Tuesday, July 21, 2009

The Unspoken Key Issue re Health Care Reform

The medical establishment already kills over 100,000 people every year as the result of medical errors. Countless more people stay sick longer or get sicker because of such errors. For example, someone just told me that because of an error in surgery, he became blind.

Under President Obama's health care proposal, we'll be providing health care for 45 million more people with the same number of doctors, nurses, hospitals, MRI machines, etc. That 45 million has greater-than-average health care needs while having lower average income, and thus will often get low-cost or free health care under the Obama plan. The result will be that even more of the people who do fully pay into the system will stay sicker longer, get sicker, or die.

From where I sit, the answer is a two-tier system: a basic level of care for everyone and a higher level of care for those who pay into the system. Alas, I doubt seriously whether the Democrats could ever support such a plan. Their core principle is that equality trumps merit.


Anonymous said...

I saw the following video today:


This is a Missouri Congressman attempting to explain the current health care bill to his constituents. There are a couple of moments where the crowd laughs at him, loudly.

At the end somebody asks, “If it’s so good, why doesn’t Congress have to be on it?” Brilliant. Naturally, the Representative doesn't answer.

And it looks like somebody else in Congress asked this question, too.


Not that they'll actually go along with that, of course.

You know, every time the political elite does something to us from which they are exempt, we should ask that question. Why isn't it good enough for them?

Publicly, I think their core issue is indeed "equality trumps merit." But in their minds, I think it's that famous line from Animal Farm: "All animals are equal, but some animals are more equal than others."

Anonymous said...

We already have a two-tiered system in the US, with many folks being cared for at safety net clinics.

Democrats and Republicans are supportive of these clinics, as are the smarter regional hospital systems.

A typical safety net clinic has few doctors and far more nurses and physicians' assistants in its provider mix than does a hospital or HMO, and the providers like the environment because they are given much more authority than they would at a hospital or HMO run facility.

Folks with chronic conditions are a ton cheaper to care for in this setting. Diabetes is a great example. Proper diabetes care involves teaching people what to look for, bringing them in periodically for monitoring and educating them on food choices (I think many folks would be surprised at how challenging it is to eat a decent diet if you have mobility problems and live in a poor neighborhood, where the local market often stocks much the way a 7/11 or a gas station does, but with more liquor.)

If you are not able to do this, what you will have is folks keeling over and ambulances being called and patients being seen in the ER and then admitted to the full-service hospital while they are stabilized. Admitting diabetics to hospitals is far more expensive than seeing them as outpatients - and relatively little of the outpatient care they need requires an MD to intervene.

There are other examples as well, diabetes happens to be one I'm familiar with.

Michelle Obama worked in Chicago on strengthening ties between the U of C hospital system and community clinics on the South Side. She took a lot of heat from some folks who felt they were being shuttled to a second class system, but knew that the work had value and kept doing it.

Safety net clinics are structured to be keep afloat on the payment rates from Medi-Cal (our variant of Medicaid) and Medicare, which many for-profit enterprises or larger not-for-profits are not able to work with.

Definitely expect to see this model of care growing and hopefully becoming increasingly professional as well.

As far as the error rate in medicine goes, most people get more medical care in the last six months of their lives than in their lives up until the end. Based on that, I would guess that more than half of the errors you cite are for patients who are coming in in bad shape and are in decline.

If my guess is accurate, one has to ask if these errors are causes of or contributors to the patient dying. An error in pain relieving medication, for instance, can hasten a cancer patients' death. In some cases, the patients themselves are pleading for the error to be made; I am not sure how that situation would wind up being reported out in a statistical summary.


blogger templates | Make Money Online