Posted on 11/19/2002 1:25:46 PM PST by sarcasm
ASHINGTON, Nov. 19 — The National Academy of Sciences said today that the health care system in the United States was in crisis and that the Bush administration should immediately test possible solutions, including universal insurance coverage and no-fault payment for medical malpractice in a handful of states.
Administration officials said the report would probably become a blueprint for demonstration projects to be proposed by President Bush and Tommy G. Thompson, the secretary of health and human services, who requested the study.
"The American health care system is confronting a crisis," said the report, from a panel of experts appointed by the academy's Institute of Medicine. "The health care delivery system is incapable of meeting the present, let alone the future, needs of the American public."
The tone recalled the alarm and urgency of President Bill Clinton in 1993 and 1994, but the panel proposed a more modest agenda, using states as laboratories to attack "disturbing trends" that have worsened in the last two years.
Members of the panel acknowledged that health care was not a top priority at the moment, as officials worry about the economy, terrorism and the possibility of war in Iraq. But they predicted that health care would soon move back to the top of the nation's agenda, and they proposed ambitious demonstration projects in five areas.
The 16-member panel said, for example, that the federal government should provide federal money to three to five states to help them make health insurance available to all or virtually all of their residents. States could take either of two approaches: providing tax credits to the uninsured, to help cover the cost of premiums, or expanding Medicaid and the Children's Health Insurance Program.
The number of uninsured has been climbing for more than a decade and now stands at 41.2 million, or 14.5 percent of the population, the report noted.
The panel also said that four or five states should test alternatives to medical malpractice lawsuits to compensate patients injured by doctors and hospitals.
Under the proposal, doctors and hospitals would have to inform patients and state agencies of errors that cause medical injuries. Patients would receive "faster, fairer, surer compensation" if they agreed to surrender the right to a jury trial.
"For the first time in 20 years," the panel said, the United States is facing a broad-based crisis in the availability and affordability of malpractice liability insurance for physicians, hospitals and other health care providers. Most instances of negligence do not give rise to lawsuits, and most legal claims do not relate to negligent care."
The panel acknowledged that there might be constitutional problems in compelling consumers to accept these arrangements, but it said that patients might be allowed to opt out when they enroll in a health plan or enter a hospital.
Other demonstration projects would test getting rid of paperwork and test a "paperless health care system," increasing the use of computers; beef up 40 of the nation's community health centers, with sophisticated equipment; and upgrade treatment of chronic conditions like diabetes.
I think this is going to be more of a political crisis than anything else. There are a lot of people out there like me but who, unlike me, aren't alarmed by the prospect of government-controlled health care. All they'll see is "free" healthcare, or at least that they'll be guaranteed treatment.
When you're talking about 40 million people and rising, that's a big voting bloc if they get mad enough.
If we don't want socialized medicine, we need to come up with a better plan.
But when you get sick and need an MRI, a Cat Scan or a heart cath, high tail it back to the states because the waiting list in Canada is longer than there life expectancy when they are seriously ill. Its one of those conundrums of socialized medecine.
At this point, high health insurance premiums are actually skewing the labor market. I know people who have kept horrible jobs because of the benefits packages, or taken ones that their skills didn't match because of benefits packages. It's driving people into 9-5 jobs when they might be better suited to other things.
I think this is a good idea - cut out the overhead, and the doctors might charge less too. Maybe you pay $80/visit instead of a $20 co-pay, but if you only go once a year (or less) the savings in premiums might make it worthwhile.
Any others?
Now pointing out the 3 day wait in UK emergency rooms might give people pause.
But most of the uninsured who will be pushing for major reforms do not itemize their taxes because they earn under $50k a year, or else are in brackets where payroll taxes are stiffer than income tax. They're not poor, but they're not rich enough where tax incentives really make or break the case.
| The National Academy of Sciences said today that the health care system in the United States was in crisis and that the Bush administration should immediately test possible solutions, including universal insurance coverage and no-fault payment for medical malpractice in a handful of states.
If they were talking about better procedures for performing heart surgery, I would be happy to hear that they were being listened to. However, I do not care what a bunch of medical practitioners has to say about how to run the business side of things, or the legal system. In fact this whole thing sounds to me like a bunch of liberal professor types trying to use their seats on a science advisory board to promote their political beliefs. I am really tired of that act. If I understand Bush, he will happily adopt some of the recommendations, and postpone consideration of others. In other words, he will use the NAS report as cover to stick it to the tort lawyers, while accidentally forgetting to implement any of the other stuff. It is good to be king. |
The real problem here is that any product or service that is paid for through an insurance claim is what I call an "impure" economic transaction. The fundamental laws of economics don't apply because there are too many players in the mix. Most transactions have a "buyer" and a "seller," and normal market forces will lead to natural fluctuations in price depending on supply and demand. If something costs too much, the potential buyer won't buy; and if something doesn't cost enough, many sellers will leave the market.
The problem with a health care procedure is that there is one "seller" (the doctor, for example) but two "buyers" with distinct objectives. The patient is the one who is the recipient of the service, but the insurance company is the one who pays the cost. The end result is that the patient isn't going to care about the cost because he isn't paying it, and the insurance company isn't going to care about the quality of the service because it doesn't have to live with the results. And this doesn't even factor in the expected increase in costs due to the inherent "moral hazard" of insurance in general (that is, the fact that a person is insured may cause him to do things that he would not do if he were uninsured -- the saga of George Bailey in "It's a Wonderful Life" is a perfect example).
Now you might say that health care is different than any other economic transaction because people will "pay any price" to live a longer, healthier life. There may be some truth to that, but you'll find that there are striking similarities between the underlying causes of increasing health care costs and of increasing auto insurance costs. If I am involved in a car accident and I file an insurance claim, I want the body shop to use all the best parts and make my car look like brand spanking new. Who cares if it costs the insurance company $2,500 for the repairs? If, on the other hand, I was paying for the repairs myself, I would certainly consider accepting 90% of the "best" result at 75% of the "full" price. In other words, I would consider the various cost and benefit combinations like I would with any other purchase I might make.
That's a very good point. I've always said that one of the best things we can do to "fix" the health care system is to completely remove the employer from the insurance picture. The whole concept of employer-paid health premiums is nothing more than a relic from World War II, when employers began paying these costs because there was a wartime wage freeze in place that prohibited them from paying higher salaries.
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Other than the fact that it has a fancy name, how is the National Academy of Sciences qualified to make recommendations on the subjects of insurance financing and tort reform?