Saturday, August 22, 2009

A "radical solution" to the health care crisis

If you have been reading this blog for a while, you may wonder where on the political spectrum I fall regarding health care reform. While I'll decline to reveal my major party affiliation for now to avoid possibly alienating half of you, I can say quite honestly that I consider my views of health care reform to be very non-partisan. What do I mean by this? I think that Democrats are right to believe that any health care system that continues to provide no insurance coverage, even for catastrophic events, to 47 million Americans will never be able to improve quality and control costs. I also agree with Republicans who believe that trusting the government (even though I'm a government employee) to efficiently manage the majority of the nation's health resources is a recipe for failure, and that in some ways government over-regulation of health care has led to unnecessary inflation in costs. On the other hand, I don't think that dumping another $1 trillion into an essentially flawed system will automatically deliver the long-term cost savings that we need, and I disagree with many Republican leaders who seem to feel that their "less government" philosophy means sticking with the status quo (for example, you can't favor less government involvement in health care and at the same time keep Medicare exactly the way it is).

However, until recently I've struggled to articulate a viable third way out of the health care morass. Now I don't have to. In a riveting piece in the Atlantic, titled "How American Health Care Killed My Father," business executive David Goldhill makes a convincing argument for a model of health reform that harnesses the advantages of market incentives while protecting the less fortunate and less wealthy. Far from being "radical," as the teaser paragraph describes it, his proposed solution makes more sense than anything I've yet heard out of the health care debate. Rather than trying to read the thousand-page bills currently winding their way through both houses of Congress, I recommend that you read this article instead to understand what's at stake and why reformers are probably moving in the wrong direction. The sections include:

1. Health Care Isn't Health (Or Happiness)
2. Health Insurance Isn't Health Care
3. The Moral-Hazard Economy
4. There's No One Else to Pay the Bill
5. The Government Is Not Good at Cost Reduction
6. Uncompetitive
7. Our Favored Hospitals
8. You Are Not the Customer
9. The Strange Beast of Health-Care Technology
10. The Limits of "Comprehensive" Health Reform
11. A Way Forward
12. $636,687.75

Goldhill concludes: "But let's forget about money for a moment. Aren't we also likely to get worse care in any system where providers are more accountable to insurance companies and government agencies than to us? ... Let me ask you to consider one more question. Imagine my father's hospital had to present the bill for his "care" not to a government bureaucracy [Medicare], but to my grieving mother. Do you really believe that the hospital - forced to face the victim of its poor service, forced to collect the bill from the real customer - wouldn't have figured out how to make its doctors wash their hands?"

Powerful stuff.

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