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Health Care: First We Need to Understand the Problem

Posted in healthcare, politics by dingodonkey on August 15, 2009

Health care reform is currently the focus of a fierce debate in this country, with a deeply divided populace passionately engaged in efforts to radically reorganize one of the basic pillars of our social order. But for all this deep disagreement, there is one thing on which almost everybody agrees (even if certain members of the pundit class deny it as a rhetorical device): the system as it exists today is badly in need of reform. Reform is popular. Everybody wants reform.

We just can’t even come close to agreeing on how to reform it.

I think there are many components of a comprehensive overhaul that overwhelming majorities could agree upon, but in order to evaluate those, we first must analyze and understand the existing problems, and how they came to be. I have found David Goldhill’s How American Health Care Killed My Father from The Atlantic immensely helpful for this purpose. Goldhill takes a look at our health care system as a system, and tries to apply business sense to understand what structural features of our system give rise to its failures (these he already knows quite well: they killed his father). I could not recommend more highly that you read this article.

Among his points — and I’m taking considerable liberties here, dressing them up with my own thoughts — that I believe can help us develop better understanding and, ultimately, solutions:

  1. “Health care isn’t health,” an important conceptual distinction that gets lost in the rhetoric.
  2. “Health insurance isn’t health care,” another important distinction that our politicians in particular do not want to acknowledge.  Think over the ramifications of just these two fundamental points.
  3. We’re massively overspending for the care we receive.
  4. Stemming from the second point above, there is a big difference between an insurance policy and a payment plan.  My car insurance doesn’t pay for my oil changes, it mostly pays for unexpected catastrophes that I can only afford to cover by pooling my risk.  I pay for the other car stuff out-of-pocket (and I’m able to do that because I’m not massively overcharged for that stuff).
  5. We aren’t the customers if we have insurance (or if the government provides it).  The idea of sick patients being thought of as customers instead of sick people isn’t warm and cozy, but on the necessary business side of health care (as opposed to, you know, the caring side) it’s vital.  We’re not really the ones calling the shots.
  6. Inter-state competition amongst insurers is virtually impossible under the current system, throwing a wrench in the gears of the market system.  When we allowed such barriers to be built up in our banking system, we had a Great Depression.  The insurance game isn’t that different.
  7. Government mandates, regardless of how they impact the caring side of the industry, are really hurting the business side.  We need to ask when and if they are worthwhile, because we are paying for them.

So the obvious question is, how are these issues addressed by the current proposals before the Congress?  Goldhill, himself a Democrat favoring fundamental reform coming from a government level, concludes that they are at best ignored, at worst exacerbated.

After that, since we all agree something needs to be done, the really big question remains: What do we do?

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