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Wordful Wednesday: Health Care

Like most people, I’m concerned about Health Care.  Not for myself, though, or for my family, because I’m covered through my employer with a fantastic health plan (High-Deductible, Health Savings Account).

But I am concerned about the move toward nationalized health care, and concerned that the current system doesn’t do everything it can to help those who really need coverage.

So I agree that reform is needed, but I can’t imagine any rational person believing that a government-sponsored plan would be anything but bad coverage at a worse price.

The Top Ten Myths of American Health Care: A Citizen's Guide, by Sally Pipes, is a great discussion of much of the misinformation politicians fob off on us.  The book succeeds quite well just on the basis of the myth-busting.  But where it really excels is in the concluding chapter, making recommendations for improving the current system without making it a government takeover.

I suppose it’d be helpful to list the myths:

Myth #1: Government Health Care is More Efficient

I’m not sure who exactly believes this, because we’ve got the examples of Medicare, Medicaid, and the VA to beat the snot out of this myth.

Myth #2: We’re Spending Too Much on Health Care

This one’s interesting, because it has a grain of truth in it.  We do spend more, as a percentage of GDP, on Health Care these days.  But the author points out that we also receive more value for our spending.

Myth #3: Forty-Six Million Americans Can’t Get Health Care

This is probably the most-quoted myth in the bunch.  And it’s true there are a bunch of truly needy folks out there, but it isn’t anything like forty million.  Lots of people either don’t want coverage or don’t avail themselves of coverage that’s provided for them.

Myth #4: High Drug Prices Drive Up Health Care Costs

Another interesting one, since drug prices have been steadily dropping (free market and all that).  But we use more drugs now than we ever have before, mostly due to the greater availability of them, thanks to the market-driven system that makes new drugs possible.

Myth #5: Importing Drugs Would Reduce Health Care Costs

Just wrong on so many levels.  It’s possible, even now, to buy drugs from Canada.  The result of this kind of thing?  Higher prices for the rest of us.  Because Canada puts price controls on drugs, so the pharmaceutical companies can’t make any money selling to them.  The Research and Development budgets of such companies are enormous, and they have to cover that overhead.  So prices go up in the U.S.

If we expand importation of drugs, we’ll see both higher prices and limited innovation (read: fewer products).  Which is pretty much what always happens when you take the free market away.  Duh!

Myth #6: Universal Coverage Can Be Achieved by Forcing Everyone to Buy Insurance

It’s been tried at the state level (Massachusetts, for instance).  Hasn’t worked.

Myth #7: Government Prevention Programs Reduce Health Care Costs

Sounds good, but wrong.  Costs go up, because more people use the system when they might not need to.  I’m not suggesting, and neither is the author, that prevention is a bad idea.  It’s a good idea.  Just don’t think it’s going to drive costs down.

Myth #8: We Need More Government to Insure Poor Americans

Problem is, we already have programs that just aren’t being used.  And people game the systems that are already there (think Medicare-fraud).  Doctors don’t like working with patients with this care, because they lose money on the treatment.  Sounds like a recipe for success, right?

Private insurers could do the job if the government would remove some of the mandates from insurance coverage.  Less expensive, less expansive coverage could work if the government would allow it.  Instead, insurers have to cover Breast Reduction Surgery and Acupuncture, and the prices stay high.

Myth #9: Health Information Technology is a Silver Bullet for Reducing Costs

Again, sounds good.  But what about the huge expenditures required to move to HIT?  What about small practices?  Require expensive IT conversions, and you drive some practices out of business.

Myth #10: Government-Run Health Care Systems in Other Countries are Better and Cheaper than America’s.

Unfortunately, this myth is generally based on inaccurate and problematic factors like life expectancy and infant mortality rates. 

Life expectancy includes non-medical things like traffic fatalities and murder rates.  Problems in themselves, but hardly a measure of America’s Faulty Health Care System.

Infant mortality is reported differently by different countries.  For instance, the U.S. goes with the WHO’s standard for a live birth, which means the baby came out of its mom and showed some sign of life.  In France, a baby born at 26 weeks or earlier is automatically listed as dead.  One wonders what their infant resurrection rate is with standards like that.

Apart from those issues, those other “great” health care systems suffer from rationing and loooong waits for treatment.  Let’s not emulate them.

One thing I learned while reading this book was that the Free Market can work in medicine.  For instance, consider the case of Lasik eye surgery.  Know why it’s decreased in cost dramatically over the last decade or so?  It’s because it’s not covered by most insurance, so people have to actually pay for it.  If it was covered, more people would get it and would be able to easily afford it, so the price would go up.

As I mentioned, the final chapter discussed ways to reform the current system.  Some of them included these:

Change the Tax Code

This one boils down to making it fair for self-employed folks, who can’t currently purchase insurance with pre-tax dollars the way corporations can.

Reduce Costly Government Mandates

Mandated minimum coverage is just a horrible idea, even though it sounds good.  If insurers could offer cheaper, no-frills coverage (say, with a high deductible for Major Medical), they would.  But the government forces insurers to cover some ridiculous stuff (hair-transplant, anyone?), driving costs up.

Allow Purchase of Insurance Across State Lines

This one goes back to competition.  If a plan in Nevada is cheaper and better, why shouldn’t folks in Wyoming be able to buy it?

Expand Health Savings Accounts

I can attest this one personally.  I love that I get to set aside funds for our major medical.  If we use it, fine.  If not, we keep it!  I used to spend thousands per year on my low-deductible plan for services we didn’t really use.  Now we spend less and get better coverage.

Support Retail Health Clinics

This is something I hadn’t really though about much.  It’s a non-hospital hospital.  You come in, get treatment, and pay (with or without insurance).  No long waits, because it’s basically a store, and stores can’t afford to keep people waiting.

Tort Reform

At this point, I think every reasonable person who isn’t a lawyer wants tort reform.  Reduce the need for costly malpractice insurance, and doctors don’t need to charge so much for treatment.

Health Care Vouchers

I’m for school vouchers, but Health Care Vouchers are a great idea.  This would allow the truly needy to purchase coverage.

I loved the quote at the end of the final chapter, from P.J. O’Rourke.  “If you think health care is expensive now, just wait until it’s free.”

I imagine some well-meaning but overly convoluted plan will get passed before too long.  I also expect to pay more for it than I do now.  And I expect the quality of care in the U.S. to go down as a result of the more-expensive coverage.  Yes, I’m a bit pessimistic about this.  I just hope I’m wrong.

(Book Review Etiquette question here: Is it wrong to read a book for the sole purpose of relieving it of its viscera in a book review?  Because I’ve got one that seems to be made to be eviscerated.)

Next up, perhaps tonight, is Sam Harris’s woeful Letter to a Christian Nation.  Speaking of gutless books…