Tuesday, April 7, 2009
I'm scared. Yes I believe health care is a right but fear that extending that right to all U.S. residents could kill me.
Already, errors by doctors, nurses, etc., kill over 100,000 people a year who shouldn't have died. Countless more get sick or stay sicker longer because of medical errors. Some of that is caused by shortages of health care providers, especially highly qualified ones.
If President Obama keeps his promise to extend health care coverage to the 48,000,000 U.S. residents who don't have health coverage, many more people will become victims of medical errors and all of us will have to wait longer for care, perhaps for inferior care.
My liberal side says all people have the right to health care but my libertarian side says I worked hard so I could afford to pay the many thousands of dollars in health care premiums in hopes of living longer and healthier. So why should I be forced to pay even more tax dollars to subsidize 48,000,000 people getting health insurance, including 13,000,000 illegal immigrants, and millions of others who took welfare instead of a job or refused to delay gratification and took a part-time and/or low-paying job rather than getting a degree and then a full-time professional job so they could afford health insurance? Worse, my paying for them to get coverage will mean that I am at greater risk of morbidity and mortality because of medical errors and long waits, for example, for an MRI exam or to see a specialist.
There's no perfect answer but if President Obama asked me (fat chance) to propose the ideal approach to reinventing health care in the U.S., here's what I'd propose:
1. Here's how I'd address the shortage of health care providers that would result from providing health care to all. Currently, training programs are unnecessarily long and expensive, largely because they're provided by university faculty, who want to teach their academic specialties (chemistry, calculus, etc.) Many a potentially good health care provider has been lost to the profession because of the training's unnecessary length and difficulty. Training should be shorter and based in hospitals, doctors' offices, homes, and other medical facilities, supplemented by a few courses taught at community colleges.
2. Everyone would, as a right of being human, get a basic-level single-payer health care--no paperwork required, no questions asked. "Basic-level" means, for example, that everyone would get exams and routine care not by a physician but by a physician assistant not of their choice,. They'd be entitled to receive cost-effective treatments administered by health care providers not of their choice. Wait times for non-emergency care would be moderate to long. That safety net of basic national health care would be funded as a surcharge on income tax--That would ensure progressivity.
2a. Individuals could purchase a higher level of health care on a fee-for-service basis or with private insurance. Those people could choose their doctor and other health care provider, have shorter wait times, and obtain less cost-effective treatments for example, an 80-year old who'd prefer bypass surgery over treatment with drugs.
3a. People with preexisting conditions would pay the same insurance premium as those without--It is wrong that a person already suffering with a condition should have to suffer additionally by having to pay more. However, insurance companies could add a surcharge for smokers and for people who abuse drugs or alcohol.
4. Health care providers would be incented to focus on primary prevention: weight, smoking/alcohol/drug prevention and cessation, teen pregnancy prevention. They would also be incented to focus on secondary prevention, for example, having medical assistants call patients to ensure they're taking their medication.
5. Health care providers would be paid a salary rather than piecework so there's no incentive to overtreat.
5a. Tort reform would limit physician liability, which would also reduce the expensive overtreatment and defensive medicine that is widespread.
6. Electronic medical records should yield improved medical care at lower cost. A patient's information, diagnoses, treatment, and outcomes are entered into a computer, using nationally adopted software. The results are aggregated anonymously, which provides health care providers with evidence-based data on the meaning of symptom clusters and on what treatments work best and most cost-effectively for what diagnoses. Of course, electronic medical records also benefit individual patients: records are readable (no physician scrawl) and instantly transferable to other health care providers. Patients would have access to efficacy data on individual health care providers, hospitals, and treatments--crucial to making informed choices.
Do you like my plan? Have a suggestion for improving it? Care to propose a totally different approach?