Friday, September 25, 2009

Conserva-Care

Interesting reading from the LA Times - on four prominent conservatives opinion's of how to reform health care.

I find myself pretty much agreeing with Bill Frist - the only reasonable one in the article and the only MD... his proposition to focus on wellness - on preventing health not through screening for diseases (which is still needed and saves lives) but by actually addressing such as working with employers to get employees to eat better and exercise (umm, not just sit and eat Dunkins all day) and looking at how we build our communities to be better for health (increasing utilization exercise, reducing sprawl) his service on the board of the Robert Woods Johnson Foundation's Commission to Build a Healthier America is doing. That was a good start.

After that it went downhill. The most vexing was David Frum. Healthcare will NEVER work as a regular market such as how consumer products such as what does work with computers or say, shoes. I just don't see how you can incentivize health by making it monetarily penalizing people who utilize health care services more.... can someone please explain to me concretely how this would work?

I see health care costs as multi-factorial... the major factors driving up costs, I believe, our really outside the control of insurance/healthcare complex as it is currently in the debate going on right now. These are:

Habits/Behaviors - think smoking, exercise and food
Built and Work Environment (sedentary lifestyle + commuting)
Pollution (indoor + outdoor)

A lot of that has to do with how we've built our suburban dream... the long commutes, quick meals and need to drive EVERYWHERE leading to our current obesity and diabetes epidemics...

In terms of actual health-care system issues... a few come to mind:

The Fee for service of system of healthcare (hospitals/docs get more money for more tests, not for better care)
Malpractice Reform (one of the top issues eroding the salary of many physicians and leading to defensive medicine)
Uninsured Gap - it's unjust not to close this even it if costs a little bit of money.
Big Pharma (20% profit margin) and the device makers (16% profit margin) need to be reigned in
But, ultimately, Technology COSTS MONEY AND SAVES LIVES

In terms of the current bills going through Congress, it appears that the first point on "systemic" issues got watered down, that malpractice reform won't be touched and that we'll only get some - but not all - of the uninsured gap closed. And nobody has said much of anything about reigning in Big Pharma...those device makers also have excessive profit margins that insurance companies would kill for...

But the last point is really a take home from medical school. You know all those things that have extended lives (um, chemo) and made grandma be able to walk (hip replacement) and keep you alive while youre in a drug induced coma so you can survive that car accident caused by some idiot drunk drive (see the "non-systemic" section for that) - those things actually cost money. And they've gotten much better over the past few decades but also more expensive. I don't think it's the main factor, I think the "systemic" factors are all minor factors second to the "non-systemic" behavior/built environment. But it's good to have it in context of what you're paying for... which is your life. Not an iPod.

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