Warning: long long post ahead. I apologize for the length, but it's impossible to offer a level assessment of healthcare reform that doesn't get simplified to left wing or right wing insanity without long explanations. If you just want a cliff notes summary here it is:
If there is no strong guiding authority and you do not reform the entire ****ing system, all you do is open the door to cost and power shifting. We've already seen this before as recently as 1997-1999.As some here know, I had a short career as a physical therapist and I spent my first two years out of the clinic doing a job that gave me a chance to travel see lots of cool medical gizmos and study how different high profile organizations delivered care. I'm no authority, but I've seen a lot more than most people will ever see.
First let's clear up a couple of things. To the people who think we have the best healthcare in the world: you are probably right and you are certainly wrong at the same time. The same goes for people who say the US healthcare system is horrible. It depends on how you define "the best" and if you define it by how many cutting edge procedures we have a lock on, you love it. If you define it by general outcomes and the number of people we serve with any care at all much less quality care, it's pretty bad.
I personally would prefer a system that is more outcome oriented. That is my own personal bias in this argument. That said, there are many ways to achieve an outcome and I'd prefer to see us find a way to achieving better across the board outcomes without abandoning the pursuit of cutting edge technology.
People from all over the world come to the US for procedures if they can afford it and the US hospital system openly courts international patients because they're cash cows that help keep hospitals afloat. (BTW, medical tourism cuts both ways. US citizens have also started leaving the country for healthcare because it costs too much here.) The danger in changing the US Healthcare system so that it's more equitable is that it could suppress some of the high end of healthcare that our system depends so much on to balance the books both because our resources will be spread more thinly and because there may be a smaller profit incentive for companies to pour more and more money into R&D.
I personally think this could be a short term problem, but longer term things even out. Healthcare is an economic system in of itself and in every hugely complex model, it is so complex and has so many buffers against change that even when things change, the net effect is not very dramatic. This is why incremental change is not possible and incremental change is probably the worst idea to come out of the US healthcare debates because if you target ONLY ONE area to reform, the abuse will shift immediately to another area. You will never wrap up the last loophole before the next two open up. This happened in the late 90's and probably derailed my physical therapy career when Congress reformed laws affecting inpatient stays and rehab care. Physical Therapy went from being one of the safest jobs you could have to being one of the scarcest in the matter of months because hospitals suddenly had to push critically ill patients out the door to save money and there was nothing left over to pay for rehab. That act of Congress failed because it was too narrow.
If there is no powerful hand to referee and dictate change, all the most powerful players in the healthcare industry will flex their political muscle to protect their turf so that the most vulnerable in the industry end up taking the brunt of the downside. This might sound like I'm talking about insurance companies and they're certainly implicated in this, but I'm also talking about healthcare professions.
Healthcare is a much more political world than anyone one the outside can understand. There are power structures and mini-goverments entrenched in healthcare at every possible level. Think about the power structure of a hospital. People have ranks in there and there's a chain of command and there is constant constant head butting. Even before you start scrutinizing the insurance industry, you already have turf wars, protectionism, and back stabbing within the hospital. Want to go troll a doctor's group? Ask them if the most important specialist is a cardiologist, a surgeon, or a radiologist.
There is no one single culprit so there needs to be strong government involvement if we're to improve the healthcare system here, but also strong private sector involvement. The chances for disaster or intentional sabotage would be unacceptably high if we went straight into a socialized healthcare model. Our system as it exists today was not designed to operate like that. There are too many power players up and down the chain. It would be like going into Afghanistan and making it illegal to be a warlord and we know how that story plays out don't we?
Inside every insurance company, you have a government. They see the problem. Everyone agrees that there's a problem, but within their own organizations they cannot mobilize the forces to change things for the better. Even when they do manage to reform their own organizations, they need the cooperation of other insurance companies to fully realize the benefits of the changes. Without an entity that has the ability to enforce fair play between insurance companies none of them will want to stick their neck out.
The much maligned managed care movement of the 90's in the US to a lot of people was an example of pure greed on the part of the insurance industry. There is undoubtedly some truth in that, but it was also an attempt to create a more sane cost contained healthcare market.
The private sector was ahead of the general public on this front and they failed miserably. In the short period of time that I practiced, I had a hell of a time trying to figure out what I could and couldn't do for people based on their insurance. Every insurance provider had their own idea on how much care was allowed and for what care was allowed. HMO based cost containment was mayhem, inefficient, and it didn't work in the end because everyone learned how to cheat. Doctors would make their therapy prescriptions vague so we could choose a diagnosis that would give us more visits. It was different from insurance to insurance and often made little sense. If you had a severe shoulder injury and your insurance only allowed two visits, well then we wrote down you had a neck injury and you instantly came back with four more visits.
There is no right answer right now. There are only wrong answers and the most wrong of them is letting things keep going the way it is now. Healthcare reform will be bumpy... very bumpy, but it's going in the right general direction. I'd like to have seen a modest public option in the mix to help keep the more powerful players in the insurance industry honest,
but also to provide guidelines of service to the lesser players. I am willing to bet money that there are plenty of smaller insurance companies who are welcoming reform with open arms.
Healthcare reform is not an either or kind of issue. If you see a simple solution, you are part of the problem.
