Wednesday, April 29, 2009

Healthcare in the U.S.

The White House and Congress have argued that the skyrocketing cost of healthcare will continue to hamper U.S. competitiveness and further constrain consumer choice. They are right. However, the solution they offer - single payer, and the reasons for it - greedy drug companies and pilfering insurance providers, are not only simple minded but also disingenuous.

The real cause of skyrocketing healthcare is not the cost of drugs, which, for most therapies, is a fraction of the total cost. The cause is skyrocketing health insurance, driven by a legal system that encourages doctors and hospitals to order unnecessary tests in order to defend against no-limit malpractice lawsuits, and a reimbursement system (Medicare and Medicaid) that incentivizes healthcare providers to maximize procedures.

If the politicians are honest, they should tell the people that a single payer system will require caps on malpractice awards. In Canada, with a single payer system, malpractice awards are capped. However, we do not need a single payer as a reason to cap or eliminate malpractice punitive awards. Such reforms can be justified by acknowledging the senselessness of pitting patients against doctors and hospitals, which is the state of our current legal system.

Congress and the White House should restructure the payment system at Medicare and Medicaid to incentivize wellness and disease prevention rather than just treatment.

These two measures will cause insurance rates to drop, doctors to go back to doctoring (rather than acting as quasi-lawyers), and drug companies to return to discovery instead of spending resources to justify their existence.

Finally, we should have an honest discussion with our politicians. As consumers, we in the U.S. are not only spoilt for choice but have very little stomach for tradeoffs. We want that 5000 sq ft house even though we really can't afford it. We want the biggest and baddest cars to drive to soccer practice but are unwilling to pay for gasoline. We want the best healthcare in the world at all costs (more than 80% of healthcare costs are expended in the last third of life) but someone else has to pay.

Reform cannot and will not happen until we live in the light and speak the truth to ourselves. This year, however, the White House is manuevering to make its healthcare plan filibuster proof and with the defection of Specter, woolly headed thinking now has the impetus to become policy.

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