A few days ago, another DK member(I can't remember who, sorry) wrote a great diary about single payer vs public option. At the very bottom was a link to an article that I found really interesting.
http://www.newyorker.com/...
If you have not read this article, please do.
It reminded me of a book I had read called:
Better : A Surgeon's Notes on Performance by Atul Gawande
Let me first state that I strongly support cheaper health care in either the form of single payer or the public option or even private insurance.
I don't however think that in its current form either single payer or public option is going to solve the issue. And here is why...
Neither is actually addressing the quality of health care. Yes you can get coverage at a low cost but is it really going to improve the quality of health care.
The article above went through a case study of a town in Texas and dug into why health care cost per person was some of the highest in the country.
It wasn't a case of sick people, or bad lifestyle choices. It was the doctors and insurance companies together that were driving up costs.
I have heard about the big bad insurance companies over and over again on this site. And I agree, they suck. I don't want to pay 75% of my premiums for an executive’s plane. However health care insurance spends most of its time denying claims rather than giving me services. Nothing is covered so any extra tests I need are usually out of pocket. The doctors are reluctant to do additional test because of the hassle of trying to get it covered.
Is this good for my health? No.
So let's give everyone a Medicare style public option and all our problems will be fixed.
Actually no. According to this article, because the government pays less for certain procedures (Good for the government), doctors are less likely to recommend low cost preventative measure and are more likely to skip to highly invasive procedures that cost more money and can raise their revenue.
A good example of low cost versus highly invasive and expensive is presented in the book Better that I mentioned before. The author is a doctor himself and he presents the case of C-sections. They are more common now than ever before. He mentioned that one reason that C-sections happen are due to babies who get stuck in the birth canal. In the old days, a doctor would use forceps to get the baby out. These days the majority of these cases end up with C-sections. Why? Because
a) Doctors are risk-averse due to malpractice issues.
b) It's easier for a doctor to do a C-section than deal with forceps.
c) C-Sections are good business for hospitals.
d) Not enough doctors are trained in how to use forceps.
So at the end of this procedure, the doctors were able to deliver a healthy child without the risk of malpractice and were able to raise some revenues. Who is the loser?
Well the loser is the mother. Yes she has a healthy child but she had to undergo major surgery that carries far greater risks than forceps. She also has a longer recover time.
It's a case of expensive to the tune of 60K versus a low cost method that ends up enhancing the patient’s quality of care.
See my problem with single payer and public option is it doesn't actually address the quality of my health care. I don't want unnecessary procedures because my doctor sees me as a cash cow with the government footing the bill. I also don't want to deal with health care insurance that decides it more profitable for me to die than to get treatment.
(Disclaimer: Not all doctors’ are like this, I'm generalizing to make a point)
So what is the solution?
How about putting doctors on salaries?
How about standardizing the cost of procedures across the board?
It cost x to do open heart surgery.
And before doctors start complaining, here are the benefits:
- No malpractice insurance. We cap payouts and the government pays out claims.
- Government covers the cost of medical school. I don't want people discouraged from being doctor's because they can't afford to pay back loans.
- A really high salary. I appreciate doctors and know they have a super tough job.
I think by de-coupling medical decisions with profit, our health care quality would go up. Doctors would be able to focus on giving care without worrying about the bottom line. I can have peace of mind that I'm receiving the best care possible without worrying about invasive procedures designed to drive up costs.
The Mayo Clinic pays doctor's salaries rather than by procedure. And by the way, they have some of the lowest health care cost per patient in the country as well as some of the highest rankings for patient care.
How am I going pay for this? Probably single payer through some sort of tax. See I said at the beginning of my diary, I wasn't against these options, I just didn't think they are really going to fix the fundamental problems. I don't need health care to be cheap; I need it to be good and comprehensive. I'm also to willing to subsidize lower/middle or non income peoples health care so that we all enjoy quality care.