Tuesday, March 16, 2010

Ruminations on the now infamous Health Care Bill of 2010

I keep hearing variations of these phrases over and over in the discussion on health care:
  • "We cannot do nothing"
  • "Doing nothing is not an option"
  • "Even if this bill isn't really what we wanted, it's still better than doing nothing"
There's been a lot of articles about the cost of doing nothing.  And I mostly agree - things can't go on in the direction they're going.  We probably shouldn't do nothing as far as health care goes.  Of course, it seems odd that the number one priority of the American voter is the economy, and doing nothing is the very strategy being implemented to address those problems... but I digress.

As I was saying, I don't have any trouble with the statement that we cannot just do nothing - the problem I have is with the continuation of that statement - that what is being proposed now is somehow better than doing nothing.  I don't believe that's true.  Not for a second.  I believe that with our country facing record deficits, two wars, a disappearing job market, an out-of-control housing market, an insufficiently-regulated and poorly understood banking system, baby-boomers about to retire, and Iran making nuclear threats that are eventually going to force us to act - we are in for a world of hurt if we do the wrong thing here.  Doing nothing is actually a better option than doing the wrong thing.  And that's what I think this bill is in it's current state - the wrong thing.

Now, should we do something - yes.  There's no dispute.  Should it be the most pressing thing congress is doing now? Should Obama be the proverbial emperor Nero? Fiddling-with-Health-Care-as-Home-Burns? Well, lets forget all that. Lets just pretend for a minute that our country isn't in the greatest economic crisis since the Great Depression and that unemployment isn't in double-digits; lets pretend we live in some alternate era where most rational people could agree with Health Care as the #1 priority on the docket.  Lets look at just a few of the problems with our Health Care system in this country in no particular order in a list that is far from exhaustive:

Some problems I see with our current health care system:

  • Health care costs are increasing at a rate vastly greater than inflation.  The rate is not sustainable.

  • The young and healthy are less likely to contribute to the system since they don't need to utilize the system.  And they have no way to invest in it in any reasonable way for the future when they will inevitably need more health care - you pay your premiums for a year and that's all there is to it.  No future thinking - this isn't a 401k.

  • Health care is often tied to your employment and subsidized as a benefit.  This means:

    1. Free-market principles don't work - consumers cannot shop around for comparable insurance - they either take what their employer subsidizes, or pay extravagant premiums for their own, or they go without and pay out-of-pocket.
    2. If you leave your job, you're all of a sudden without insurance.  You can do COBRA, but without the subsidy from your employer it's not worth the cost.  The only reason to do COBRA is if you have major medical expenses, or have a pre-existing condition where you fear having a gap in coverage.

  • Free-market principles don't work in the doctors office - the consumer is not knowledgeable about the cost of tests, labs, and procedures - nor do they know about their necessity, effectiveness, or alternatives.  Often, there's just a race to meet the deductible, and then all the real costs of health care get buried in insurance EOBs.
  • The quality of care and the knowledge of your doctors varies.  One doctor may order a bunch of unnecessary tests (hey, insurance pays, right!?) or recommend costly surgeries.  Another doc may treat with medications or non-surgical options.  Practicing medicine is sometimes an art, not just a science.  Some people are better at it than others.  Some are good docs, but are out of date.  Some run up a tab like it's an episode of House.

  • Big Pharma spends big dollars educating docs on the newest meds they sell - less costly generics may be just as good, but the docs don't always hear about those alternatives.

  • People don't understand their health care - it's often very confusing.  The Dr. is in a hurry, or the patient doesn't know what questions to ask.  This leads to misuse or non-use of medication, re-admission to the hospital, and all sorts of other costly health care incidents.

  • People self-refer to specialists (often the wrong one, so big $$$ wasted), or they use the ER or Urgent Care as their primary Dr. office.

  • Americans are (statistically speaking) fat and lazy which contributes to all sorts of health problems and costs.

  • Doctors don't (and often can't) easily share information.  Is that procedure duplicative?  Did that patient just have an MRI that is usable from last month?  ERMs (electronic medical records) are not ubiquitous by any stretch, and are still too costly for many small practices.

  • Many, many people are uninsured, or unisurable.  They're often poor, or very sick, or both.  The number being bandied about is 30 million.
...and I'm sure that you can think of 100 other problems with our health care system off the top of your head.

How many of these problems is the president even talking about, and how many of these will have solutions in this bill?  The one and only one appeal I've heard lately from the president is the last bullet point I mentioned above - we keep receiving the emotional appeal about the 30 million uninsured.  They're hell-bent on fixing that one, at a cost of who knows how much.

I'll be the first to admit that it's easier to be a critic than it is to create something of real value.  I don't envy those we've sent to Washington.  They're tackling an issue that, quite frankly, career politicians probably aren't qualified to understand.  The trouble is, they're unwilling to admit that they don't really understand the implications of what they're doing.  They keep saying "trust us", while we keep begging them to "please just listen to us".  Doing the wrong thing here will have more severe consequences than doing nothing.  At least with doing nothing, you're not under the delusion that you've made progress.  Of course, I'd much prefer that they do the right thing than nothing, but it's doubtful anyone can agree on what that even is.