February 8, 2008
On Socialized Medicine
Here TSO mentions that Quebec has the lowest Doctor-Patient ratio of (what, civilized countries, I forgot to check, and don't feel like clicking back...it doesn't matter anyway) its class. He mentions this as an argument against Socialized Medicine.
But he has it all backwards. America suffers from too much medicine. Too many doctors, too much land going towards "health care". The voters in Oakland just turned down a parcel tax to support the ever-increasing monster of Oakland Childrens' Hospital, which is a surprise, since those people generally feed the trough whenever the Healthcare Hog starts squealing. If you go to the area where Childrens' Hospital is, you will see that it is a constantly-expanding octopus.
Of course, you rightfully point out, this is an example of a tax-funded octopus, and perhaps part of the problem is that so much tax money goes into medicine, constantly enlarging it.
After all, when people think that they are entitled to something, they demand more and more of it. Medicine is now seen as an entitlement, and not just legit medicine, but all sorts of quackery as well: chiropractic, aromatherapy, accupuncture, homoepathy, etc. If it is a public utility, the public will demand that everything go towards it. So, perhaps my idea of beating back medicine by turning over to crippling bureaucracy will not work.
Instead, what we need is more regulation (and much less insurance). In the name of consumer protection, let's toss out all of the quack cures, all of the ancient wisdom from nations that have been in constant states of war and starvation for the last six centuries, all of the "life-transforming" crap. Or at least, ban insurance from covering it. Then we only allow catastrophic insurance. Everything else, you pay, and you alone pay. None of these byzantine, multi-tiered pricing cystems (where you pay a piddling $15 co-pay, the insurance gets billed $10,000, and then pays a "pre-negotiated" price of $3,000, and everyone is happy).
Of course a big part of this will be to reform medical malpractice: outlaw malpractice insurance and tie civil penalties for malpractice to procedings from the regulators. Doctors are human and may make mistakes. Not all mistakes are malpractice. If there is such a pattern that the doctor needs to be removed from the business, then let his disgruntled customers step forward for some compensation, but until that happens, they have to understand that everyone is going to die eventually and that doctors, like everyone else, sometimes blow it.
This way the hobbling bureaucracy is not in the business of dispensing the medical services, and can do its job simply by making it a little more inconvenient and expensive to go whining to doctors at the slightest sniffle.
I completely agree with Alicia that we tend to go to too many specialists and too many radical interventions. I had a knee injury last autumn. Ice, anti-inflammatories, booze and some rest and it was mostly better in two weeks - all better in about five weeks, but surgery was an option! A guy I work with broke a bone in his shin. He also eschewed surgery in favor of a conservative approach, albeit with a few months on crutches. He's back to his athletic self.
The insurance angle is a one huge problem of healthcare. We had plumbing problems last week, but they didn't reach the homeowner's insurance deductible, so we paid the plumber from our own pocket. This week I had to take the car in for routine maintenance. Another out-of-pocket expense not paid for by car insurance. Health insurance is the one area where, instead of using insurance to pay for high-dollar low-frequency occurrences, we use it to pay for everything under the sun (much of which is included in policies due to the meddling of state legislatures). We need to return health insurance to being insurance against the unusual event and require individuals to take more responsibility for the routine stuff.
The big problem there is the push for "medical homes" for everyone. There's a theory afoot that people will be healthier if they routinely see the same physician or clinic and thus get duly propagandized. Thus they want everyone to have this "medical home". Right now the push is to make this part of the various flavors of medicaid, but mostly the CHP plans for children. Many of the activists are quite open that CHP plans are the slow-motion move to socialized medicine as it's easy to gradually extend eligibility for those who have already been in the medicaid pool. (Of course medicaid does things like pay providers at 72% of estimated cost of provision of care - nicely sustainable that.)
The last best hope for healthcare on the large scale in this country is, oddly enough, Wal-Mart's in-store mini-clinics. On the smaller scale, we need more people who look at healthcare as a calling rather than as a route to riches. More non-profit clinics that eschew participation in governmental programs are probably the best route to recruit these types.
Posted by: Gregg the obscure at February 13, 2008 4:32 PMI would also add that we need to invert the pyramid scheme of american health care providers. One does not always need a narrowly focused specialist - obstetricians are specialists in pathology and have no place in the care of normal pregnancies (which should be handled by midwives and family physicians) - get people back to Confession and we can RIF out a few thousand psychiatrists. Let the nurses run the hospitals and have the physicians as consultants, instead of the other way around. Oh, and the really big hidden contribution to the cost of health care? The cost of the schooling, much of which is irrelevant or even damaging to the stated goals. My remedy - don't let ANYONE into medical school who hasn't actually performed some kind of direct patient care, preferably as a nurse (but even a physical therapist or pharmacy technician would be preferable to what they currently let into med school). Stop worshipping the test score and GPA and look for real ability. I could go on and on.....
Posted by: alicia at February 8, 2008 8:43 PM