Saturday, August 8, 2009

...Okay, no, really.

We were just out in Modesto, and saw several posters printed out and stuck on trees, with President Obama's face on them done up to look like the Joker, and "Socialism" written under them.

I just... need to point something out, here.

Among developed nations, we have the highest or nearly highest infant mortality rates, death rates from preventable and treatable illness, and costs per capita to provide health care to our people.

Comparable nations with single-payer health care have much lower infant death rates than we do, far fewer deaths per capita from preventable and treatable illness, and longer life spans, and they spend a hell of a lot less per capita to do it.

This all seems very simple, to me.

The system we have now still covers people who aren't insured privately--but we do it by picking up the pieces when someone who couldn't afford to get preventative care or get a small problem like an infection or a minor wound or a bad flu looked at winds up on death's door (which is to say, in the ER) with a far more expensive problem. What could have cost a few dollars to treat or prevent costs thousands to the revered taxpayers. The prevalence of untreated disease means that it's a lot easier for diseases to spread like wildfire, too--so this isn't just the problem of the person who's sick. This is your problem, too. Yes, there are clinics, but they're overworked, understaffed, underfunded. Yes, there are some safety net programs in place, like Medicare and Medicaid and Medical, but they're increasingly underfunded, and are sloughing otherwise eligible people off of their rolls, ever day. And the ERs and Medicare and clinics are all a lot more expensive per capita to run than a central program with a strong emphasis on prevention would be.

The public option doesn't eliminate private health care, if you've got it and you like it. HMOs and the like already limit your choice of doctors and services, and while they don't run your requested services past a bureaucrat (who incidentally has no profit motive), they DO run your requested services past a mid-level businessman who wants to (1) make the largest profit possible from serving you, and (2) spend the least amount possible on you to do it. This is the nature of having shareholders; their job is not to keep you healthy or happy, their job is to produce profit. Any service they can avoid giving you, they will. The more they can charge to give you the services they do, the better. And the fewest at risk (read: in need) people they can insure...

This is really not limiting our options. It just means that people with nothing but desperation can be healthier, and fewer people die for no reason. Some people running private health care companies may lose a little off of their multi-billion-dollar profit margins. I can live with that.

1 comment:

Doc Nagel said...

A common rationing technique employed by HMOs is to use outcomes measures (aggregate data regarding effectiveness of treatments) to determine limits of treatment availability. An illustration: depressed person, let's call him Chris, is doing well on a treatment of psychotherapy and prescription medication. The HMO, based on therapeutic data drawn from similar depressed persons, determines that Chris will benefit from psychotherapy, but that extending it beyond 18 visits (2 per month, for 9 months) is too expensive for the benefit it will provide. It cuts Chris off at 9 months. If he's still depressed, his remaining treatment option is "cheer up."

Another way managed care companies manage costs is with mandatory "stop loss" and "hold harmless" agreements. "Stop loss" sets a limit to the company's liability for providing care, at which point, the burden is shifted to government, or to no one. (The loss being stopped is *theirs*, you see, not yours. You might still lose, but, as HMO execs often put it, "screw you.") "Hold harmless" provisions hold the managed care company harmless in the event that withholding or withdrawing treatment from you somehow harms you.