Health care

[kingrat]

I don't have a full policy prescription for fixing our health care system. Some bullet points on what I do think though:

• we're addicted as a country to drugs that don't do all that much good and cost a lot of money due to patent monopolies and clever promotion
• we have far less tolerance for the medical profession getting things wrong than other countries
• the incentives behind our private insurance system (healthy people have no incentive to get insurance, and insurance companies have no incentive to insure sick people) mean it won't work as is, nor will it with minor tweaking.
• our export/import policy puts lower income workers like steelworkers and janitors in competition with foreign labor, but protects higher income workers like doctors from foreign competition, increasing the costs of consumers of medical services.
• We make a lot of bad health care choices culturally (eating too much, getting too little physical activity, smoking, etc.) while still expecting the health care system to maintain us like it could if we didn't make those choices.

I'm sure there are more things I can think of. I don't know what the right combination of policy prescriptions is to fix them. And I don't know what the right combination of items fixed will actually change things. All I do know is that we'll need to nationalize some parts of health care in order to fixed it. Either that or make some really creative changes to the system to change the current incentives.

Comments

[turtlegrrl13.livejournal.com]

Our health care systems sucks. I hope that as being a practitioner, I can help people who want and deserve care who can't afford it.

XOX

[gothbitch.livejournal.com]

I don't know that you can lump smoking in there as a cultural choice. When I went to Europe it definitely felt like more people smoked there.

though I do love that British doctors get a bonus for every one of their patients that quits smoking. they should so do that sort of thing here.

*ahem* I'm sorry, was I being socialist? well. yes.

[kingrat]

I have no problems with socialism generally.

[geekalpha.livejournal.com]

Would you include the methods of assessing (large) malpractice awards as a problem in this assessment?

I was convinced years ago that cynical litigation for enormous amounts of money was artificially raising the risks that insurance companies bear, passing along costs throughout the system (principally in the form of high costs for malpractice insurance to providers, which they cannot afford to go without). My idea was to change a punitive awards into fines collected by the state rather than the plaintiff, and come up with a set of requirements and guidelines for justifying injury that requires compensation in an itemized way.

The system, including its sometimes ungodly high awards, was designed specifically to protect the economically weak from the extraordinarily powerful (such as large corporations). And, said very powerful organizations are highly motivated to manipulate perceptions on the reasonableness and impact of high court awards. So, now I am not so sure that the costs from high court awards are the problem.

Although, expectations as defined by the courts, of reasonable expectations for practitioner performance may be an area that could perhaps be adjusted and make a bigger impact.

In any case, I believe that the manipulation of the practice of medicine by corporate interests is a good illustration of how the assumptions of free market theory break down when the game is rigged. The result is less efficiency and worse services for the customer than any dmv-style big-government bureau could provide, and no viable recourse for the consumer, since health care is not a widget we can just go without, and letting Americans die on the sidewalk without treatment because they are poor is just unacceptable (to me, and I think to the vast majority of Americans).

[kingrat]

I read in Blink that the biggest predictor of medical malpractice lawsuits is how much a patient likes a doctor. As in, people don't sue doctors they like, no matter how much that person screws up. There's got to be something in that that can be used.

Some states already limit malpractice awards, and I've heard that the costs of malpractice insurance have gone down, but i've also heard that it hasn't. But what I am pretty sure of is that the overall cost of medicine to the consumer didn't go down in those states.

[(Anonymous)]

Actually, it wouldn't surprise if even if average malpractice costs and risks were substantially reduced, that the insurance companies would not substantially reduce rates do to any kind of fierce competition. I would think that since their market is anything but volitile, and customers (doctors) have demonstrated that they can and will pay, companies would essentially collude to maintain prices very high, as there is very little churn and therefore little competitive advantage to lowering rates substantially to get more customers.

In other words, it wouldn't fix the problem because of inertia and it would just translate into corporate rapine.