Wednesday, October 8, 2008

Missing the Point about Health Care

John McCain wants to give everybody a $5,000 tax break to help them pay for health insurance.  Barry Obama wants a more draconian approach, requiring by law that all children have health insurance, and setting up some sort of nebulous government group insurance.

Obviously, McCain's proposal is the more preferable one, if only because it's less intrusive.  Before I get to pointing out where the fire really is, let's clear some of the smoke from the room. . . .
The so-called health care crisis is mostly invented from whole cloth by the Democrats.  They've been hollering about this for 16 years now, ever since Hillary's attempt at creating a massive medical industrial establishment fell flat on it's face.  The fact is that most people are insured.  The massive numbers of uninsured quoted by the Democrats are specious.  A significant number of those uninsured are from the demographic least likely to require major medical care: young males.  There are huge numbers of people for whom health insurance is available and affordable, and they have consciously made the risk/reward assessment and chosen not to spend their money on health insurance.

During this whole debate, I never hear anyone pointing out that people do receive medical care, even if they're not insured.  Shriners do yeoman work in ensuring that children who need medical care get the best.  When my uninsured mother died of lung cancer, the hospice and medical care she received was second to none, and no one ever sent us a bill.

Before I go too deep into cause and effect here, let's take a brief time-out to follow the money.  In the 25-30 years after WWII, we saw a huge military industrial establishment form in this country.  President Eisenhower wisely warned us against this fusion of government and industry.  Inflated government contracts with insufficient oversight and lobbyist kickbacks ensured huge amounts of money flowed from the public coffers into the hands of industry, and John Q. Public certainly did not get his money's worth.  Since the wind-down of the cold war and increased scrutiny by the golden fleece committee, these sorts of abuses have become harder to hide.  Unscrupulous legislators yearn for the glory days when government contracts can again spend billions of dollars on a government sponsored industry, and the Democrats see health care as the perfect growth industry to support this.  They want to see a medical industrial establishment, where government gets a chance to skim the till  as the money  flows from patient to health care provider.

Medical care costs are skyrocketing, and neither candidate has come within a country mile of the real sources of the problems in our medical establishment.  Anyone who takes economics 101 understands the root of high prices is explained by supply and demand.  Demand for health care is a given, and we are happy that it is growing, because it means we're living longer.

Let's look at supply: What does it take to become a medical doctor?  Answer:  Resources.  Lot of them.  Eight years of college, followed by 3 to 7 years of residency.  With today's tuition fees, this is an absolutely insane amount of money to spend, not to mention living costs.  This commitment is expected from a demographic of under 30 who are at a time of their life where they are driven to establish life-long relationships, start a family, buy the first home, etc. By the time I was 26, I was debt free and embarking on a professional career.  By the time the medical student is 26, they are just finishing school, preparing for their first entry level position, and typically saddled with crushing debt.  The only silver lining in their world is that their skills are rare enough that they can charge exorbitant fees and get them -- which they have to do to pay their debts.  This is not a way of making a cost effective doctor.

The second leg of this medical cost crisis is our legal system.  Ambulance chasing lawyers (I'm looking at you, John Edwards!) are always looking for a quick way to sue some medical provider.  To protect themselves, doctors take out malpractice insurance.  Knowing these doctors are insured just encourages the sharks, because they know there's a chest full of cash available.  Often insurance companies settle malpractice claims out of court, because lawyers are smart enough to know how much to ask for, making it cheaper to just pay rather than fight.  Our legal system requires any claim to be given a fair hearing, and the defense must spend money to defend against such a claim, even if it's completely specious.  Insurance companies pass the costs of these frivolous lawsuits on to the doctors, who then pass it on to the consumer. Many private practice doctors have closed up their business because thay can’t afford the malpractice premiums

One cost of medical care that’s gotten a lot of press in the last few years is prescription drug costs.  Prescription drugs cost a lot of money for two reasons:  One is the risk that drug companies take in development and approval.  Developing a drug costs money, and for every drug that successfully hits the market, 100 others failed to perform adequately and never reached market. Once a drug hits the market, the company is vulnerable to class action lawsuits if long-term complications are found and people are injured. Lawyers dream of this sort of thing. Say drug XYZ reaches market and is later found to cause irreversible heart valve leakage. Some lawyer puts an ad in newspapers nationwide, collects 4,000 people who have been harmed by this drug and seeks damages in court to the tune of  $15,000 per person. That’s 60 million dollars, of which the lawyer gets half. The drug company has to pass this cost on to the consumer in the form of higher drug costs.

The bottom line is that a shortage of qualified health care professionals and a surplus of legal risk has combined to create a health care shortage. What I want to see is a candidate who has the courage to address these problems head-on:
  •  Take the government money being spent of health care that ends up in the pockets of insurance companies and HMO’s, and use it instead to fund a scholarship program for Medical Doctors. A lot of very good minds chose engineering over medicine, because they couldn’t afford the tuition and time to become an MD.
  •  Work with the AMA to streamline a course of study for Medical Doctors, and allow medical students to specialize early. It shouldn’t take eight years to become qualified to be a family practitioner. Medical students often do not utilize much of the specialized training they receive, since they do not specialize until after they have become a resident.
  • Massive tort reform is required. Our system should be reformed so that the loser pays the legal costs of any lawsuit for both parties. This by itself would cause frivolous lawsuits to become a thing of the past, and many lawyers would need to find other lines of work, perhaps in the medical field.
  • Lawyer fees and malpractice damages must be capped. People need to be aware that letting someone knock you out and take a scalpel to you entails a certain amount of risk.
  • All doctors should be required by law to make their medical practice records freely available to the public, using some sort of peer approved rating system by which the competence of that doctor may be easily evaluated by the layperson. As in any other profession there are good doctors and bad doctors. The problem is that the public has no way of evaluating the difference, and because of the legal environment, no medical provider is going to help.
Socializing health care or just dumping money into the existing system are both losing strategies. Neither party, neither candidate in this campaign recognize what the problems are, let alone how to solve them.

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