Americans view health care as a commodity – merchandise with market value. That being the case, there will always be some kind of market value (rationing), and the ration coupons will be money. The United States already spends more than twice as much money on health care per citizen as any other country in the world – so much that the cost promises to become unsustainable within a generation.
However, even though the U.S. may lead in medical research and specialties, the blinding fact is that overall U.S. health care is a sorry hodgepodge. Every industrialized nation delivers better care to more of its people – and at less cost.
The new health care bill took some steps toward cost containment, such as requiring universal participation, but in its final form it only set the fiscal storm back a few years. The hurricane is still just over the horizon.
Among the costs this law was not allowed to fully address is administration. Other nations have demonstrated that administrative costs can be well managed with a single-pay (government administered) system. Although Medicare shines like a beacon as a single-pay experiment – using only 2 percent for administration, while private insurers use 28 percent – it seems politically impossible to extend single-pay to the larger market of universal coverage. As long as the Republicans in the land of the free and home of the brave can maintain the votes for a Senate filibuster, there is no way the U.S. will expand single-pay – it looks too much like the systems used in “socialist” governments in Canada and Europe. There are too many U.S. interests with too much political clout who benefit from the present “non-system.” So, there’s one potential saving that’s “off the table.”
Turning to another serious leak in the USS Health Care yacht: Between a quarter and a third of Medicare costs are incurred in the final year of life, and more than a third of that in the final 30 days. Surely there’s a buck or two to be sequestered there. Life-sustaining treatment for patients in their 80s is largely a zero sum investment. A $200,000 heart surgery for an 85-year-old is only to lose the patient to some other frailty within a year or two. After a certain point, it seems that medicine – with the exception of hospice or palliative care – could justifiably be denied. At least, the question should be addressed, such as the authorized physician consultations attempted originally in the health bill. Such consultation would help each person make his or her own decisions well in advance – long before awareness recedes.
It, too, proved politically unattainable. As one scholar mildly observed, “The Republicans found fertile ground with the death panel myth.”
To turn to another big leak in the boat – pay for service. This insane procedure is a sickness that may eventually cause the death of Medicare. It not only encourages waste, it exploits human nature. There are few selfless folk anywhere in life, including medicine. If these medical merchants are paid for whenever, wherever, and however they prescribe – as sure as the sun rises in the east, there will be a plethora of unnecessary prescribing. European countries (and Canada) have shown that pay for outcome – overall patient management systems built on contract arrangement – works very well at lesser cost. It is already done here in the military. It would not be necessary to make old Doc Flatley stand guard duty – only to sign him up for contract care at a fixed rate. Private arrangements could continue, like Harley Street in England, known for its concentration of doctors and specialists. Arab sheiks, corporate chieftains and Bain heirs should be allowed to pay for their own medical Hermes scarves. Money is their book of ration coupons.
With Congress at a loggerhead, how about putting the NRA on the problem by promising an assault weapon in every kitchen? Maybe they would turn their political skills to patching a couple of these money leaks in the USS Health Care.
They’ve never lost a political battle yet.
Rodney Quinn, who died Oct. 27, wrote several columns in advance for publication, which the newspaper will print through the coming weeks.
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