Tuesday, December 14, 2010

Much Good Work to Be Done

One quarter into my MHA, here's what I learned/think about health care reform:
  • An acceptable level of overall population health at a reasonable cost requires universal access to health care via single program. This means that residents of all ages are in the same program, without the fragmentation of Medicare/Medicaid, employer insurance, self insurance, and out-of-pocket payment. (I'd leave the VA alone because those patients have unique needs that civilian health care is not set up to handle.)
  • Universal access is a prerequisite, not a guarantee
  • Improved outcomes and savings require robust federal, state, and community public health policies aimed at containing the dangerously rapid increase in obesity, and the major chronic diseases of asthma, cancer, depression, diabetes, and heart disease. (Obesity is a risk factor in all five)
  • Improved outcomes and savings also require a system based on primary care, not specialties. Currently, 30% of U.S. physicians are primary care doctors. The number should be 50%, at least.
  • Overtreatment in some areas and undertreatment in others is a problem traceable in part back to the high proportion of specialists
  • The state of health information technology is dismal
  • As politically significant an accomplishment as it is, the Affordable Care Act mostly buys time and doesn't address the issues of cost or quality. (In fairness, it isn't designed to.)
  • Only so much can be accomplished by government at any level. Much reform must come from within the system
  • Regarding the economics of American health care, it is supply driven and not demand driven. That is, an area with more heart surgeons with have more heart surgery than an area with fewer, but it is unlikely that overall cardiac health with differ significantly between the two
  • My right to access a health care system and the public interest in community health supersedes your right to choose to not access the system
In short, there's much good work to be done...

Yesterday, U.S. District Judge Henry Hudson struck down the portion of the Affordable Health Care that mandates the purchase of health insurance on the grounds that the individual right to not purchase health insurance supersedes anyone else's right to purchase it and the community interest in public health. Ian Millhiser thinks that Hudson's opinion reveals the weakness of the hand being played by the opposition. I think the ruling is not only misguided, it places ideological correctness ahead of addressing what should be considered a threat to our national security. It's simply foolish to be taking an option off the table when it doesn't involve shipping people off to gulags.


TAO said...

The ruling yesterday should be of no surprise to anyone: There are enough federal judges around where someone could have found the one that would have given the same ruling and forced the fact that the eventually the Supreme Court will hear this case.

Now, we can speculate to how much precedent that court will be willing to disregard in ruling on this case.

I wouldn't be surprised if they are willing to roll back established law quite a ways....

The outcome is far from certain.

Foxessa said...

Mandated purchase of insurance from the medical insurance corporations only enriches them. They are not mandated to approve or or pay for your health care or any procedure.

You cannot have anything approaching a reasonable health care system without the competition of the single payer system that must provide the purchaser with health care when they need it.

You cannot reform this thing from within. That's the medical corps talking. Nor have they an iota of interest in reform. Their interest is to force you into their mandatory payment while withholding as they choose -- and by GOD SIR! keep that satanic commie concept of universal, single payer system from even being in the debate, much less an option.

Love, C.

K. said...

TAO: Agreed, this is far from over, especially considering that the right-wing judges on this SC have shown no embarrassment over redefining case law to suit their needs.

F: The World Healthcare Organization rates France as having the best system in the world. It is insurance-based, as are at least half of the twenty highest-ranked systems. For the most part, they accomplish this by making basic insurance (with an expansive definition of "basic") nonprofit and by requiring approval of all claims.

The leading advocates of reform from within are Michael Porter and Elizabeth Olmstead Teisberg. They are articulate critics of the current apparatus, and do not contend that internal reform alone can solve the problems with health care. But they do argue that government action in and of itself is enough, and that the apparatus must be realigned to eliminate the perverse incentives that are all too common in favor of a system that competes on the basis of delivering value (i.e., the nexus of quality and price).

As for single payer, I'd like it. I'd like world peace, too. The United States has an outside shot at single payer if what we have now collapses (not impossible) and if enough people march in the streets for 5-10 years. Unfortunately, that would require a movement well enough organized that it could tear people away from their TVs for a protracted period, which could happen if the immigration reform people decided that single payer was their issue. Otherwise, I'm not holding my breath.

But there are at least two traits common to single payer countries that should/must be part of any reform:

1. A strong commitment to public health
2. An emphasis on primary care

They also have national health policies, which we do not.

Renegade Eye said...

Obama was not a wimp. He took universal healthcare off the table. Some say he is wimpy. Not true when it comes to fighting the people who supported him.

Small changes can lead to big changes. With the world economic crisis, we're seeing things happen that were unthinkable even a year ago, like the British students last week.