Map of life expectancy at birth from Global Education Project.

Monday, November 02, 2009

The proper goals of health care reform . . .

I'm too busy for a decent post today, so I'm just going to blow some smoke.

It is now fairly clear that any health care reform legislation Mr. Obama signs this year will be, to use a technical term from political science, crappy. It won't get us anything that we need. But, just maybe it will provide raw material out of which something better can be made next year. Meanwhile, here's some of what's wrong with health care in the U.S., none of which we are even talking about fixing.

It costs far too much. We don't get what we pay for. Every dollar we waste on health care -- and the waste is something like 6% of GDP -- is a dollar we don't spend on making people's lives better and securing our future.

We overtreat and often do more harm than good. When people are systematically given information and decision aids so that they fully understand the potential harms from common procedures such as prostatectomy, joint replacement surgery, coronary artery bypass grafts, etc., the proportion of people wanting such surgery declines dramatically. But right now, doctors get paid for doing stuff, so stuff they do.

Half of the drugs on the market are either basically useless and dangerous, or no better than much less expensive alternatives. Drug research and utilization are driven by commerce and marketing, not by what makes people healthier and feel better.

The system is fragmented. People have to negotiate multiple specialists who don't know them, are thinking only about the organ or disease they specialize in and aren't interested in people's lives, and they get multiple and conflicting prescriptions, advice and treatments, much of which is counterproductive.

We aren't investing in public health and improving the social and physical environment. We spend hundreds of billions every year trying to fix problems we could have prevented for five cents on the dollar, and usually we can't really fix them.

People are dying horrible deaths in sterile cells hooked up to machines while their friends and family are tortured with false hopes and pointless choices.

Primary care -- the key to an effective and humane medical institution -- is underfunded and despised. Primary care doctors don't have enough time for their patients, don't have awareness and can't manage the overall care of their patients with complex medical problems, they are overworked and underpaid, and they don't get respect within the profession. That means that as patients we don't have a medical home and we don't have a personal connection with the system that can make it work for us.

Yes, we need to cover everybody, but not at the expense of making them pay money they don't have. Universal coverage is only a progressive step if it is linked to progressive financing and reorientation of medicine away from profit and sickness care to taking care of people and actually doing health care. Without that, it's just one more way of stealing from the poor and giving to the rich. And yes Sen. Lieberman, I'm talking to you, you schmuck.

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