WhiteCoat

Two Thoughts on Health Reform

I don’t always agree with Uwe Reinhardt’s insights into the health care system, but he is so incredibly spot on with this quote that I had to post it.

[Countries with functional socialized systems] all mandate the individual to be insured for a basic package of health care benefits.

Many Americans oppose such a mandate as an infringement of their personal rights, all the while believing that they have a perfect right to highly expensive, critically needed health care, even when they cannot pay for it. This immature, asocial mentality is rare in the rest of the world. An insurance sector that must insure all comers at premiums that are not contingent on the insured’s health status — a feature President Obama has promised — cannot function for long if people can go without insurance when they are healthy, but are entitled to premiums unrelated to their health status when they fall ill.

A central concept of medical systems in many other countries is “social solidarity,” not irrational demand for the best medical care someone else can pay for.

The US is going to have to emulate another functioning system if it is going to survive. The German model deserves some consideration.

——

In addition, Alexander sent me a link to an Investor’s Business Daily editorial about how Oregon is working on health care reform. Oregon has compiled a list of 680 treatments for medical conditions and has ranked them in order of importance. Oregon will only pay for the top 503 on the list. Treatment for everything below number 503 must be paid out of pocket. Patients with broken toes, cracked ribs, and liver cancer are out of luck – they’re all ranked below number 503. However, treatments for obesity, schizophrenia, pathologic gambling and sexually transmitted diseases are fully covered.

I foresee such a system as a way that health care spending will eventually be curtailed in this country. Liver cancer isn’t covered because not a lot of patients get liver cancer. Therefore, their collective voices are relatively small. When treatment is expensive and relatively few patients are affected, the treatments will be cut. Collectively, patients will receive more care for less expensive conditions that affect more people, but to keep things budget-neutral, patients who have less common diseases will receive less care. Even though Oregon admits that malignant neoplasms are a leading cause of death in anyone 11 years old and older (report pages PT4-PT11), it won’t pay for the care of “ill-defined malignant neoplasms” (#612). Doesn’t say anything about “well-defined” neoplasms, either. Refusing to pay for treatment of malignant neoplasms is great for saving money, but it is essentially a death sentence if you develop an ill-defined malignant neoplasm. Just hope to God that any neoplasm you get is benign. Those are still covered … unless you have a benign neoplasm of the eyelid (#516), kidney (#529), nasal cavities (#539), bone (#540), genital organs (#577 and 603), breast (#638), skin (#646), or digestive system (#656) – then you’re still SOL.

Also note how many of the things that will not be reimbursed are conditions with “no or minimally effective treatments or no treatment necessary.” Who determines whether a treatment is “minimally effective”? Why the same entities that pay for the treatments, of course: U.S. to Compare Medical Treatments

It’s the Golden Rule: He who has the gold makes the rules.

4 Responses to “Two Thoughts on Health Reform”

  1. Griffin3 says:

    Hrmm. PERITONEAL ADHESION – SURGICAL TREATMENT is not covered, that would have killed my aunt at 38 (in a virgin abdomen, too). But we’re cheerfully paying for OBSESSIVE-COMPULSIVE DISORDERS – MEDICAL/PSYCHOTHERAPY and SIMPLE AND SOCIAL PHOBIAS – MEDICAL/PSYCHOTHERAPY.

    And, am I not understanding this? OPEN WOUND OF EAR DRUM – TYMPANOPLASTY is covered, but the associated MEDICAL THERAPY is not? Oregon will pay to glue or stitch the eardrum back up, but not cover the associated antibiotics?

    It looks like a bright young economics intern came up with a really nice spreadsheet, that somehow got published as a standard, without anyone checking to see if it would pass the political stink test. The first time some (well-off) kid is left deaf, or otherwise scarred by this list, it will just dissolve … into what it really is. The hospitals will still have to treat these conditions, under threat of EMTALA and lawsuit, but won’t be paid.

    Gee, citizen, better not to get any of the conditions past line 503. They’re “never events”, don’tcha know.

  2. Jennifer says:

    “Uwe” is such an awesome name.

  3. Patrick says:

    The current White House and Congress are not contemplating health care reform. They are simply re-arranging the deck chairs on the Titanic. The same players who got us where we are now, i.e., the insurance plans/HMO’s, and the pharmaceutical companies have given more money to recent congressional campaigns and the presidential campaign than any other groups. These guys “own” the decision makers. And this is why we will not see true reform of health care in the next eight years.

    True health care reform in this country will need to do three things that cannot be done by our current politicians:
    1. tort reform–take medical malpractice and medical injuries out of the tort system.
    2. Implement a patient safety system that uses a “no-fault” error reporting system similar to that used by the airlines.
    3.Ration health care according to well-publicized criteria and insulate providers from liability when they follow these criteria.

    “Health care reform” sounds great doesn’t it? Obama is a smart guy who is using this smoke screen of “health care reform” to jockey for re-election.

  4. DefendUSA says:

    Judd Gregg had this to say:

    “To be effective, health care reform must include insurance coverage for everyone, encourage prevention measures, and reform the inefficiencies in our system to ensure the future strength of our economy. CPR—Coverage, Prevention, Reform—is a plan I have proposed that sets up a system where every American will be required to purchase MEANINGFUL health insurance to ensure each family will be protected against bankruptcy if a family member becomes seriously ill or injured.”

    How is the Government going to define “meaningful”? Seriously?

    Is everyone supposed to get the same “healthcare” that Bill Gates can afford? If not, why not?

    Where’s the line between “meaningful” and “luxurious”?

    Where’s the line between “meaningful” and “not enough”?
    I say follow the Constitution. And there is not a word in it that says the gov’t can mandate that I be forced to pay for something they get to define in terms of me.
    Are we going to have sliding scales based on salary and will I be forced to pay for someone else to get better than what I have?

    Here is an analysis of the bill by Keith Hennesy:

    http://keithhennessey.com/2009/06/08/kennedy-health-bill/

    Here is a funny cartoon….
    http://www.tobydials.com/td/

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