"I wish they would only take me as I am" - Vincent Van Gogh               "How Can I believe in God when just last week I got my tounge caught in the roller of an electric typewriter?" - Woody Allen              "Our truest life is when we are in dreams awake" - Henry David Thoreau              "I took a speed reading course and read 'War and Peace' in twenty minutes. It involves Russia" - Woody Allen            "When promulgating esoteric cogitations, eschew platitudinous ponderosities" - Mark Rowan, my father            "Up, sluggard, and waste not life, for in the grave there will be sleep enough" - Benjamin Franklin             "What really interests me is whether God had any choice in the creation of the world." - Albert Einstein            "Welfare's purpose should be to eliminate, as far as possible, the need for its own existence" - Ronald Reagan            "It's odd that you can get so anesthetized by your own pain or your own problem that you don't quite fully share the hell of someone close to you." - Lady Bird Johnson              "I still want to be the candidate for guys with confederate flags in their pickup truck" - Howard Dean

Thursday, August 13, 2009

My thoughts on the Health Care Debate

I've been notably absent from this blog for some time now, but with the current state of affairs surrounding health care insurance reform, I figured I should jump back into the fray. What really motivated me was a short clip from President Obama's recent NH town hall.
In the above clip, the President describes how we pay our primary care physicians so poorly, yet pay surgeons quite generously. He's absolutely right on this fact, though he has greatly exaggerated the numbers. A surgeons fee for an amputation is in the ballpark of maybe $2,500. Frankly, I whole heartedly agree with the President that our health care is structured in a way that disproportionately rewards treatment over prevention. Yet, I see things through a slightly different lens.

First of all, a dominant reason why a primary care physician is paid a "pittance" is because of government run programs like Medicare and Medicaid. With medicare reimbursements below what the market dictates, physicians and hospitals make up for this by increasing volume. That means that physicians have less time to spend with each patient, reducing their ability to perform the time-intensive interventions that the President is discussing. With rhetoric about cost-controls in the current legislation, and proposed cuts to medicare reimbursement, how am I to believe that this will improve--in fact, I would anticipate that it would worsen.

That's not to say that addressing this issue isn't important, though I believe that it could be done in a more efficient way. Decoupling private insurance to a) employment and b) state of residence or community would be a good start. With our current system there is actually a disinsentive for insurers to pay for preventative care, because as soon as you change jobs they will no longer be your insurer, and thus your amputation will be on someone else's dime. If it is in an insurer's best interest to keep you as a customer for a longer period, then it will be in their interest to reward cost-saving preventative measures.

Second, while a public option would have incentive to reward preventative care, they would also have an incentive to withhold costly care. We see this over and over again in country after country. While I do believe that America can accomplish things that others can't, why should we expect anything different in our country? It always reminds me of a scene in Arrested Development, where Tobias and Lindsay are discussing ways to improve their marriage.
Tobias: You know, Lindsay, as a therapist, I have advised a number of couples to explore an open relationship where the couple remains emotionally committed, but free to explore extra-marital encounters.
Lindsay: Well, did it work for those people?
Tobias: No, it never does. I mean, these people somehow delude themselves into thinking it might, but... but it might work for us.

Third, I notice the irony here when the President brings up medication management. Proper use of medication is a vital component of diabetes management, as it is for so many chronic diseases (hypertension, vascular disease, etc...). Whereas studies have shown that medications greatly reduce overall health care costs, their use will undoubtedly be welcomed under the Democrat health care plan, despite the fact that pharma has been a whipping boy of the left for years.

Lastly, I have grown weary of President Obama's repeated attempts to portray physicians as greedy. It seems that in his eyes physicians are willing to subject their patients to painful and expensive unnecessary procedures for the sake of enriching themselves. Whether they are taking out kids tonsils, or directing them towards amputations, he seems to believe that doctors only care about money.

We all agree that we need reform, but let's not throw the baby out with the bathwater.