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Health Care Reform

Just a quick note here for all the people saying things like:

“The cab driver in Halifax is telling me how he had a hip & a shoulder replaced & open heart surgery. Guess how much that all cost him.. $0!”

That’s great…but who paid for it? Did Canada invent some sort of magic machine where nothing costs anything?

The reality is that he did pay for it. And so did everyone else in his country. Now, if someone asked me “Well hey—wouldn’t you help someone like that by chipping in a few dollars? Or are you just a cold, heartless jerk?” I’d say “Sure, I’d be more than happy to donate a few dollars to help out someone like that.”

I bet most of us would respond the same way. Especially if we knew the person. So why not nationalize health care then?

It’s the being forced to help out ALL the people like that that rubs me the wrong way. It kinda adds up, you know? And when someone is suddenly entitled to your service (or your pocketbook), doesn’t that take a big chunk of the joy out of service? Can compulsory service actually be called service anymore?

I got back from a trip to Europe last week traveling on trains, staying in hostels and at friend’s houses. Most of them liked to talk a little politics, and they were surprisingly on the same page in their opinions. Almost all said they like President Obama. But universally, they said they would rather have America’s health care system than their own.

So who would you trust? Someone who’s lived with nationalized health care and it’s consequences (and wishes they didn’t), or someone who wants national health care because the idea of free health care for everyone sounds like an awesome idea?

Yes—we need health care reform. But before you go holding up Canada or the UK or France or any other country with government-run health care as some banner of an ideal health care system, consider the big picture.

I realize I’m simplifying a bit. But what would be great would be to take a deep breath (+ enough time to look at a variety of options and their intended and unintended consequences) and form a solution that actually moves our health care system forward.

Because I’d rather not be covered than be covered in crap.


1 Dave { 08.13.09 at 10:43 am }

Great post. I agree and wonder if you have any specific ideas/suggestions on what you’d change. Thoughts?

2 Brett { 08.13.09 at 11:19 am }

Thanks Dave, great question. I wish I could say the ideas are my own, but I was impressed with the solutions presented by John Mackey (CEO of Whole Foods) in this Wall Street Journal article.

Things like making costs transparent so that consumers understand what health-care treatments actually cost, tort reform, equalizing tax laws, making plans portable across state lines (and other areas of increasing competition), etc. would all go a long way in solving the affordability and coverage problems.

I also think Utah and Massachusetts are moving in the right direction with state health care reform- encouraging transparency and portability through initiatives like the Utah Health Exchange.

There are hundreds, if not thousands, of great proposals out there. A quick search of alternative health care reform plans returns all sorts of ideas (both good and bad). But with all the choices out there, I’m dumbfounded by what we’ve currently got in the works.

3 Greg { 08.13.09 at 2:16 pm }


Nice post. But, if you want the blog post to be effective, you need a picture of you covered in crap. otherwise, its just seems to be missing something…

This is a post I made on facebook today that is in the same vein:
So, healthcare is super expensive, and the status quo will eventually break us. Heath care is way too much, the status quo is unsustainable, and lawyers, insurance execs, pharm giants, etc, all have a hand in the pot, more so than they ought IMO.

What is the best way to decrease health care costs then? Tort reform is important, but inadequate in and of itself. I don’t think a gov’t run system will lead to something better than we currently have, unless rationing care is something we want. I don’t. I’ll take my hip replacement when I’m 75, thank you. And yes, I would like a whipple if my Pancreatic cancer is amenable to surgery (my friend’s grandma presented to a Canadan ED with painless jaundice. The CT was 2 months later).

Why would anyone think a centralized management system of scarce resources would be more efficient than the free market? I don’t think they do. They instead make the “fair” argument, and in their minds, it is not “fair” for anyone to have better access than anyone else. I don’t think its fair for me to have lived responsibly, both in lifestyle choices and financial matters, and then be forced to pay for the enormous costs of their health care which are direct consequences of their prior choices, and which they can’t afford because they lived irresponsibly. I think I ought to help such individuals, and I would help such individuals, but to obligate everyone to pay for them is not fair, and IMO immoral.

While it is multifactorial, the massive costs of health care is due to the fact that the patient and the provider are wholly removed from costs. In other words, the patient has no clue what things costs, and which hospitals would deliver the same care for a cheaper cost.

As such, patients will keep going to institutions who bill up the wazoo because the patient is removed from the cost. The institutions then do not have any incentive to cut costs, but to drive them up as much as possible (for example, yesterday I was sent 26 separate containers of prostate cores to gross in, b/c then you can bill 26 times. IF they were all in one container, you’d only make 1/26th of the revenue). It just increases their revenue. Then, there are rankings. Which hospital is ranked #1, 2, etc. There are many algorithms to derive rankings, but essentially, in order to be a “top hospital”, and to avoid malpractice, the institution and providers will order and perform a battery of tests that really don’t need to be done.

The solution as I see it is to remove the big business and government from the system, and move to a patient-doctor direct cost relationship. Gov’t should not be price setting (did you hear about the dr in NYC that was shut down for charging under the medicare/caid reiimbursement rates? case and point). Technology has decreased costs in every other industry, except health care. Thats because no one has any incentive to cut costs, together with excessive governmental regulation (2nd only to nuclear energy). If patients stopped going to a hospital that was 3 times the price, the hospital and the vendors would find some cost cutting solultions quick. And it would be a much better system than the VA. You should read Ron Paul’s book “a manifesto”. He’s an old school physician who writes a few chapters about what medicine was like before the government got into the insurance business. I have found it very influential in my views. As was a different college roomate who had a grandma in canada fall, break her hip, wait 6 months to get it set, and they had to rebreak it again to set it. no thanks.