May 30, 2011
Reforming Health Care Reform
By Michael D. Shaw
Let’s start off by defining the basic problem. Given the ever-aging demographics of the first world, the cost of health care is becoming intolerable. Countless methods are in place to control expenses, with some countries having greater success than others.
Notably, the United States spends more per capita on health care than any other country, racking up 1.5 times the expenditures of the next in line (Switzerland). Making matters worse, our outcomes rank nowhere near the top.
The outcomes gap is traditionally explained away as follows:
- Having a much more ethnically diverse population than the other countries, we are saddled with many issues they do not have.
- Other countries are not quite as diligent about health care statistics.
While there is some truth to both of these arguments, when viewed in the context of how much we are spending, they are pretty thin gruel. At any rate, such points do not address the cost issue, which itself is traditionally accounted for as follows:
- Far too much is being spent on health care administrators, compared to health care providers.
- Litigation run wild, with no tort reform in sight, has made defensive medicine the norm. Conservative estimates peg 25% of all diagnostic tests as being medically unnecessary.
- Foolish reimbursement schemes overwhelmingly favor procedural medicine over cognitive medicine.
- Medicare and private insurance fraud (including medical identity theft) occurs on a massive basis.
- Although freedom of choice within a medical free market system is the mantra, the giants are regularly gobbling up smaller providers.
Virtually all attempts at health care reform have focused exclusively on reforming the details of insurance coverage, and reimbursement to the providers. The formula here is quite simple, since there are far more patients than doctors. Reduce the out-of-pocket expenses of the patients, by lowering the provider reimbursements. This formula can be expanded to include restrictions on pharmaceutical coverage, with it being limited to generics or even so-called therapeutic substitution.
All such efforts, however, can be likened to polishing the brass on the Titanic. No mere cosmetic enhancement will prevent the inevitable sinking of USS Health Care. And, like the ill-fated British vessel, there are not enough lifeboats.
Physicist/philosopher Thomas Kuhn’s notion of the paradigm shift is often illustrated by the emergence of the Copernican heliocentric model of the solar system, compared to the once accepted Ptolemaic geocentric model. As problems developed with the Ptolemaic theory, more and more complex rules were added by its proponents, until it became clear that (to use another cliché) it was broken model.
Might I suggest that we have reached that point with health care reform. Here are some guidelines for a paradigm shift:
1. We must recognize that what we currently call “health care” is perhaps 99% disease care. Would the term “auto care” be sensibly applied to a model whereby essentially no preventive maintenance were done, and the typical car would present to the provider (mechanic) only once the engine had failed?
If auto care insurance existed, would claims not be disallowed based on lack of routine maintenance?
2. Any government-led health care program must embrace sensible ideas of wellness, including encouraging a sound diet. While few want some sort of health food Gestapo, it is long past time for agricultural subsides to favor healthy fruits and vegetables.
3. Any government-led health care program must do far more than merely regurgitate shopworn conventional wisdom, which always seems to favor Big Pharma.
48% of all people in the US have used at least one prescription drug in the past month. In the age group of 45-64, that number shoots up to 65%; and for those 65 and over, it’s an incredible 90%. How much could this national drug dependency be reduced if primary care medicine freed itself from its obsession with “normal” blood numbers—usually based on very sketchy science—that must be fixed with the latest drug?
4. Related to this is the opening of a meaningful dialog on quality of life, and not just extension of life. Let’s run a comprehensive cost benefit analysis on the billions we spend on drugs and outcomes, focusing on improvements in the quality of life for our seniors.
I realize that a change from disease care to health care will not come easy, as there is a colossal empire in place dedicated to the status quo. But then, empires do fall. Just ask the Romans.