Health Care

I’ve been thinking about the health care debate. Some of it has been dishonored by thugs trying to drown out speakers, and people with no sense of integrity making the most outrageous and false claims about it. They dishonor America.

Some of the health care debate has been shadowed by claims that we have the best health care system in the world and therefore we should keep it as it is. Let’s be charitable. That means that because people love their country, therefore they are unwilling to confront the possibility that some things are wrong. It does not mean they have studied or experienced health care somewhere else. So OK the translation is they are flaunting their patriotism. But let’s also be clear that those who insist that we are the best and therefore we shouldn’t change a thing are actually telling us to stick in a soggy rut while everyone else goes driving by. That is a form of suicide under the banner of patriotism. Real patriots are willing to look at the problems.

Actually there is a lot wrong with American health care. Doctors have been filling my ears with their complaints about the system, the time that they take not to deal with their patients but to deal with the insurance companies, their problems in getting the health care they want for their patients. We know that lot’s of people are not covered by any insurance and don’t have the benefits of a primary care physician. We know that the longevity of Americans is far less than many other countries in this world, both at birth and in later life. We know that health care creates a problem for firms of different sizes who have to compete with each other over health care and compete with firms and countries where health insurance is not a cost of doing business. We know that American’s largest corporations have been advocates of changing the system. Claims that everything is fine will stick American health care in a soggy rut while the rest of the world drives on.

Instead of looking at evidence, doctors are forced to look at company formularies about what a particular patient’s insurance company will pay for. They are not paid for the outcomes, but paid to do procedures. That payment system pushes the entire health care system toward unnecessary expenses and away from the basics which are not covered or compensated. The system skews the profession toward specialists at the cost of squeezing out the basics. Nobody has the time these days to take a basic history of what happened to the patient with the result that there are far too many mistakes made by people in a rush, a rush to see the next patient. And the quick resort to specialists by the shrinking base of family and primary care doctors means that lots of problems fall in between the cracks – when your problem is not something that this or that specialist knows about your problem is likely to be overlooked or mis-diagnosed. Claims that everything is fine will stick American health care in a soggy rut while the rest of the world drives on.

We have lots of impressive technology. And we keep talking about how technology is making things better. Actually, technology is too often used to shift costs rather than reduce them. So it takes less of the doctors’ time to order tests than to spend the time examining the patient and getting the full history of what happened, but sending the patient for tests as a replacement for a thorough workup takes more of everyone else’s time. Whether we get the benefits of technology depends on how we use it. And it is often misused as a substitute for the basics. The doctors know that. Those who study the system know that. Fancy machines do not mean we’ll get good care.

Claims that everything is fine will stick American health care in a soggy rut while the rest of the world drives on.

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