Let me first say that Veritas made an excellent commentary that addresses some very fundamental issues of health care reform and the ongoing debate. I agree that the current discussion is not being helped by fear mongering such as "socialized medicine" or "government-run health care" or "no one wants a bureaucrat between them and their doctor" (and the last would be different how from HMOs?). As Veritas points out, health care like so many other resources, is a limited resource and by definition is rationed in one form or another.
So how to do it? I heard an excellent segment recently on Fresh Air by Maggie Mahar. It's only 20 min long and well worth a listen. She highlights some of the reasons for skyrocketing costs of health care and offers some interesting solutions to at least part of the problem. A few of her points:
1) Like Veritas pointed out, going away from a fee-for-service approach vs. a lump sum payment might be one way to shift the focus to spending what is necessary and important for patient care rather than trying to make money. One perverse thought - might doctors/hospitals actually cut out certain tests or treatments in the interest of making more profit? Presumably this would be held in check by conscience as well as potential for lawsuits, but I wonder.
2) Making all insurance companies nonprofit. Another potential way to focus services on efficient, outcome based patient care rather than profit.
3) Increasing payments for primary care providers and reducing them for specialists. I certainly do see the inequity in salaries and reimbursements for procedures vs. primary care services. This may be one way to increase our supply and effectiveness of primary care providers.
I also wonder what happened to the discussion of malpractice lawsuit reform? I really like the idea of having a panel mediate such disputes and think this would go a long way towards bringing health care providers on board, even if it is a relatively small part of the cost of health care.
Speaking of the numbers, Henry Aaron has a very nice commentary in the New England Journal discussing the projected costs of the current health care bill as well as options to pay for it. This is well worth a read, and at some point Americans need to be better informed as to how we might pay for all this if we are going to do it. Adding to the deficit is really not an option at this point in my opinion. One option that has been put forth is making cuts to Medicare and Medicaid which Aaron shows to be one of the biggest areas of savings, though it remains unclear to me what these cuts would entail or mean.
On a more general note, I wonder if some (or much) of our increasing health care costs are due to lifestyle factors of Americans. Rates of obesity have skyrocketed along with its consequences of diabetes and cardiovascular disease. Perhaps we should really be targeting our funds towards prevention such as weight loss counseling and treatment and exercise programs. Reducing this burden would have tremendous effects on the long term health of Americans and I predict would go a long way towards lowering costs in the long run.
I really look forward to more discussion on this and feel like I have so much more to learn. It's a complicated issue but a very important one. And as Veritas points out, what we are doing now is simply not sustainable.