07 September 2009
Health Care, not Insurance, Reform
The problem with the U.S. health care system is not how it pays for medical services but how much it pays for them. The health care insurance system is, admittedly, bureaucratic and aggravating. However, residents of the U.S. pay at least 50% more for keeping their lives going than those of any other country. Somehow those expenses are getting paid for, and the health insurance system is paying for them, however inefficiently.
The cause of excessively costly health care in the U.S. is really that the system provides inefficient medical service to its participants. Legal tort practice is part of the reason, necessitating redundant testing, therapies, hospitalizations, pharmaceuticals, specialists, etc. in order to satisfy jury opinions rather than the judgment of wise physicians. The typical American belief in technology as the ultimate solution to every shortcoming is another source of the country’s dilemma. Why rely on the advice and diagnosis of a generalist, the family doctor, when there is probably a highly-trained and compensated specialist for any ache or pain?
Reforming the country’s health care system will not prevent medical costs from growing. Even those countries that spend less per capita than the U.S. with similar or better outcomes will suffer the fiscal consequences of increasingly long life expectancies—older populations simply require more health care services. But health care expenses will grow less rapidly if the practice and expectations of medicine are reformed to support its ability to guide individuals in leading healthier lives by emphasizing the key role of general practitioners in keeping the public physically sound. This may require government intervention in the way the market compensates primary care doctors so that more competent and imaginative physicians are attracted to field.
Athul Gawande’s recent New Yorker article illustrated how Medicare billings are bloated by careless reliance on overtreatment and specialization in one community when compared to another. It wasn’t the absence of public health insurance that made the difference between them, for the public health insurance provider was forced to pay in both communities. In the long run, devoting the nation’s health care dollar to raising the financial rewards and results-oriented incentives of family doctors will be cheaper than creating another public vehicle to channel insurance funds to health care providers in the same wasteful way.
The problem with the U.S. health care system is not how it pays for medical services but how much it pays for them. The health care insurance system is, admittedly, bureaucratic and aggravating. However, residents of the U.S. pay at least 50% more for keeping their lives going than those of any other country. Somehow those expenses are getting paid for, and the health insurance system is paying for them, however inefficiently.
The cause of excessively costly health care in the U.S. is really that the system provides inefficient medical service to its participants. Legal tort practice is part of the reason, necessitating redundant testing, therapies, hospitalizations, pharmaceuticals, specialists, etc. in order to satisfy jury opinions rather than the judgment of wise physicians. The typical American belief in technology as the ultimate solution to every shortcoming is another source of the country’s dilemma. Why rely on the advice and diagnosis of a generalist, the family doctor, when there is probably a highly-trained and compensated specialist for any ache or pain?
Reforming the country’s health care system will not prevent medical costs from growing. Even those countries that spend less per capita than the U.S. with similar or better outcomes will suffer the fiscal consequences of increasingly long life expectancies—older populations simply require more health care services. But health care expenses will grow less rapidly if the practice and expectations of medicine are reformed to support its ability to guide individuals in leading healthier lives by emphasizing the key role of general practitioners in keeping the public physically sound. This may require government intervention in the way the market compensates primary care doctors so that more competent and imaginative physicians are attracted to field.
Athul Gawande’s recent New Yorker article illustrated how Medicare billings are bloated by careless reliance on overtreatment and specialization in one community when compared to another. It wasn’t the absence of public health insurance that made the difference between them, for the public health insurance provider was forced to pay in both communities. In the long run, devoting the nation’s health care dollar to raising the financial rewards and results-oriented incentives of family doctors will be cheaper than creating another public vehicle to channel insurance funds to health care providers in the same wasteful way.
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