Progress and health care
This morning driving to work I listened to a story on NPR Morning Edition. It described the effort to build Charles Babbage’s Difference Engine – a mechanical predecessor to today’s computer. Babbage died before he could ever complete his machine but modern engineers have recreated it.
The analogy with health care struck me. Congress is building a Babbage machine in an era of super computers.
And we dare to call it progress?
Logic, facts, socialism, fascism, guns and health care
November 28th, 2009
When a 2,000 page piece of legislation traverses the legislative sausage making process, it is a large target for those who want to take pot shots.
When you are trying to fix a system that is broken in lots of places, it is not an easy process.
Let’s remember what we are trying to fix.
The system does not cover everybody. Estimates on the number of uninsured range from 30 million to 70 million depending on whom and how you are counting.
It’s expensive. Our economy already sets aside more resources per person than any other country on the planet. We pay more in taxes for health care than any other country on the planet.
We are not a healthy country. Relative to other industrial countries, we don’t live long. Our babies die before they reach their first birthday. Our pregnant mothers die in child birth.
That’s a lot of fixes.
In fact, the 2,000 pages is a pretty mediocre start. If either the House or the Senate version survives intact, it still will not cover everybody. It still will be expensive. And there isn’t much reason to believe that we will be any healthier as a result.
But it is a start.
And let’s not forget that simple in the form of single payer (HR 676) was taken off the table very early in the process.
Barack Obama – Can we re-imagine health insurance?
With the election of Barack Obama, there is a lot of hope and optimism about the potential for health care reform.
There is also some nervousness.
The nervousness originates from those who think that the current economic crises will inhibit reform efforts. That somehow the price tag of reform will scare people away from health care reform. I am encouraged by an insightful article by Ezra Klein on Obama’s choice of Director of the Office of Management and Budget.
According to Klein, Peter Orszag believes that health care reform is the key to the fiscal future. Since it his office that will pin the price tag on any health care proposal, his biases matter.
Others are worried that Obama might be soft on insurance companies.
I am not a great friend of the insurance companies. I deal with them every day. But neither am I a knee-jerk opponent of insurance companies.
Insurance companies reflect the markets they operate in. And health insurance companies function in a market that brings out their worst qualites.
Unlike home insurance, or auto insurance, there is no legal or market mandate to have health insurance. This allows health insurance companies to avoid insuring the very people that need it the most – high risk (read sick) individuals.
Outside of the Medicare supplemental insurance market, there are very few limitations on what should be covered or not covered in a health insurance plan. This gives insurance companies the license to put restrictions and exclusions in their policies as they, or their customers, see fit.
Health Care Reform – Three different themes
Three reports this week about the costs of health care and health care reform caught my attention. One said that health care reform will be a sure fire economic stimulus because it will replace jobs lost from the current recession. Another suggests that a modest upfront investment will produce $530 billion in savings. The third moans that without a commitment to hard choices, we are doomed to health care spending profligacy.
John Nichols in The Nation describes a report and follow-on campaign by the National Nurses Organizing Committee/California Nurses Association (NNOC/CAN) that attempts to bolster the argument for a Single Payer health care system by describing its impact on jobs and the economy.
A report in Reuters describes a report by DeLoitte that argues that a $220 billion investment in e-prescribing and electronic medical records will produce $530 billion over ten years.
Lastly, Robert Samuelson in the Washington Post reports on findings of a report by the McKinsey Global Institute that provides valuable insights into why US health care costs so much more than it does elsewhere in the world. Unfortunately, it was short on constructive “shovel ready” policies.
So how does one react to such disparate perspectives. Clearly, each study support a specific ideological slant and approach to fixing our admittedly broken system.
In my last post, I wrote that health care reform proposals need to focus on the patient side of the health care delivery system by designing systems that eliminate the cumbersome, even tortuous routes that patients must travel to enter that increasingly privileged space – a person with health insurance.
An illustrative example is the Qualified Medical Child Support Order (QMCSO). QMCSOs apply to those children who live with one parent but the court orders the other parent to provide the health insurance. The parent who has custody of the child is called, logically, the custodial parent. The other parent is called, can you guess, the non-custodial parent.
Every child support agency in every county and state in the country has a bureaucracy for the purpose of enforcing and administering QMCSOs. It does not matter why the parents are not together. Some are divorces, but some were never married. For a group of 25,000 Participants, my staff probably spends one to three days per month on issues related to QMCSOs.
Very little of that time is spent processing the paperwork. Most of it is dealing with custodial parents, non-custodial parents, child support agencies (issuing agencies in bureaucratese), carriers, attorneys and other stakeholders. In other words, our staff’s time is matched by someone else’s staff time. I did an extrapolation to the US population. It assumes our population is a representative sample of the general population. By my estimate, it is costing the United States economy $100,000,000.
Since November 4th, interest in health reform proposals has understandably intensified. I like to flatter myself that this blog might make a small contribution. But I do have a day job and so the horn I blow here only has one note; if we simplify the system we can find the money we need to cover the people without health insurance and increase product satisfaction among all stakeholders.
I am not a policy wonk who views the health care system wonderfully distilled through the glorious abstraction of statistics; nor am I encumbered by practical politics. I view the system from the bottom looking up. I have a stake in the present system, but that stake is poorly represented in these musings. I am a gatekeeper to the health care maze. In my ideal world there would be far less need for the work I am doing.
I know from daily encounters just how daunting that maze is for people needing care. I tend to demonize piece rate physicians who are too quick to deny care rather than trust the maze.
So when I read others who write about health care reform I look for my theme. On Sunday, November 23, 2008, the Washington Post published an opinion piece by Shannon Brownlee and Ezekiel Emanuel, 5 Myths About Our Ailing Health-Care System. The authors are right on target with four of the five myths that they debunk. They drive home the point that we are paying a lot of money for our health care, that we are paying a lot of money for not particularly good health care, that we really are paying the price through premiums, taxes, and lost wages, and that Americans are ready for a change.