This will be a short diary because I am at work. I listened to Steve Inskeep (sp) interview David Goldhill, who wrote an article critical of the current US healthcare system. No suprise here, many of us are highly critical of the current state of affairs. Goldhill's solution to this problem, however, is both nonsensical and perverse.
Goldsmith's basic point is that healthcare decisions should be driven by consumer choice and that by removing insurance companies as the source of health care payments, all will be fine, or at least much better. He states:
And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.
This is demonstratively false. Healthcare is not like buying DVDs. When you or someone in your family is sick or has suffered a serious injury, you don't have the luxury of comparison shopping for the best deal or read hundreds of reviews of health care providers over the next two weeks before deciding where to send Dad with his heart attack.
Health care is more like paying for police and fire protection. You only need it occasionally, but it needs to be there regardless of your ability to pay for it. Does it make sense to bankrupt yourself paying for the fire department to put out your house fire once in a lifetime, or to spread the risk of house fires across the entire city were everyone pays a small amount to cover the times when a fire breaks out? Goldhill gets out of this problem by saying that consumers would pay for "non-catastrophic" medical care by putting it on credit.
What about care that falls through the cracks—major expenses (an appendectomy, sports injury, or birth) that might exceed the current balance of someone’s HSA but are not catastrophic? These should be funded the same way we pay for most expensive purchases that confer long-term benefits: with credit. Americans should be able to borrow against their future contributions to their HSA to cover major health needs; the government could lend directly, or provide guidelines for private lending.
Great as long as you have a job. What happens if your injury keeps you from working and you lose your job. This is a recipe for exploding bankruptcy, orders of magnitude worse than the housing crisis.
Goldhill does make some good points about how to improve care by focusing on outcomes instead of procedures and promoting integrated health care.
I was very disappointed that Inskeep didn't ask the crucial questions: Won't treating health care as a commodity will make cost the defacto rationing strategy of the brave new world of health care even more than it is in the current system?
Why is purchasing health care NOT like buying a washing machine or computer?
All in all, I am unimpressed with Inskeep's interview because he didn't ask the right questions