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July 17, 2008

More On Health Care For America Now

Not everyone thinks the new organization Health Care for America NOW is what we need. Here are some other views:

• David Himmelstein, MD: "A Policy Response to Health Care for America Now"

• Rose Ann DeMoro: "Why is Health Care for America Now giving up on real reform?"

• Jenny Brown: "Health Care for America Now: Which Side Are They On?"

—Jonathan Schwarz

Posted at July 17, 2008 10:54 AM

You know, I'm somewhat surprised that no one discusses the problems caused by providers. Insurance companies are a favorite demon, and perhaps rightly so for refusal of care and so on, but they're not uniquely, and maybe not even mostly, responsible for the high cost of health care in this country, which probably causes most of the problem. Insurance companies want low costs, and they should be able to negotiate with providers to bring costs down (i.e., "Lower costs, or we won't cover you, and you'll lose business.") HMOs also encourage a PCP; family medicine is an important way to lower costs, since specialization amongst doctors is a uniquely American disease and probably one of the major reasons health care costs are so high.

Both of these mechanisms are stymied or circumvented by health care providers. Agglomerating into huge "provider networks", like the "Partners Healthcare" network that I got care from in Massachusetts, is precisely a tactic to allow providers to raise costs and avoid the insurance companies' negotiating power. Why don't we discuss that? How come there's no movement to break up such networks? Why is there no discussion of doctor's salaries and overspecialization?

I realize it's easier rhetorically to tar the insurance companies, since their role does not include providing care. But doctors have been hiding behind their caducei for a long time, now. They're not blameless, and we can't fix health care without assigning blame correctly.

Posted by: saurabh at July 17, 2008 04:30 PM

Though I believe that medicine should be socialized its going to be an uphill battle to eliminate insurance companies due to not only the powerful influence of insurance lobbies but possible misconceptions by people about the “horrors” of socialized medicine. I’m sure most have heard them, someone has a friend in Britain or Canada and they had to wait twenty years before they could get medical attention from a doctor or that somehow the quality of physicians would be less because they would be getting paid less and therefore the “best” people would not be attracted to becoming doctors. I think one could easily argue that the people who are interested in making lots of money may not be the “best” people to become care givers. One might even argue that if socialized medicine paid physicians less than they would otherwise be paid in a privatized system it might only attract those people who are genuinely interested in helping people suffering from whatever maladies. Who would you like operating on your body, someone who is out to make a quick buck or someone who cares about what they are doing?

Aside from those issues insurance companies do cherry pick their patients, that is a fact and it simply isn’t fair to those who are in the age group when medical help becomes more and more important. While nothing is perfect it does seem that socialized medicine is the best way to go as health should be a right not just something the wealthy can afford which is how it stands today here in the States.

A number of years ago my father was visiting a friend in France and became ill during the flight. When he got to his friends home she called a doctor who made a house call (see if you can get a doctor here to make a house call) and gave my father a very thorough exam and then decided my father was fatigued (my father was 87 years old) from the flight, gave him a shot of adrenalin after which my father immediately recovered. My father asked him “how much” the doctor replied no charge, smiled and left. Doctors here in the States may be part of the problem but that may well be eliminated by socializing medicine.

Posted by: Rob Payne at July 17, 2008 09:24 PM

The goal of insurance companies is to make a profit. Providing anything more than the de minimus amount of care needed to do that reduces profit. Insurance companies are, from the standpoint of individuals, sociopathic; they cannot act for the common good. Further, they are distinctly anti-capitalist since they are the only industry that makes a profit by not providing a service. While other actors in the health care field may, as individuals or distinct entities, act contrary to the public good, their immediate goals are not by nature at odds with those they ultimately serve. What we have is a massive institutional problem: we have an institution, the insurance companies as a political bloc, that needs to be destroyed.

Posted by: No One of Consequence at July 17, 2008 09:45 PM

Providers fees comprise only a part of the total cost of health care. The rest consists of: pharmacy, tests (blood, xrays, angiography, etc); immunizations, hospitalizations, etc. I'm sure there's a nice pie chart somewhere for relative outlays for Medicare, eg.

It is estimated that as much of a third of private health care is spent on administrative overhead. Administrative overhead for Medicare is about 2 percent.

Physicians are rarely heroes in the health care debate, but to state that they are solely responsible for rising costs of health care is, at best, deceptive.

Posted by: djinn at July 18, 2008 05:12 PM

I didn't say they are SOLELY responsible for the rising costs of health care. But, if you do a side-by-side comparison, American health care costs are not just 30% higher than those of other countries; it is not just administrative costs and insurance company profits that are to blame. I'm not suggesting letting insurance companies off any meathooks - by all means, eradicate them. But there's other factors that should be entered into the debate, as well. Merely removing insurance companies from the game will not by itself bring costs in parity with the rest of the industrialized world.

Also, it should be emphasized that insurance companies DO serve a public good, here - they socialize costs. The providers may be "reducing overhead" by refusing insurance, but the era when people can pay for medical expenses out-of-pocket is long gone.

Posted by: saurabh at July 18, 2008 10:14 PM

Providers are, like teachers in education, a sacrificial goat for the real bad actors for one important reason: provider costs include administration overhead. Anyone who believes that providers deserve some of the blame would have to back up that claim by unpacking said costs from their bills (and not include insurance administrative costs, which are usually combined). Anyone who has worked for any sort of provider can tell you that most of their admin costs are the result of dealing with insurance companies whose practices are deliberately inefficient in order avoid claim payment. Eliminate insurance companies and you eliminate provider costs as well.

Posted by: No One of Consequence at July 21, 2008 03:38 PM

the solution is for all US healthcare dollars to be paid to me. I will disburse funds as I see fit, and keep costs down with a team of Calcutta-based accountants who I'll pay ten bucks an hour.

Posted by: Jonathan Versen at July 23, 2008 12:58 AM