What are we taliking about, really? Health Care Reform

Interested in America's Health Care Reform conversation but wondering if you, or the pundits, are talking about the main issues? At over 1000 pages, does anyone really know what's in the document currently being debated?

I've heard some really dumb conversations about it recently, scaremongering from those who only listen to one radio station, whichever station agrees with them.

You have to ask the question; What is it we are actually trying to accomplish?

• Free medical care of an extremely high standard for all Americans?
• Reasonably priced medical care to cover major ailments?
• A two tiered system so that the poor get care and the wealthy get choice?

Another question I ask is, Since when is it the government's responsibility to provide everything anyway?

It's been fascinating too to hear the conversation from parents of underemployed adult children and from others who have always been covered by corporate insurance plans. Night & day!

I've lived under three different systems. I grew up with terrific insurance provided by my father's employer. I now pay for major coverage that covers me internationally. They cover 100% if I'm treated overseas and 80% if I'm in USA. They also increase my premiums when I'm in the US. Hmm. Kinda encourages me to stay overseas for medical care, doesn't it.

My personal favourite was when I lived among medical professionals who knew me and didn't send a bill, but that was in a remote area of Africa and fraught with limitations, immense suffering and contradictions. Not a feasible option, but appropriate for the Malaria and scorpion sting I needed attention for at the time.

Read one American man's personal point of view from the perspective of a business man who recently lost his dad to infection obtained in the ICU of a NYC hospital. Go to The Atlantic for the entire article. I've only included one salient passage here.

How American Health Care Killed My Father by David Goldhill

Indeed, I suspect that our collective search for villains—for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions.

They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value.

These are the impersonal forces, I’ve come to believe, that explain why things have gone so badly wrong in health care, producing the national dilemma of runaway costs and poorly covered millions. The problems I’ve explored in the past year hardly count as breakthrough discoveries—health-care experts undoubtedly view all of them as old news. But some experts, it seems, have come to see many of these problems as inevitable in any health-care system—as conditions to be patched up, papered over, or worked around, but not problems to be solved.

That’s the premise behind today’s incremental approach to health-care reform. Though details of the legislation are still being negotiated, its principles are a reprise of previous reforms—addressing access to health care by expanding government aid to those without adequate
insurance, while attempting to control rising costs through centrally administered initiatives. Some of the ideas now on the table may well be sensible in the context of our current system. But fundamentally, the “comprehensive” reform being contemplated merely cements in place the current system—insurance-based, employment-centered, administratively complex. It addresses the underlying causes of our health-care crisis only obliquely, if at all; indeed, by extending the current system to more people, it will likely increase the ultimate cost of true reform.

I’m a Democrat, and have long been concerned about America’s lack of a health safety net. But based on my own work experience, I also believe that unless we fix the problems at the foundation of our health system—largely problems of incentives—our reforms won’t do much good, and may do harm. To achieve maximum coverage at acceptable cost with acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value throughout the economy. We will need to reduce, rather than expand, the role of insurance; focus the government’s role exclusively on things that only government can do (protect the poor, cover us against true catastrophe, enforce safety standards, and ensure provider competition); overcome our addiction to Ponzi-scheme financing, hidden subsidies, manipulated prices, and undisclosed results; and rely more on ourselves, the consumers, as the ultimate guarantors of good service, reasonable prices, and sensible trade-offs between health-care spending and spending on all the other good things money can buy.

These ideas stand well outside the emerging political consensus about reform. So before exploring alternative policies, let’s reexamine our basic assumptions about health care—what it actually is, how it’s financed, its accountability to patients, and finally its relationship to the eternal laws of supply and demand. Everyone I know has at least one personal story about how screwed up our health-care system is; before spending (another) $1trillion or so on reform, we need a much clearer
understanding of the causes of the problems we all experience.

Read the rest of Goldhill's article in The Atlantic, September 2009. David Goldhill is a media and technology executive.