wish to solve. The closest thing to a problem definition we have seen is the very general requirement for “affordable and accessible health care”. We know from long experience that whenever government sets out to fix a problem that it does not understand, a disastrous outcome is inevitable.
We cannot fix what’s wrong with today’s health care by mindlessly accepting a gratuitous solution to an undefined problem. We must first put forth the effort and cost to define our current health care system. Then we can systematically go through each defined segment to ferret out and understand what problems exist. Only then would we be prepared to develop solutions that could provide desired results.
Second, many or most Americans are not ready for health care reform. Even without a detailed systems analysis, we can be pretty sure that what our citizens want is good health. But it appears that too many of our fellow countrymen do not perceive that they have any individual responsibility for their own health; in their minds, their personal health is the responsibility of the doctors and the hospitals.
Medical experts have come to believe over the years that good health requires an active cooperation between patient and doctor. Chronic disease accounts for about 80% of all health care costs, and a significant fraction of chronic disease is more the result of individual choices than of genetics or environmental factors. Therefore doctor-patient cooperation is the critical element in disease prevention and health maintenance.
We have seen commendable progress in a number of health initiatives, most of which have been public and private cooperative efforts. Among the better-known efforts are those to reduce smoking, prevent the spread of AIDS, and (more recently) head off obesity among our children. What we need most is an expanded effort to educate Americans about healthy living. An initiative by the combined forces of federal and state governments, including public schools and universities, could be implemented at an extremely modest cost (by today’s standards).
Third, all single-payer systems implemented in the world to date are, or eventually become, health care rationing systems. This is true in Canada, Great Britain, Cuba, etc.
The first modern innovation in health care came about relatively recently: the Health Maintenance Organization (HMO) pioneered by the Kaiser Permanente company. Henry Kaiser was best known as a man who, by thinking outside the box, figured out a way to build cargo ships during World War II much more quickly than had ever been done before. So it is not surprising that the first systems approach to making health care delivery a more effective process was in a Kaiser organization.
The Kaiser Permanente HMO worked well initially, and it became the model for future HMOs. But fast-forward fifty years, and you find “HMO” is today a sort of epithet. One bit of black humor reflects this: “triage is the process of dividing patients into three groups—those with cash, those with health insurance, and those with HMO”. The word is out, and now HMO is most peoples’ last choice for health insurance.
The reasons why national health services eventually become health care rationing mechanisms seem to be (1) the irresistibility of something-for-nothing and (2) the failure to comprehend the critical distinction between good health and health care. The resultant over-use, and questionable-use, of the “free” system leads to a tidal wave of cost overruns.
We have actually seen an American example. The Medicare system was projected to reach a cost of $15 billion per year by its fifteenth year; it actually reached that level in its third year. Ever since, we have watched our government work diligently to reduce costs, by a means that more and more resembles rationing.
Fourth, Congress should suppress its desire to legislate for the sake of legislation because I said so. (Actually, this reason is not 100% facetious.)
During the ten years I worked for a regional health insurance company (where I was responsible for data security and corporate business continuation / disaster recovery), I read a daily digest of health news the first thing every morning—25,000 or so in total. I would mark articles that related to my duties, or just caught my interest, for later reading: I have no idea how many thousands of hours of reading that amounted to in ten years.
Among my reading interests was the subject of disease prevention and health maintenance and its growing acceptance in the health care community (an ounce of prevention is worth a pound of cure?). Early in my tenure I was meeting with the vice president I reported to and the executive vice president who was his boss. The conversation touched on disease prevention and health maintenance, and I suggested that there were business opportunities in this area. The executive vice president disagreed, noting that the company had not made earlier “wellness initiatives” profitable or popular with the employers who purchased health insurance for their workers.
But times changed, and before I left the company it was solidly into “wellness initiatives” demanded by those employer-customers. One of the programs, diabetes education and management, turned out to be valuable for me when I was diagnosed with the Type 2 version of the disease. (Should you have the interest, and the time, you might take a peek at several previous postings: “Healthcare Reform Lost Opportunity?”, “Health Care: The Next Prohibition Amendment?”, “Better Health, Lower Healthcare Costs”, and “Political Change: The Healthcare Debate”.)
Tags: cost overruns, health care rationing, health care reform, national health insurance, national health service, problem definition
