The recent "reform" was, like most politics, a distraction. That plan was more about paying for health care than about actually delivering it (see a later entry), and the right steadfastly ignores that it's almost identical to the plan Mitt Romney set up in Massachusetts. The delivery system is just as broken, though. Almost nobody talks about these problems, and the government won't touch them. The dangerous idea here is that "we have the best health care system in the world." In a handful of metrics we do better than other countries, but overall it's a bleak picture: we pay more and get less for our health care expenses. The insurance apologists seize on anecdotes from other countries and that handful of metrics, but they can't change the facts, and they certainly can't save any lives.
Problem the First: Basic economics. The principle of supply and demand is easy to understand: when supply goes up, prices go down; when demand goes up, prices go up. In other words, something that's easy to get is cheap, while something that's hard to get is expensive. The demand part of our health-care system is us--that is, people who get sick. That demand is only going to go up as the population gradually increases and even more as the boomers age. The supply part is medical personnel, such as doctors and nurses. Everything else is incidental: you can't staff a hospital, run a test, or prescribe a drug without personnel. The supply has actually gone down, because almost all medical students these days (an amazing 98%) become specialists, not general practitioners. Specialists earn much more money, which tells you where their priorities lie. So supply is going down while demand is going up: prices are inevitably going up.
Solution the First: Doctors have abandoned the role of general practitioner, so we need a different profession to fill that role. Nurse practitioners are the likely stopgap solution. In the long run we must have primary care providers who can diagnose and treat simple problems, prescribe medicine, and refer patients to providers with more specific skills. A major step toward fixing this problem (and several others) would be to blur the line between doctors and everyone else, that is, create grades of medical personnel based on function, not education. Allow people to learn as much as they can about medicine in whatever way they can, then let them take tests to certify themselves. If I can learn what a GP should know without the time, expense, wasted energy, and built-in prejudices of medical school, why shouldn't I be able to do a job that doctors themselves refuse to do? It wouldn't be a bad thing, either, to show doctors that they can be replaced; that might put a dent in their arrogance.
Problem the Second: Geriatrics. One-third to one-half of all medical spending in this country goes to keep people alive in their final month. Preserving life is a worthwhile goal when it makes sense, but postponing the inevitable for a few hours or days doesn't make sense. The patient goes through unnecessary indignity, discomfort, and pain. The family goes through false hope and often financial hardship. The only benefit goes to the doctors, hospitals, and drug companies, and that benefit is purely financial.
Solution the Second: Encourage living wills. This has nothing to do with "death panels"; nobody wants to kill your grandmother. Try to understand the distinction. It's one thing to euthanize people who are still healthy. It's another thing entirely to allow someone to pass away quietly, someone who would die anyway and has already made an informed decision to do so without any fuss. I'll repeat the critical part--someone who would die anyway. There is too much focus on the quantity of life and not enough on the quality of that life.
Problem the Third: Prevention. An ounce of prevention, in medical terms, is worth about ten ounces of cure. Less than a pound, but still a substantial savings. It may be dramatic for surgeons to save someone's life with a risky operation, but real life is not like TV. It's much less expensive to teach someone at risk for heart disease to eat properly than to do bypass surgery. There's no mystery here. Most chronic diseases can be prevented. For some reason, though, many of us listen to the politicians, who would rather pretend to solve splashy expensive problems than quietly prevent them from ever happening. The system is geared towards trauma care, towards rescuing people from imminent demise, towards the dramatic rather than the sensible.
Solution the Third: If you're at risk for, say, heart disease, get some exercise and change your diet. If you refuse to do so, you are committing slow-motion suicide. The medical establishment should recognize this fact by classifying you as a coronary DNR. If you ever have a heart attack, nobody will try to resuscitate you; nobody will perform bypass surgery on you; nobody will try to save you from your own bad behavior. On the other hand, if you have a genetic predisposition to heart disease, you should get treatment and medication to reduce the risk of a heart attack, and you should be treated properly if you do have a heart attack. Conversely, if you have no risk factors at all and still have a heart attack, you should get treatment. The operative principle here is to prevent what you can and treat what you must.
The bottom line: Somehow we have gotten the idea that medical resources are infinite. We can treat everyone for everything, we can look for cures to every known disease, we can save every accident victim and premature baby, all at the same time. Is it any wonder that prices are going through the roof?
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