15 thoughts on “Health Care Reform”

  1. You’re assuming that the hard part is drafting a new system.
    It isn’t – as your essay notes, there are a ton of relatively small improvements and changes that could be made that would leave to a measurable improvement.

    The hard part is negotiating a political resolution which will satisfy a sufficient number of parties that it starts a chance of becoming law.

    Start addressing __that__ issue, and you’d be coming up with something interesting.

  2. You should remove all traces of sarcasm, humor, and pictures of obese people. You should then repackage this essay as your central platform for running for Teddy’s vacated Senate spot. You should run as an independent, or better yet, as a reformed socialist green hawk; just confuse the hell out of the other candidates. Don’t under any circumstances wear a Ross-style moo moo to a debate. Do bring your dog to public appearances. Start all of your answers to political questions with, “well… let’s use something from the common sense toolbox on this problem.” You might consider actually HAVING a common sense toolbox prop with you for campaign stops; I suggest one of the old wooden ones for extra New England flavor. You can’t become a solution until you become part of the problem.

  3. Sadly I have to agree with Noel. I think if Obama taxed healthcare spending and got the states to stop regulating hospitals & insurance companies, everything would dramatically improve. Rather than vouchers, I would probably prefer Milton Friedman’s negative income tax: just give everyone money, and ditch 90 of the government programs: Mediare, Medicaid, Social Security, food stamps, public schools, etc. Having read Mancur Olson, the chance of this happening is zero. Fortunately, after the machines take over in 2040, it won’t matter.

  5. You address Health Care, but do not sufficiently discuss financial and personal incentives for individuals to be pro-active about their health. Americans expect the quick fix, the silver bullet of pharma instead of good habits of nutrition and exercise. One of the reasons our health care costs are higher are because we are generally less healthy than Japanese, in terms of obesity and other lifestyle diseases (source, US #4, Japan #44). Additionally, doctors are paid to treat illness rather than promote health.

    First, get everyone healthier. Promote exercise. Have doctors be rewarded for improving health of their patients. Reduce forms of obesity causes, like HFCS.

  6. David: Eventually even a Japanese marathoner gets cancer. Being healthy and exercising adds a lot to one’s quality of life, but given our current system I’m not sure that it can save a lot of money. Mostly it will defer costs. The guy who would have died at age 75 of heart failure would instead die at 90 of cancer. As long as people die in the ICU with a Medicare tab of $250,000, the overall cost of our health care system should remain roughly constant.

    Also, I don’t think it is practical for the government to get everyone to exercise and eat sensibly. The changes that I propose in my plan are things that the government can do without any cooperation from citizens. I don’t think a plan is workable if one of its characteristics is that decades of trends toward obesity must be reversed for it to succeed.

  7. Your essay on health care reform is excellent, the question, as from other comments above is how do you sell it? Some of the points made in your essay could be even applied to our health care system up here in Canada.

    Unfortunately, it seems to be really difficult to sell any policy that involves analytical thinking, most of the time “sound bites” are what sells policy, so you would have to come up with a sound bite that the average citizen can understand and phone their politician an say this is the way to go.

    The key points are most likely getting the “legal industry” out of health care and changing the life style of the population. The hardest is probably the lifestyle of the population, any affordable health care system will require an active population that is not obese. One start would be mandatory gym class through out the public and private school systems, at least one hour or 1.5 hours per day, no more of this PC stuff about making it easy for obese students.

    The problem of the $250,000 ICU sounds like an engineering problem, how do we make the ICU more efficient so that it does not cost $250,000?

    Also, technology maybe already at a point where we can extend life indefinitely at infinite cost , but at a zero quality of life, society will have to look at solutions to this very difficult question.

  8. Pavel: I know it sounds harsh, but it is not clear to me that obese people are costing society money, any more than smokers were/are. A bus driver here in Massachusetts can retire with a full pension at age 41. Were he to become obese, the taxpayers might have to pay for treating his complications from diabetes and his $250,000 ICU death at age 70. Were he to play tennis every day of his retirement and live until cancer kills him at 91, we still have to pay for his $250,000 ICU death but we also have to pay for 21 extra years of pension and routine care.

    Can we really blame fat people for all of our problems?

  9. Here is a study from Canada done on the cost of obesity in Canada, from the Canadian Medical Association Journal
    http://www.cmaj.ca/cgi/reprint/160/4/483.pdf

    Table 2 is particularly interesting from its estimated direct costs of obesity and selected co-morbidities.

    But then there is a Dutch study that found that Healthy people are the problem
    http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050029

    Healthy people also can contribute more to the economy rather than somebody with heart problems and etc. So maybe the solution is to encourage a healthy lifestyle and remove health care subsidies after 75 or 80 years? Maybe those “Canadian Death Panels (TM)” could be useful 🙂

    The public pension ponzi scheme is a separate problem.

  10. Phil,
    Simple question that I’ve yet to see addressed:
    Why is everything always (or ultimately) equated to life expectancy?
    Isn’t quality of life what’s really important? Shouldn’t that be the
    ultimate barometer?
    Let’s see a study or even a poll taken wherein these
    other countries citizens tell us how COMFORTABLE their
    life is or how they regard their quality of life, rather than
    simply saying “Well, Mexican citizens have a life expectancy
    of only two years less than the average US citizen and their health
    care costs are much lower so there you have it, our system doesn’t
    work.”
    Let’s go ask the citizens of these other countries about their
    quality of life. I’d wager a Mexican citizen would rate their own
    quality of life as it relates to their health care much lower than the
    average US citizen would rate theirs.
    Prison inmates in the U.S. have a decent life expectancy and I seriously
    doubt their health care offerings rival my own, but I don’t think they’d say their
    quality of life is that great.

  12. Some fine ideas here. All that’s needed is to reboot under a new system. Probably the financial system and the educational system need rebooting, too. What would be more surprising and useful would be one or two catalyzing steps that would not require reboot, yet drive things in the right direction. That is, rather than sweeping changes, eliminating programs, and wholesale transformation, is there least-painful migration path. The argument can be made that there is no waste in the current system because the 17% of GDP (or whatever the real number is) is well-enjoyed by the current stakeholders. To convince them otherwise, they should be motivated to see that the pie will get larger and they will have even more in a new system.

  13. I think we could do a little more with the Health Savings Account model that already exists to extend the idea of patient as consumer and reduce the harmful influence of third party payer systems. By using those as a food stamps equivalent, we could make welfare payments to individuals that could only be used on health care. As consumers, we would seek out value in care, by realizing savings- allowing providers to compete on price. I understand th

    I agree though that some limits on end of life care are a necessity. That sort of care is simply too expensive for the quality years of life that are the positive result of when it works. Unfortunately, we are using the wrong metric to measure the end result of health care.

  14. Wilbur: I do think that some of the stakeholders would do better under a new system. For example, right now the best doctors cannot effectively market themselves to patients or explain how they are better. A doctor’s customers are accountants at insurance companies and bureaucrats at Medicare. All these folks care about is how much he charges; they don’t care whether or not he is more effective at curing disease. This may explain the narrow range of physician compensation. Doctors who barely meet the minimum standards for their specialty get paid not that differently from superb physicians in the same specialty. A doctor can make millions of dollars per year, of course, but he or she does it by opening a chain of clinics and taking on some business risk/hassle, not by treating patients more effectively than another doctor might.

  15. “Yeah – what he said” – as usual, Michael Pollan is far more eloquent than me in relating health to health care and the need to reform food policies and treat obesity: “Big Food vs. Big Insurance”

    Sure everyone eventually dies and adding an extra year or two of very expensive treatment is hard to justify on costs alone. However, like Obama’s speech, an essay on health care reform is incomplete without discussing improving everyone’s health prior to expensive treatments.

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