Health care, a light at the end of the tunnel

medicineman · #1 11-16-2006, 12:37 AM

Maybe we should start envying the french:
Health Care WrapUp

Having spent the last week of my life drowning in health care statistics and system comparisons (the products of which you can read here), I want to make a few wrap-up points on the whole thing. First, I see why Clintons plan failed. In an effort to avoid the political baggage of single-player, he tried to emulate Germany's system, which is really the worst of the bunch. Complicated, bad at controlling costs, and obviously jury-rigged to accommodate an evolution that wasn't necessarily organized. Bad move.
Employer-based health care, which Germany and Japan's universal systems rely on, is a poor choice. There's no compelling fiscal or policy reason to use it, and employer's, frankly, should not be in charge of their worker's health care. It's just a silly way of organizing it.
Canada's system is too biased against the private sector; some degree of private, supplementary insurance should be allowed. We do not live in an equal society and we've never had a problem with allowing the richest to benefit from their funds. But if Canada's problem is that they have a ceiling, our problem is that we don't have a floor. Liberals shouldn't construct a system that stops Americans from getting ever-better health care, but we need one that guarantees a certain level of care. In essence, we want a floor without a ceiling.
France and Britain are more interesting, Britain for their enormous cost control and France for the fact that their health care is really very good. But Britain's frugalness has a price -- care simply isn't as good, surgeries are underused, medicines under-prescribed, and so forth. While they still have better outcomes than we do, it's only because so many of our citizens are totally without access to health care. If you had to decide where to be treated, you definitely want it to be here.
France is more my speed. Government provided, ceiling without floor, etc. The lack of a gatekeeper leads to overuse (i.e, the French go to the doctor's too often), but that's changing their, and it could easily be side-stepped here. What a shame, then, that France is so off-limits in political dialogue. But whether or not we can invoke the French, they're the closest thing to a model structure out there, and we should study them for ideas.
Moving beyond countries and into specifics, our doctors make too much money and we credential too few of them. The road to an MD is torturous, inefficient, bottle-necked and enormously, enormously expensive. It's such a terrible path that high pay is the least we can do. But the AMA has codified this absurd state of affairs, and serious reforms will need to chip away at it. Doctors either need to make less, or we need to radically increase the usage and training of nurse practitioners. One way or the other, we need cheaper general providers who don't have crushing debt they need to pay off. To achieve the last, the government needs to step in and subsidize medical training. That shouldn't be hard, our public universities do it, to some degree, already. It's time to radically increase the degree.
What really leapt out at me during this series was how normal government provided health care is. Other nations have doctor choice, hospital choice -- in France, they don't even have limits on specialist choice. Americans have somehow fooled themselves -- or been fooled -- into believing that government-run health care is somehow different from what they enjoy now. I genuinely believe they carry some sort of dystopian vision around with them, of gray waiting rooms and faceless bureaucrats and bread lines with stethoscopes, rather than grain, at the front. In order to keep that prophecy whole, they've had to mentally classify medicare as some weird, third sort of category -- government paying for private health care.
Medicare, of course, works great, and its beneficiaries are enormously pleased with the service. it doesn't seem like government-run health care because, well, it's like normal health care, only the government pays. We need to use that. Which is why my vote for health care reform would be a radical expansion of Medicare, almost exactly along the lines of what Ted Kennedy has proposed. Americans need to be assured that government run health care is not, in some weird way, a wholly different state of affairs. They need to know that it's the health care they enjoy now, just better, cheaper, and guaranteed. Medicare, because it's already used and liked, comes with those benefits.
Lastly, all my comments are on the structure of health care systems. There are many other problems too, the rapid advance of technology and ever-longer life spans chief among them. Changing our structure won't solve those issues. But our dysfunctional system currently makes them worse. The poor get care, but only once the situation is catastrophic and the costs of healing them have drastically increased. We pay too much, get too little, and remain tied to bad jobs because we can't sacrifice our coverage, In the end, our health care system is a lead weight on employers, a shackle on employees, and a great drag on our economy. It's not the best in the world, it's not near it, and we shouldn't pretend otherwise. Instead, we should set out on the task of making it better.

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