Monday, September 14, 2009

Furthering the health care discussion

I'm putting my conversation with Ryan from the comments below into a new post, for various reasons. Partly because it gives me an excuse to have another post on the blog, partly because the amount I'll need to write is just not conducive in the meager commenting function Blogger offers, and partly because it's my blog and I feel like it. So there.

Anyhow . . .
  • Re: Preventative Care
I wouldn't fuss with this one, except that the people attempting to sell the President's health care bill keep saying that this will pay for itself by cutting costs and finding new efficiencies, such as emphasizing preventative care. This raises so many problems for me. How do you achieve such savings, since preventative care is largely dependent on the cooperation of the patients? How much money would this actually save, since the estimates say that Obama's plan will cost at least $1 trillion? Would a failure of patients to follow preventative care measures result in penalties for doctors? Would treatment of conditions which could be prevented be rationed, discouraged, or used as reason to punish doctors?

I'd like answers to those questions before I accept "More preventative medicine!" as a cure-all for this bill.
  • Re: Other models
I'm not sure which country the Obama bill most resembles, a lot of people suspect that it's a "foot-in-the-door" strategy to get to a British system (based largely on things like this).

In any case, I'm still not sure why we'd want to emulate the health care models of other countries. We still have the best system in terms of outcome following treatment, and the other systems have plenty of problems associated with them. Japan faces a problem of staffing shortages as well, and Germany's care comes at the cost of what I understand to be excruciating taxes.
  • Re: Skepticism on the spending
First off, I don't think it's unreasonable to be concerned with revolutionary levels of spending during painful recessions; there are a lot of estimates that the passage of Obama's bill could strangle any economic recovery for years, maybe even decades. It just seems like a bad idea to restructure such a large portion of our economy in one fell swoop like this, especially when it keeps seeming like Obama wants to hurry it through.

In any case, I think the appeals to Iraq and Afghanistan are unfair. "If you're going to spend money on X, why not spend it on Y as well?" doesn't strike me as a logical argument if X and Y aren't really related. It's a debate of national security vs. domestic policy, and it's not really the topic at hand (plus, I think most people will agree that national security ought to take priority). In any case, I did complain during the spending sprees of the previous administration; not in regards to foreign policy, but definitely relating to TARP and automotive bailouts.
  • Re: Insurance industry collapse
I posted a link earlier as to why people think the insurance industry will be threatened by this, but I'll sum up the arguments: The plan currently would force insurance companies to accept all applicants, the plan forces mandatory coverage, the proposal is to subsidize those who can't afford coverage, and the plan puts mandates on employers for employee health care as well.

I don't have a lot of data to support the threat those issue pose. I can say that they seem threatening. I can say that mandatory coverage doesn't seem to have worked so well for Massachusetts. I can say that forcing insurance companies to compete with the government will never work out for them, but I'm incredibly skeptical.
  • Re: Letting them die
You know, I never said I just wanted to let the uninsured sit outside emergency rooms and die. I feel like that's putting words in my mouth.

To the best of my knowledge, the law on the books is that hospitals have to treat emergency patients, regardless of insurance or ability to pay. While I understand such a thing to be a burden to the hospitals, how much of a burden is it? It seems to be assumed that this is a massive cost, and while I've seen various numbers bandied about as to how much this runs, I've yet to see a citation for those numbers. It's worth asking, however, whether moving to a system where the uninsured receive taxpayer-subsidized insurance will actually do anything besides shift costs around; again, people still seem worried that a sudden influx of newly insured people will cause a strain on the system that will decrease the quality of care currently available. There's also the concern that a publicly subsidized plan would ration care in order to control costs. Is any of that unreasonable?

In the end, I'm not sure I'm the best spokesman for the issue; my grasp of the fine details is lacking, and I work mainly with hunches, suppositions, and reasoning based on incomplete knowledge. That doesn't change my position that it's a bad idea in its current form, though, as always, my mindless blatherings should be taken with an extra helping of salt.

1 comment:

The General's Wife said...

Our hospital, who serves a 6 county area at ~700 beds + trauma center lost $80 mil last fiscal year in unpaid med bills, several million for what we budgeted for.

As the uninsured rise, so will the cost of health care. We're lucky to keep the lights on.

In the meantime, I will keep encouraging insured smokers to keep smoking so they will eventually end up in hospitals, unable to breath, and need my services.