06 March 2007

Universal Health rundown




  1. It's not necessarily that states could (or would) handle it better. As you said, some would, some wouldn't. I just don't agree that guaranteed provision of healthcare to all citizens is a federal responsibility.

    We are a nation of states, and not all states are equally prosperous or adept. Our roads are not equal, our schools are not equal, our individual circumstances (such as the numbers of illegal aliens, unemployment, college education, teen pregnancy, and the like) are not equal. Why should we be subjected to a one-size-fits-all national healthcare financing system?

    Huge federal nanny programs lead to complacency, dependence, and ultimately poverty. We can do better.

  2. My take, btw, is that it doesn't matter who is paying. Our healthcare crisis will not be solvable by any solution until the realization sets into the American consciousness that not everyone is entitled to the same level of healthcare, and that a lower level of care is often sufficient. Heck, I hate paying the exorbitant cost of my family's healthcare too, and I'm a "rich doctor." Going to the dentist is a huge financial hit, but we haven't heard many arguing for universal dental coverage.

    You want to tax everyone $500? Then you can give $500 worth of healthcare to all. That's less than one ER visit for a sprained ankle, the Radiologist's fee for reading a CT scan, or a few months of Lipitor. Forget about the MRI, PET scan, endoscopic pill camera, or TEE.

    Would it ever be OK to do a transthoracic ECHO in a "poor patient" instead of a TEE, even though the TEE would give better info? How about serial examinations instead of a CT scan? A trial of Zantac instead of an EGD? Amputation instead of fem pop? Pain meds instead of knee replacement? Diet and exercise instead of bariatric surgery?

    These are the sorts of things that are on the horizon, if not now then eventually. Prices (and expectations) have to come down. We overtest, overtreat, and skip over many simple inexpensive therapies, and that is what is straining our healthcare wallets.

  3. While you are at it why not b/l orchiectomy for prostate cancer? The cheapest quickest cure for prostate cancer by far...

  4. Nah, watchful waiting is cheaper. But if that's the only treatment someone could afford, then why not? They might even offer it in shadowfax's single payer plan for "free."

    Would they offer radical prostatectomy? Maybe to selected cases on a waiting list basis, after one has obtained the proper clearance.

  5. scalpel:

    taxing everybody $500 gives $2500 of care to all, because only one in five is uninsured. you are correct, of course, that the issue of universal coverage is different to that of rising health costs; however, a monopoly purchaser is better able to negotiate with pharma, with doctors, with other suppliers about reducing these. in Australia (the other health system that I am familiar with), the government negotiates prices with pharmaceutical companies; if agreement cannot be reached, the drug is not listed in the formulary and the great majority of doctors don't prescribe it. OTOH, the government has decreed (not negotiated) doctors' reimbursement (like Medicare reimbursements) and so now 25% of general practitioners and about 80% of specialists will charge a fee above the reimbursement, which comes out of the patient's pocket. Where the government and doctors have negotiated (primarily radiology and pathology), rates of "bulk billing" (ie not charging a surcharge) are much much higher.

    what does this mean for the US? you're right that states are not equally prosperous. for things that are supplied nationally (drugs, stents, supplies) national price negotiation is appropriate. however, for things that are supplied locally (primarily services) local supply and negotiation is appropriate.