Monday, July 9, 2012

Health Care

While my experience in health care has become dated, I will hazard some opinions on myths and solutions to health care in the United States.

1)  The US needs more clinics.  Yes and but mostly no.  While it is true that one shouldn't have to go to a grocery store to get a loaf bread, the cheapest avenue for providing bread will be through grocery stores.  What small dispenseries like gas stations do is allow for people of greater means to purchase either a higher valued substitute good or a better experience.  While in the case of bread, there are places outside of grocery stores where you can get cheap bread, convenience stores aren't the place to organize the wide distribution of cheap food.  So MRI systems at the clinic level likely aren't saving a whole lot of money system wide.  They are however a convenience and are likely utilitized for more marginal cases.

As for the yes part of the answer, there is gross underutilization in the poor community with a dearth of clinics.  Rather than fee for service, the better model seems to be salaried professionals at the clinician level.

2)  Hospitals are expensive.  They are, but that seems to be an outcome of prior choices.  A lot of clinician work and hospice care used to be done at hospitals.  Taking out the bottom has made the top more expensive.  (The $100 aspirins are a billing choice, much like the old $60 dealer oil change.)  The other change is the proliferation of 6-figure administrators.  Despite television advertisements protesting otherwise, it doesn't seem that the 'hospital' adds much to the health care experience, so one should question the value of all the 6-figure administrators.  (Particualarly galling is the demand for volunteers at hospitals among this excess.)  Then there are the doctors themselves who enjoy large incomes and a disproportionate number of professional protections, albeit protections not as rich in other countries.  Those countries demand doctors receive less pay for those protections.  If this money were adding value, it would be another issue.  There is little evidence for this.  The quality of care in this country seems to be actually divergent.  The cause of this seems to be the relatively weaker oversight of doctors.  Doctors are most accountable to the insurance industry, and the protection for them there is to simply paint by numbers.  Hospitals often fear the doctors more than the doctors fear the hospitals.

3)  Insurance as a huge problem is a myth.  It is only a funding mechanism.  Asking it to control costs is something it is not equipped to do.  They are too distant from cost centers and lack ability to induce providers to find efficiencies.  While I don't think insurance as presently constituted is the best funding model for health care, it is too broad of a brush to claim that wiping it out would significantly lower costs.

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