Sunday, August 16, 2009

Government and Health Care

I've heard a few comments this week that summarize why there are doubts about government's ability to "reform" health care.

"Government does some things effectively, and a few things efficiently, but it never does one thing both efficiently and effectively."

The examples cited included the military and U.S. Postal Service. Yes, they function, but no one can claim, at least not with any honesty, that the Pentagon is efficient. Procurement is a nightmare and waste is rampant. Mistakes, even on the battlefield, are common because innovative thinking is rare. War games are, sadly, rigged to support preconceived notions that "more is better" -- more soldiers, more information, more technology. (Malcolm Gladwell has written on this, documenting the changes made during simulations to assure outcomes!)

"Any public option will either compete unfairly or end up needing a bailout. Look at Fannie Mae and Freddie Mac."

Yes, we also get our mail (usually). But the USPS is generally second choice to UPS or Fed/Ex when a package has to get somewhere quickly. So, when given a choice, the private company wins the business.

Why is that?

If a "public option" does compete, will it do so by under-compensating health care providers? That's how Medicare functions -- and it's still a financial mess. It pays less than insurance, so private insurance indirectly subsidized Medicare patients. That's not competition.

Once established, no public program would be allowed to fail. It would get federal funds and "temporary assistance" (like the USPS) when it runs a debt.

What happens when a public program does deny a claim? Will the government end up covering any and every claim? How could insurance compete against that? No, to control costs, as the politicians supposedly promise, some care must be denied because, as insurance companies rightly state, not every claim is reasonable based on science or cost effectiveness.

Hating insurance companies is easy, because they do have to deny some claims. I'm sure any federal system will do the same. Somehow, people assume that feds will approve more care, more tests, and provide more benefits for lower costs. That's simply not realistic.

The chances of government really reducing waste to expand care? There might be some savings, minor savings, but certainly not enough to dramatically expand care.

Here's the dirty secret: Americans live a few years less than others, but we have horrible habits. We overeat, exercise too little, and engage in more risky behaviors. To reduce health care costs, do we want the feds banning "unhealthy" activities? Mandating exercise?

When I read that Americans live 78.4 years and Europeans live 79 to 80 years (and the Japanese up to 81.5 years), I have to ask if I'd be willing to reform my unhealthy habits for an extra year of life.

The real ways to reduce costs, without radical change, are unlikely to be enacted by federal regulators or passed as legislation by Congress.

Tort reform is needed, badly. Malpractice claims sometimes blame doctors for simply not being perfect. Sorry, but life itself is risky.

If a drug, rightly or wrongly, is approved by the FDA, drug makers should receive some legal protections -- unless there is evidence a clinical trial was intentionally misleading. (I think the government should do all testing, with fewer chances of manipulating results.)

Regulate at the national, not state level. Let every insurance company compete on a national level. Right now, there is a patchwork of regulations and mandates, varying by state. Plus, you can only buy insurance from a company approved by your state. Insurance should be interstate.

Nothing is likely to improve, of course... but they will change.

Friday, August 7, 2009

Reading Health Care Bills

This is the current mess of health care bills:
http://energycommerce.house.gov/Press_111/20090714/hr3200_summary.pdf
http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf

When I read the bills, they do worry me. I tell everyone, read the actual bills. Trust no press coverage. Anyone claiming these are an "improvement" forgets the HMO history:

In the Senate, Kennedy, author of the 1971 HMO Act: "I have strongly advocated passage of legislation to assist the development of health maintenance organizations as a viable and competitive alternative to fee-for-service practice..."

Signed in 1973. I have to ask: How did that Kennedy "improvement" work out for everyone? Senators at the time admitted, "The bill is a bit too complex to read and understand" (Senator Herman Talmadge, only "NO" vote -- and a Democrat.)