Democrat solution: um, decrease reimbursement to doctors, a bunch of other nips and tucks.
The Republicans have the solution that is simpler to understand, that's for sure. Of course that's not the best way to judge a policy proposal, but when it's put up against a complicated, incoherent plan, it does pretty well.
Truth squadBut in many ways, the whole political debate about providing healthcare is incoherent because there are many competing interests, and not all of them are openly declared. Here is a sampling of some of the objectives in the debate:
- Provide healthcare to as many people as possible.
- Provide healthcare to as many Americans as possible, but not to immigrants.
- Provide healthcare to productive members of society (and retired productive members of society).
- Eliminate the problem that some people don't have health insurance.
- Provide enough healthcare to the uninsured so that it's not embarrassing or unchristian, but also minimize taxpayer expense.
- Allow patients and doctors to make healthcare choices without interference from bureaucrats.
- Protect individuals from the high cost of healthcare by spreading the cost to larger groups.
- Slow down the growth of healthcare costs dramatically.
- Demonstrate that life is the most important consideration no matter what.
- Cast doubt on the motives of your opponents regarding healthcare availability, cost, and who shoulders the bill.
- Too much of the political debate is centered on electoral goals where it's important to cast doubt on your opponent and insulate your side. Clarity, not surprisingly, is sacrificed.
- When it comes to individuals deciding how to vote or what to advocate for, often the issue is fear of losing access to needed healthcare, plus the desire to shift costs. Cost prevention or cost containment may not register.
A goal we can agree on?In the all debate, fear, and sniping, something that is often lost is whether we should try to make our medical spending more efficient and how. Efficient really means not doing the low value or no value procedures. If we don't want to cut the number of procedures, we have to squeeze what we pay for them. That means not passing the Doc Fix every year, and hoping the people doing the work won't resent performing the same job for a lot less money.
Rather than simply squeezing the providers, I'd prefer to cut the number of procedures. But no one seems to want to talk about making do with less medical care. I can easily do it as a personal choice (sure-I'll wait five years for my next colonoscopy!), but how can we get large numbers of people to sign on? And make the right decisions about what to trim?
Doctor's adviceReally, the doctors should start this revolution. We have more trust in them than in having our insurance companies or government panels make the recommendations. Doctors could save the entire country a lot of money by cutting back on the testing they recommend. I saw an article (now irretrievably lost in the web) that Americans spend 40% more on outpatient testing than other advanced countries, so this is one area we can definitely trim back.
Unfortunately, doctors often have a business interest in recommending testing, since GE has sold them a bunch of expensive medical equipment, and the docs need to make those payments. There is also malpractice fear. I think someone is going to have to persuade and guide our medical professionals, but that brings us back to the hated insurance companies or government bureaucrats. Oh what a mess. Still, I hope it would be possible for some of our larger medical groups, like Kaiser Permanente and the Mayo Clinic, to study what treatments and testing are effective and cost-efficient. If we can save enough money by stripping out inefficient medical spending, we may not have to touch that third rail: rationing of medical care.
I'll break the taboo, just a bit, and talk about rationing. But to some people, any management of healthcare choices is rationing. In one way I agree, but I see it as good rationing. (Similarly, there is good discrimination, which is what you use if you date only sane, responsible people.) In the future, we may need to ration medical care on a variety of criteria including: odds of survival, odds of recovery to productive status, cost of care, citizenship, etc. This is where the arguments really heat up, and I don't want to go there yet. Let's remove inefficient spending from our system, and see how much breathing space that gives us.
Maybe we can pay with play money...
Extra: Explore some detailed data on healthcare spending with this nifty/easy tool.