I Hate the Healthcare Debate
June 30, 2009
I’ve been working on some videos concerning the healthcare reform issue over the last couple weeks and I’ve come to the conclusion that I hate this topic.
The reason I hate it is because it is so hard to find solid data on almost anything. Identifying the problem is nice and easy:
The US spends more per capita on healthcare than almost any other country, but we don’t necessarily get better results.
That statement is easy to prove with numbers.
Actually, I take that back, the first part is easy to prove with numbers. The second part of that is extremely difficult because judging the efficacy of health care is not an easy thing to do. Some metrics are easy to make judgements on. Wait times for CT Scans and MRIs are not dependent on whether or not the patient is skinny or fat, sick or healthy. How many people you can shove through a machine is far more dependent of scheduling efficiency, the availablility of personel and equipment, etc. In other words, there are few outside variables that are going to screw with your results.
But other metrics like life expectancy are heavily dependent on variables outside the health care system. Life expecancy for latinos, blacks, asians, whites, jews, arabs… near as I can tell they are different for all these groups even when other variables are controlled for. This makes it a very messy metric to use when trying to determine the efficacy of only one of those variables like health care.
As for controlling the cost of healthcare, there is one surefire way to do it: stop paying so much money. But this will result in less care and almost certainly lead some level of health care rationing.
The other ideas that have been thrown out there are not surefire ones, they are either educated guesses or “if I believe in it enough it will happen” wishes. Some of these ideas may work… but we’re not entirely sure which ones.
Which brings me to my preferred solution, which isn’t really a solution so much as it is a suggestion for identifying good policies a little more accurately: I think we should take the ideas that the Obama administration has and separate them out into a) ideas that can be applied to Medicare and Medicaid immediately and b) ideas that require a larger scale implementation.
Medicare and Medicaid are enormous programs with more than 70 million beneficiaries. It is absurd to say that they aren’t big enough to introduce some cost reduction programs without adding another 39 million people to government insurance programs (which is essentially what the Obama administration is saying).
Second, I think the government should set up some kind of public health care metrics program to gather the data that is currently so difficult to gather. Imagine if you could go online and look at hospitals around your city to see which ones deliver better outcomes and how much different procedures cost at different hospitals. This would go a long way toward inspiring competitive pricing in health care.
Third, I think we need to do away with the tax exemption for employer provided health insurance. Not a popular position, but it seems obvious to me that this policy has led to a large part of our health care overconsumption.
So… that’s all I’ve got for now.
I’m still working on some concepts that can be boiled down into something that is both accurate and striking. But the fact of the matter is that in healthcare we can trust very few of the numbers being tossed around right now. They are educated guesses at best and the Obama administration has a pretty bad track record at being able to predict the future.