TBD on Ning
TIME FOR A NEW HEALTH CARE SYSTEM:
This is not mine, how I wish I could claim otherwise, but was posted today in the Coeur d'Alene Express, a local newspaper. It is penned by Rolf Nesse, MD.
I am very familiar with the issues at stake in the health care reform debate. So here are some things to think about when judging what you hear about reform efforts.
1 - Medicare is scheduled to have inadequate funds to fulfill its obligations starting in 2017.
2- Private insurance rates will double in 10 years if things remain the same, making it impossible to buy for employers or individuals.
3- The Baby Boom generation, now just entering Medicare is expected to leave behind a debt of $40 to $60 TRILLION for their care over the next 30 years if nothing is changed.
So anyone believing that we should somehow postpone our descussion about reform, hoping to hold on to whatever fortunate position they hold in the system will be very disappointed with the results of inaction over the next 10 years.
What are other important issues that most people don't talk about?
1 - Regional variation in health care costs. The sterling example of this is the fact that The Mayo Clinnic, which is a very low cost system, also provides the highest quality results documented in the US today. They provied care for Medicare at 1/2 the price of some systems. We need to debate how to get the entire nation's care system to meet the care standard set by the Mayo Clinic.
2 - All liberal and conservative health economists agree that the fee for service payment system is one major cause of health care inflation. The needed debate is on how to structure tghe delivery system to go to a new system of payment. This is a complex issue, but if we ignore it we will end up with the $60 TRILLION dollar debt issue.
3. Identifying what care is valuable? The amount of new medical knowledge is doubling every eight years. No individual physician has the ability to keep up with thiss torrent of information. Also very little research is done comparing different types of treatment for the same condition to see what works best. this yields highly variable quality of care. Unfortunately, established best practices are only met about 50% of the ime according to good research. Organizing our deliverers of care so they can actually get the decisions right for each patient will not be easy. There are many uncertanties about what will work best but we must learn how. We didn't know hwo to get to the moon before we tried, but we did it. Let's work harder on this now.
4 - We need to know how to deal with the"moral hazard." If you want complete control over your medical decisions, you must pay for yourself. No industrialized nation has chosen such a personal pay plan, as it would violate the "Good Samaritan Rule" by letting the poor die if they couldn't pay. How will we then, having joined resources by taxes or insurance premiums to cover the costs of health care, regulate the individual's use of shared dollars? Unfortunately the sum of all our desires is much grater than our willingness to pay. The conflict between what I want and what my neighbors wish to pay for can onloy be reduced, never eliminated. Someone umst decid what the core coverage should be. This real decision must be made. Remember, what your neighbors don't provide, uyou can buy yourself.
5- Health costs endanger the economy. Or nation is no longer as competitive as it was in the past. This is partially due to the large excess cost of health care. An employer can put a plant in Canada and have a health care bill of about one half of that in the US and still get needed health care delivered. No one wants health costs to drive out jobs. This need to remain competitive is as strong an issue as the Good Samaritan Rule. We could just ignore one or the other of these challenges, or do the hard work of providing universal high quality care at a good price.
6 - Too many people believe that more medical care will result in better health. Unfortunately this is only partially true. You health is improved only 15-25 percent by health services, and 75-85% by social and economic factors. removing your bad gall bladder does lengthen your life,but living within a social and economic structure that enhances health does as well. Unfortunately the US rates last in the industrialized world in having supports for health that do not come from the medical system. A result is that in the US, death rates are three times higher for people in the lowest 20% of income than the highest 20%. It is powerfully true that a person's health is strongly determined by how valued he or she feels within the community.
7-8-9 etcl. Many other issues.
But PLEASE, everybody stop YELLING and ACTING FEARFUL. We deserve real problem solving deliberations. Remember, both our public and our private systems off insurance are objectively failing. The old systems have failed; it is time to create new ones.
I am very familiar with the issues at stake in the health care reform debate. So here are some things to think about when judging what you hear about reform efforts.
1 - Medicare is scheduled to have inadequate funds to fulfill its obligations starting in 2017.
2- Private insurance rates will double in 10 years if things remain the same, making it impossible to buy for employers or individuals.
3- The Baby Boom generation, now just entering Medicare is expected to leave behind a debt of $40 to $60 TRILLION for their care over the next 30 years if nothing is changed.
So anyone believing that we should somehow postpone our descussion about reform, hoping to hold on to whatever fortunate position they hold in the system will be very disappointed with the results of inaction over the next 10 years.
What are other important issues that most people don't talk about?
1 - Regional variation in health care costs. The sterling example of this is the fact that The Mayo Clinnic, which is a very low cost system, also provides the highest quality results documented in the US today. They provied care for Medicare at 1/2 the price of some systems. We need to debate how to get the entire nation's care system to meet the care standard set by the Mayo Clinic.
2 - All liberal and conservative health economists agree that the fee for service payment system is one major cause of health care inflation. The needed debate is on how to structure tghe delivery system to go to a new system of payment. This is a complex issue, but if we ignore it we will end up with the $60 TRILLION dollar debt issue.
3. Identifying what care is valuable? The amount of new medical knowledge is doubling every eight years. No individual physician has the ability to keep up with thiss torrent of information. Also very little research is done comparing different types of treatment for the same condition to see what works best. this yields highly variable quality of care. Unfortunately, established best practices are only met about 50% of the ime according to good research. Organizing our deliverers of care so they can actually get the decisions right for each patient will not be easy. There are many uncertanties about what will work best but we must learn how. We didn't know hwo to get to the moon before we tried, but we did it. Let's work harder on this now.
4 - We need to know how to deal with the"moral hazard." If you want complete control over your medical decisions, you must pay for yourself. No industrialized nation has chosen such a personal pay plan, as it would violate the "Good Samaritan Rule" by letting the poor die if they couldn't pay. How will we then, having joined resources by taxes or insurance premiums to cover the costs of health care, regulate the individual's use of shared dollars? Unfortunately the sum of all our desires is much grater than our willingness to pay. The conflict between what I want and what my neighbors wish to pay for can onloy be reduced, never eliminated. Someone umst decid what the core coverage should be. This real decision must be made. Remember, what your neighbors don't provide, uyou can buy yourself.
5- Health costs endanger the economy. Or nation is no longer as competitive as it was in the past. This is partially due to the large excess cost of health care. An employer can put a plant in Canada and have a health care bill of about one half of that in the US and still get needed health care delivered. No one wants health costs to drive out jobs. This need to remain competitive is as strong an issue as the Good Samaritan Rule. We could just ignore one or the other of these challenges, or do the hard work of providing universal high quality care at a good price.
6 - Too many people believe that more medical care will result in better health. Unfortunately this is only partially true. You health is improved only 15-25 percent by health services, and 75-85% by social and economic factors. removing your bad gall bladder does lengthen your life,but living within a social and economic structure that enhances health does as well. Unfortunately the US rates last in the industrialized world in having supports for health that do not come from the medical system. A result is that in the US, death rates are three times higher for people in the lowest 20% of income than the highest 20%. It is powerfully true that a person's health is strongly determined by how valued he or she feels within the community.
7-8-9 etcl. Many other issues.
But PLEASE, everybody stop YELLING and ACTING FEARFUL. We deserve real problem solving deliberations. Remember, both our public and our private systems off insurance are objectively failing. The old systems have failed; it is time to create new ones.
Views: 10
Comment
-
Comment by Dazzling Zoomer Gal Diana on August 15, 2009 at 3:08pm
-
activities.html
A news feed for Rolf Nesse, MD
-
-
Thank you for introducing some reason and sense into this fray. I've been reading the doctor's new feeds since you posted this. Very interesting and informative view point. Thank you MadHatter!
-
Comment by Grace Linda on August 15, 2009 at 2:59pm
-
It would be really nice if the idiots that are raising cane could read, but I fear they can't so even this no non-sense explanation from someone who obvious sees how things aren't working form the inside out will fall on deaf ears.
© 2024 Created by Aggie.
Powered by
You need to be a member of TBD to add comments!
Join TBD