Let's take a moment to talk about communism, capitalism, humanity and health care. How does it all relate? Read on, True Believers!
First of all I want to address the accusations of socialism and the cries of rampant nationalization being leveled at Fearless Leader.
I favor the establishment of a Federally run health insurance or care option. Not a outright nationalization, but the providing of a baseline option. Now before anyone cries Trojan Horse, let me point out a little fact about a government provided service: the public school system. What exactly am I trying to point out? The fact that the existence of the public school system, which has been operated as a government institution for decades, has not caused the disappearance of private education. Same-same with the Post Office; we have FedEx, UPS and other private parcel shipping companies even though there is this thing called the USPS that is largely subsidized by federal tax dollars. So much for the Trojan Horse.
Now the next point I want to address is a bit convoluted, but bear with me.
I am a fan of the free market. I like Capitalism and have a healthy distrust of Communism, simply based on the track record. Specifically we have seen, through the Rise and Fall of The Soviet Union that Communism tends to commoditize human beings, essentially treating them like the property of the state. I don't think anyone would argue against that (except of course, genuine Communists). That being said however, we must keep firmly in mind that "The Market" is not a moral or ethical entity; "The Market" is a construct, a mechanism for distributing goods and services. Even in a liberal society, that is one that is largely free from governmental dictation, we must keep in mind that the sole concern of "The Market" is fulfilling its function as a mechanism and that the societal values we purport to hold dear are the work of the participants in our society, not the products of Capitalism.
The problem, Oh My Children, is that Capitalism cannot and does not make value decisions about anything other than profitability and when profit because the focus of a society, you get the exact same problem that you get under Communism. People become commodities, like raw material. Which brings me to my point.
My Sainted Mother (who will both deny and beat me for saying it again) likes to continue repeating to me that, "People are not things." Unfortunately, that is exactly what has happened in the current health care system.
I'm told that once upon a time, hospitals and health insurance were strictly no-profit agencies. Then at some point in the 1970's certain parties lobbied, successfully, to be allowed to run for profit set-ups, on the theory that profit motive and market force competition would improve the quality of health care and many good things have come from the competition for the next big breakthrough or advance. Unfortunately what has been gained has come at enormous cost, in terms of health care for the vast majority of people.
In the first case we have the dark side of profit motive currently afflicting health care operations: Greed. In the continuing search for more money, patients are being rammed through as fast as possible. Doctors spend something like fifteen minutes with a patient in a given visitation and then move on to the next as quickly as possible. The rule is to push as many people through the doors as fast as possible in order to rack up as many sales as possible. This is not good medicine, which like any scientific discipline should be handled in a careful, deliberate manner with an eye for accuracy. We're talking about people and their health, not ticket sales for an amusement park.
Secondly is the matter of individual practitioners. There are now fewer general practice physicians than ever entering practice while the ranks of the highest paid specialists swell, particular in fields such as cosmetic surgery. It isn't hard to understand why; that's where the money is to be made. So now we can compound the production line health care policy with a paucity of GP's, which both increases the strain on those GP's and decreases the number of patients which can be seen at a given time.
Third on the list, we need to have a long, hard look at the pharmo-corps manufacturing the medications vital to our health care. Now I don't think anyone cold possibly argue that the drug companies have every right to make a profit on the discoveries they make. Nor can anyone legitimately argue that they shouldn't try to match supply with demand. At what point however, was it decided that non-therapeutic modifications of existing drugs constituted a legitimate reason to exploit patent laws in order to create a monopoly? Furthermore, current direct to consumer marketing has created a situation where individual patients are coming to their doctors and screaming for drugs they don't need for conditions they either don't have or whose legitimacy is at best questionable; we're talking about convenience drugging. Dammit people, we're talking about pharmaceuticals not bloody soft-drinks!
Point the fourth is the shameless profiteering of the insurance companies. I can almost give these people a certain amount of sympathy; they have a mandate, as profit companies, to maximize shareholder value. How do they do that? Simple, only insure people who are the least likely to actually need health care and charge the highest possible rate you can. In other words maximise revenues and minimize expenses, which is basic econ. The problem here is that the people who most need health care are the exact same ones that the for-profit insurers do their bloody best to drop from the rolls as fast as possible, assuming they ever sign them to begin with! Worse yet, if you do happen to need to use your coverage (assuming you have any) and further assuming they can't get rid of you afterwards then you can reasonably expect your rates to double or even triple, as the insurer does its level best to extract the money they spent out of you.
There's more but there you have the single biggest, most obvious problems. What does it amount to? In short, in the business of health care, health care has taken a back seat to profitability. Patients have become commodities to be shuffled about and traded, like little potted money trees.
Finally, there is the problem of rampant, frivolous lawsuits and abuses of laws enacted to protect the rights of patients from slipshod medical practice. Vast amount of time and money are wasted in the practice of defensive medicine.
I don't know, maybe I'm more sensitive to the situation than most having worked in the medical field, in the production end. Having worked, furthermore, as part of the DoD health network. I can honestly say that I've seen the system work, at least in my own experience. Admittedly it isn't perfect and I know personally of a truly spectacular case of bad judgement, but that was a matter of a human being making a piss-poor decision. The decision wasn't the result of a system failure, other than failing to sufficiently impress on the individual in question the importance of correct medical judgement. That sort of thing can be dealt with through proper training. In any case, setting the issue of federal health care aside, lets just take a minute to consider a proposal.
Why is it a good idea to pay doctors on the basis of volume? Should they be judged on the quality of their work, rather than the quantity? Some hospitals bring in doctors and pay them salary. I think that this, combined with returning hospitals to their non-profit orientation, would produce a good net result. How, you ask? Because the way to improve health care is to put the focus back on patients instead of profits. It is possible to do this without completely stripping out competition or individual motivation. Converting hospitals back to nonprofits doesn't eliminate their ability to hire and pay health care workers on a competitive, salaried basis. Hospitals that want the best physicians will compete with each other for those physicians, in terms of salaries and spending on R&D, equipment and the myriad of ancillary services that the best health care demands. Physicians will be competing with each other for entry to the best hospitals with access to all the above.
Additional measures should include:
Reform of drug patent laws which allow a handful of companies to monopolize drug production and prevent the availability of inexpensive generic medicines
Reform of medication marketing laws which allow these major manufacturers to by-pass the trained medical community and push drugs directly on the public.
Reform of medical lawsuits, to protect health care workers from frivolous suits and end the practice of "defensive medicine".
Finally, health insurance agencies need to be restructured as non-profit organizations, with regulations specifically tailored to protect patients' rights to treatment and guarantee the ability of providers to focus on treating patients instead of maximizing monetary gains for the insurer.
