I felt enlightened when I read an article in the New Yorker by Atul Gawande that described the reality of health care in America.
I may have been naive in thinking that the information conveyed would be sufficient to drive real reform into the American health care distribution system. We keep fighting each other about pieces of the pie when we should be pulling together to drag our county into the 21st century.
Bottom line - any health care system has three "perverse incentives". Patients want all services immediately. Providers may see patients as revenue streams. Payers want risk pools that exclude high-cost individuals. These are realities, no matter what the structure of the payment/delivery system is.
I'd love this to be a rich diary that includes deep links to proof of my points (summarized above) but what you'll get instead is a discussion of principles and realities. There are many diarists and front pagers that have far more facts, and I encourage the community to explore them. I'll try to respond to comments as my work responsibilities allow.
First, my agenda: I would love for us to implement a single payer system - either in the Canadian model, or a European model. Either would be less expensive and better for our citizens than what we have now and that is proven by factual results that I won't try to repeat.
The reality is that the American public can't be convinced to take that option. Instead the best we can achieve is a "Public Option." Fine, lets work with that and move forward. In conjunction with "no pre-existing" and "no-lifetime-limit" we're getting the core of what's needed.
So the opponents of this plan are proposing "co-ops" as a solution. Co-ops have a great track record for progressives - think Credit Unions as an example. I'm 110% in favor of this, and bank with a local Credit Union myself. The question is, what does this mean in health care.
The Mayo Clinic is presented in the article cited above as an example of a Co-op with great results. And for good reason. They are a world-renowned provider of advanced medical care with excellent outcomes. One of the key enablers of these outcomes is that individual Doctors are not incentivized to prescribe more tests and procedures, they are paid on a salary that represents the success of the organization as a whole. And the organization is not measured by profitability, but by the outcomes of their efforts.
This is what a health care "co-op" does best. It's not about managing the overall payment and services to a community (no matter how broadly that community is scoped). Please read the article cited to understand what this means to communities and individuals and to the overall costs of providing healthcare services to the individuals who represent the goal of this "reform" effort.
Reform isn't about "who pays" or "how much to bill" or "will I be covered". It's about providing basic healthcare service to Americans in a rational way.