Saturday, June 5, 2010

Why I'm not a fire eater in the health care debate

If you skim my blog you know that I am by disposition "conservative" on many issues, although such labels fail to do most folks justice.

One of the reasons I've been pretty mum on the health care debate is that I have two disabled/special needs family members. I'm in that crowd of "Something needs to be done but I don't know what" people.

Exhibit A:

Just opened the mailbox and found the pre-insurance tab for my wife's week in the hospital. She had a painful GI issue - treatment included a couple of diagnostic tests but no surgery, thank God. But it comes to


Exhibit B:

My autistic kid takes several meds. I got a look at what just one of them would cost without insurance:


I work two jobs, the second one mainly to carry a good medical plan for my family. The deductibles will still leave me out a few thousand, but I won't have to come up with $50K for the hospital or $2K per month for the pharmacy. Still, the staggering cost of health care really comes home when you look at an invoices like these.

This keeps me humble when it comes to health care policy. More than a year's salary for a week of gastrointestinal distress is absurd, as is expecting a person to pay more than their mortgage each month for a bottle of pills.

How to make the costs realistic without devaluing and degrading care and research is a big challenge, sprawling into several aspects of our political and economic systems.


Kim said...

It’s hard to know where to begin, but this cry of absurdity deserves a response. You are right, it is absurd.
I am a believer in free markets. I know that’s frightening when faced with a critical need that carries such an enormous financial impact. But there isn’t a way to fix problems, born out of needless complexity, with more heavy handed complexity.

Medical care bills are high for many reasons:
3rd party payers = price and cost distortion.
Regulation = price and cost distortion
Managed markets in insurance coverage = price and cost distortion
Mandates = price and cost distortion.
Legal protections and liability = price and cost distortion

We don’t have real insurance. We don’t have competitive pressure on prices or on enhanced technology and treatment. We don’t have transparency, so we don’t have the information for the cost/ benefit analysis of the care we choose…the doctors, the procedures, the drugs.

It is not possible that more central control of medical care can make more available at less cost. Less cost means, necessarily, less availability. Expanded availability means, necessarily, more total cost. And the cost centers are then targets for cost cutting, meaning reduced availability.

TLF+ said...

Hi, Kim. I appreciate your summary of cost drivers.

Do you think that there can be

a) a coherent remidial platform stated and

b) public will to support it? (Correcting mandates means undocumented people can't use the ER as primary care; Legal protection/liability reform means people can't win the lottery when their doctor messes up).

As with a number of messed up aspects of our national life, solutions will require sacrifices. Will take some amazing leadership to get people through the changes.