Thursday, February 9, 2012

Ain’t Nothin’ In Life Free


I’ve been accused of a lot of unfortunate things in life, many of them true. But being a shill for the medical industrial complex is a certainly a first.

The most pernicious aspect of a fee-for-service health care system is that you get paid for doing stuff. Seeing patients. Lots of patients, usually as fast as you can. Ordering tests. Lots of tests, whether patients need them or not. Doing procedures. Lots of procedures. You see where this is going The more you do, the more you get paid. Unfortunately, the only system worse than fee-for-service is getting paid for what you don’t do, for refusing or limiting care. Under such a system, it follows as night follows day that patients will be denied treatmen they need. That’s what the HMO debacle of the 80s demonstrated, and why it ended.

Buying health care is not just like buying groceries, or socks, or a new car. It can’t be (or shouldn’t be) considered as a choice among other choices. I’ve tried, and will continue to try, to leave the question of justice aside and meet you on your turf in terms of making economic arguments for the policies I espouse. Certainly a single payer health care system, which I support but will not happen in the US in my lifetime, is a perfectly rational and efficient way to provide the best healthcare to the most people for the least cost. So short of that blessed day, and in my usual fashion, lets see what we can agree on

1) Eliminate the tax deduction for health insurance. Talk about a regressive tax. The richer you are, and the more expensive your insurance, the more you benefit. What a deal for the 1%.
2) A system of quality control that demands that expenditures have some relation to outcomes. The country does 80 million CT scans a year.  We only have 300 million people.  And no more paying 100 grand a year for drugs/treatment that don’t work. How is it that conservatives think is perfectly fine to sell snake oil
is beyond me
3) Skin in the game. Some small way in which  patients participate in the economics of all this. I’ll let you the economist figure it out
4) On the flip side, support for folks who draw the unlucky straw of a rare or chronic illness that needs extensive support.


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