How American Health Care Killed My Father

The Atlantic ^ | September 2009 | David Goldhill

[Ditto]

Another benefit we are deriving from this is that doctors are closing their offices in other parts of the country and re-locating here.

If you read the article, you can see that under the current 3rd party payer system, more doctors in a give area can and does actually drive total costs higher with no improvement in quality of care or outcomes than in areas with fewer doctors per capata.

I know it is counter-intuitive, but the author gave an example that included the Dallas metro area.

Under the perverse incentives of the current system, more health care providers does equal more competition and lower costs. It actually results in higher total costs. The authors point is that we have removed traditional market mechanisms from the system which distorts everything.

[cynwoody]

particularly that we shouldn't be 'fixing' something until we truly understand it.

And also not while the current set of 'fixers' are in office.

[DustyMoment]

Dallas is rather a unique situation, much like Houston and San Antonio. Dallas and Houston are both gigantic metroplexes that span thousands of square miles and, literally, could qualify as city-states. Dallas is 1/2 of the Dallas-Ft. Worth metroplex which is virtually an endless urban area that spans from the west side of Ft. Worth to the east side of Dallas.

Houston is another huge metroplitan area that consists of Houston proper, plus a spate of smaller cities including the (growing) city of Katy on its west side. San Antonio is experiencing its own growth boom though, while smaller than either Dallas-Ft. Worth and Houston, is rapidly growing, even in today's economy.

What distinguishes these three areas from the rest of Texas is that each has major, nationally and internationally recognized health facilities. IOW, they are the exceptions to the rule and, within the proximity of the health facilities in these regions, it would be natural for costs to be higher. However, when those costs are spread across the breadth of Texas overall, average health costs are lower than in other states.

[Ditto]

I have been to Dallas and Houston many times. I know they are large and I know each has world-class medical facilities. I also live in a metro area with 'world-class' hospitals and it's one of those places to be if you need a transplant or some other major exotic procedure. But for all that high-tech whizzbangs, standard hospital care, including basics like infection control, have done nothing but decline. They focus on the sexy stuff and forget the fundamentals.

But that is not the point I was making. Without me going into a very long post here, please read the article to see the author's point about the perverse incentives and 'moral hazzards' that are now endemic in the current health care system that serve to push costs higher and quality of care lower.

He makes a very strong argument.

[neverdem]

From at rat no less, BTTT!

[1010RD]

Wrong. Private insurance is a contract. What the system has proven is people don’t understand contracts or insurance.

Purchase the right kind of insurance and you’ll get platinum service. Buy a basic policy and you won’t.

Saving what we have isn’t idiotic. We’d be better off derugulating medicine, reducing governments grip on doctors, drugs, hospitals and the process would make health care more affordable for everyone and improve the quality.

[1010RD]

I am not optimistic that politicians of either party can fix it.

Name the things they have fixed and compare it to a list of items they've worsened.

The reason we don't have a preventative care system is their is no incentive to do so. If I get policy AAA and an obese, drug using, smoker who drinks gets policy AAA we both get the same level of treatment despite the fact that I am at my ideal weight, have no heart disease, etc.

The only way under our current system to get preventitive care is to make people do it by force or by incentive. Government prefers the former, I'd prefer the latter wouldn't you?

[1010RD]

Something’s better than nothing, no? Check your contract.

[1010RD]

I was in a household on section 8 yesterday. Four adult women and one adult male (sleeping at 11AM). None of them work, though they are all physically capable. You can imagine yourself how much money they could make at even pure cash wages of $40/hr/pp/week. Instead they sleep, drink, watch television and fornicate. None of them is or were married.

Welfare, even medical welfare, is the problem. Americans are very generous, but our system has been created by the same gods who punished Sisyphus.

If we want America to return to her true greatness, gradually get rid of welfare and don't under any circumstances create a new medical welfare. It will be a disaster.

I assure you that no one would go without medical care if Medicaid and Medicare were wound down over the next decade and hospitals could turn away patients from their emergency rooms.

[SunkenCiv]

Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality.

IOW, we aren't spending enough money on this.

Kill all the lawyers -- starting with the invisible ones who sit in every examination room in doctors' offices and hospitals.

[Ditter]

The only doctor’s “house call” I ever had was when I was about 12. That would have made it 1952.

[sport]

If you do not like the “healthcare” system, or you think that the doctors are crooked, inept, or charge too much, the solution is simple. Don’t go to the doctor. Go to obama.

[ican'tbelieveit]

Oh, I find it ironic considering I work for a biopharma that touts how well they take care of us in our insurance. I need to follow up with the company because I doubt they would find this acceptable. It has happened to us twice this year.

[ican'tbelieveit]

I don’t think doctors are crooked, inept, or charge too much... I think they are victims of big insurance companies, hmos, malpractice, etc. etc.

[sport]

So do I. But it gets my goat about how people always gripe. If you don;t like them, then don’t go to them.

As far as the doctors go. because of insurance and lawyers they have to hire 4 or 5 more people per office.

[montanajoe]

Your comments indicate you either work for for the insurance industry or have luckily never had the occasion to utilize the insurance product. I honestly believe the people working for insurance companies at the high management level those working at the lower levels are either ignorant schills or evil themselves.

[1010RD]

Your comments indicate you either work for for the insurance industry or have luckily never had the occasion to utilize the insurance product.

Wrong on both counts.

I don't know what happened to you or your loved ones, but your comment is not rational or acceptable.

Insurance companies are not evil. They are, like all things of this world, imperfect, but not evil.