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Discussion Membership
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Health Care Hints
Dan Gillmor asked for comments and considerations for a new health care policy. I contributed the following: Hi, Dan... Look first at the history of business-provided health care. I believe it became popular in the [1940s or] middle 1950s during a period of wage-price controls (better check) as a low-cost perk to entice people to work for a company. It blossomed. Then it ballooned and finally bloated because, on one side, a large portion of its costs are one level removed from the employee, and on the other side, the costs of providing the service are one level removed from the legislatures that mandate the benefits. Since it has become almost ubiquitous, the first step to correction is to remove businesses as middlemen -- who mask the total cost to both the consumer (out of ignorance) and to the legislator (by design). Only when the voter feels the pinch in the pocketbook will the legislator feel the pinch in the voting booth. The pinch needs to be felt by both. As William Burroughs said, there is no such thing as a free lunch so people need to be able to decide how to allocate scarce resources -- first, between health care and other services and secondly, within health care, to specific services. The first fallacy to debunk is that money paid by a company for health care doesn't come out of the pockets of employees. The second fallacy to debunk is that mandates by the legislature to businesses don't cost anything. Guiding us into a better future, how about some precepts: 1) "One of anything never encourages efficiency." 2) "Information is better than advertising." 3) "Continuous feedback leads to continuous improvement -- Good ideas (and bad ideas) can come from anywhere." 4) "Legislative solutions are oxymorons." 5) Lawyers are not doctors - Defensive medicine limits doctor liability but raises insurance costs. 6) Legislators are not doctors -- They should not micromanage or restrict care. 7) Doctors are not perfect - Since they are not infallible, and only a partner in health care, they need to listen to patients, nurses, administrators and insurance companies. They also need to police themselves. 8) Health care is not the lottery - Exorbitant malpractice verdicts are paid by patients. Tort reform is a must. 9) Doctors are not always the answer -- Other levels of skill can effectively and economically assist treatment. 10) Holistic medicine makes sense -- Treating the whole person starts in school. Questions: 1) How much health care is enough? 2) Who should pay for orphan diseases or extreme medicine and how much is enough? 3) Shouldn't treatment occur where people need it? Schools? Malls? Shouldn't records be transportable? 4) Shouldn't treatment be the level of service that people need? -- Sometimes nursing homes are too much care, sometimes too little. Sometimes a visit to an emergency room is too much care. 5) Where belongs the internet? Virtual doctors? Distance medicine?
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