In recent news, Los Angeles County is hustling to keep from rolling down the shutters on a large portion of the public healthcare infrastructure.
Meanwhile, voters in Oregon are looking at a statewide one-payer plan (which appears to be getting mixed reviews, at best).
So heres another thought-question for the folks out there: How would we know when the public health system here had collapsed? What would that collapse look like, and how would we react?
The problem seems pretty simple; Hospitals are morally and legally mandated to care for patients with little regard for their ability to pay. Some of those costs are covered by state and local government, some by the owners of hospitals (who are simultaneously declaring record profits on one hand, and going out of business on the other), and some by insured patients, who face cost pressures as hospitals try and stay solvent.
So the cost of taxes and insurance goes up, meaning fewer people can pay until < sarcasm> there is only one insured, tax-paying patient, and he (Bill Gates) is covering the costs for all the rest of us.< /sarcasm>
Clearly, were in an untenable position, and headed into deeper water on a leaking boat.
So, back to my original question: How do we know when the system has finally broken? What will it take to get the necessary political will to deal with the problem?
Date: 10/13/2002 00:00:00 AM
Ross,I disagree with Mr. Hartin on several points. (Since Armed Liberal did not support Track back and had a 2500 character limit, I posted my full comments here.”It is a simplification and largely false that he costs of health care are also “driven to a very large extent by government regulation.” The extent of regulation, the arcane minutiae and micromanagement so common in health care, is a result of the large number of participants, again including multiple insurance companies, pharmaceutical companies, trial lawyers, for-profit hospitals, not-for profit hospitals, free-standing diagnostic and surgical centers, medical equipment suppliers, and doctors. Among these, there is a profit motive and not a little bit of greed, fraud, and provision of unnecessary services. Deregulation of the current “system” would not help. Indeed, the results of the savings and loan fiasco, Enron and energy traders, and WorldCom suggest that the reflexive Republican call for “deregulation” should be viewed with extreme scepticism. This is a code word for a laissez faire approach allowing unscrupulous individuals and companies to game the system.”For the rest see here. For more, check out Dr. Marcia Angell’s editorial in the NYT or my own blog.
Date: 10/13/2002 00:00:00 AM
Ross – As a health law attorney, I can assure you that a great many healthcare regulations arise solely from either (a) protection of current professional monopolies and the desire of the current health care providers to reduce new entrants into the marketplace or (b) the fact that the government is doing business directly with providers. I believe a political deal could be struck eliminating much of this regulation in return for the kind of public databases you call for.As for “ensuring a truly informed and protected consumer making the choices” – you have a choice to make between consumers, in all their flaws, and government bureaucrats, in all THEIR flaws, making the decisions. I personally would rather make my own mistakes, than have someone else impose THEIR mistakes on me.The choice isn’t between stupid consumers and wise bureuacracies, it is between a wide range of consumers and stupid bureaucracies. A very great deal of local knowledge and preference goes into making health care decisions that will never be available to a bureaucrat attempting to make one decision on behalf of thousands or millions of people. Naturally, a certain level of regulation is called for, but the level that benefits you and I is much lower than the level we currently have.
Date: 10/11/2002 00:00:00 AM
FYI:DIAGNOSIS CRITICAL:An Urgent Call for a Healthy Los AngelesA Town Hall Meeting on health care issues in your communitySunday October 20th, 20022:30 – 5:30pmAgape International Spiritual Center 5700 Buckingham Pkwy Culver City, CA 90230with featured guest speakers:Warren Olney – Panel Moderator from Radio Station KCRWAssemblyman Gil Cedillo – California State AssemblyDr. Thomas Garthwaite – Director and Chief Medical Officer for the LA County Department of Health Services and Local Community Leaders Eleven public health clinics and all school clinics closing. Trauma centers threatened. Reductions in hospital beds and funding for private clinics anticipated. 5000 jobs lost. 2.5 million residents without health care covereage.There are solutions for a healthy LA. Find out what we can do!PARTNERSCommunity Health CouncilsInterfaith Communities United for Justice and PeaceOffice of the Americaswww.NonviolenceWorks.comADDITIONAL SPONSORSCouncilman Mark Ridley ThomasAgape International Spiritual CenterSEIU Local 434BThe Gas CompanyT.H.E. Clinic
Date: 10/11/2002 00:00:00 AM
The costs of health care are also driven to a very large extent by government regulation, so I think a spot of deregulation would help with the problem.The fundamental disconnect in the healthcare marketplace has to do with third-party payers (employers and government). By having one person demand/consume the service, and someone else pay for it, you have broken the critical link that makes any system for delivering goods and services work. The consumer and the payer have to be the same person to some extent. Naturally, catastrophic insurance has a role to play, but the link between getting care and paying for care has to be maintained.One way to start to rebuild that link and start to roll back regulation is to go from our current Medicare/Medicaid system of having the government pay directly according to an unthinkably complex formula, to a voucher system, where the government’s involvement is limited to giving money to individuals to use to buy their own health plan. This gets the government out of the middle of the doctor/patient relationship and creates the groundwork for some serious deregulation (and cost savings) – much of the current federal regulation is based on the fact that the government does business directly with providers.It also creates some room for variety and creativity in delivering and paying for health services, which cannot exist in a system as dominated by direct government payment as our own.
Date: 10/12/2002 00:00:00 AM
I agree that part of the problem is the disconnect between payor and ultimate user of services, however, I am not sure I completely agree with the solution T Hartin offers, primarily because of the difficulty with, on the one hand, “deregulation,” and, on the other hand, ensuring a truly informed and protected consumer making the choices. Most people do not enter the health care system unless they are in some level of crisis, which, arguably, leaves them at some level of disadvantage when making choices about their health. Can a person who has a child that is severely injured (for example) make an objectively rational decision about which service to receive, or are they going to go to the nearest provider? If they go to the nearest provider, who, in an unregulated market, is going to prevent that provider from charging a disproportionate amount for that care? I suppose we could say “Fool me one, shame on…” and say that, eventually, the market will catch up with that provider; however, I fear we could have problems like these all over the place, and the ones who will suffer will be the patients.Finally, before we can have deregulation, we would need to have more transparent information about the quality of care provided by hospitals and physicians, and hospitals and physicians are not about to open up the files and let people see all of the relevant information.
Date: 10/10/2002 00:00:00 AM
I would add two more questions:1) To what extent is the solution an infusion of more money2) To what extent is the solution “reform” of some kindBrad Delong, in a comment on what you would want in a good health care system, once wrote”Figuring out what would be good reform is very hard: you want to balance (a) lots of low-cost preventive care with (b) making users feel the full social cost of unnecessary, wasteful, and duplicative care, and (c) provide essentially full catastrophic insurance to everyone. I don’t know how to do that. . .” glad to be of such great help in clearing things up;)
Date: 10/10/2002 00:00:00 AM
Great questions. Wish I had clear answers. The system is, already, darn near broke. The new infusion of cash due to bioterror will help slow the leak, but it doesn’t plug all the holes (witness the article you cite to about LA). And California ain’t seen nothin’ yet: the report of the first West Nile case in California occurring just this week means that whatever resources are available for other public health programs — food safety & restaurant inspections, vaccinations & free clinics, disease tracking, etc. — may be pressured to have money shifted to handle the emergent situation.