Tuesday, October 20, 2009

The American Health Care Debate

I have a serious brain-crush on Ira Glass of This American Life fame.  I was thrilled by the show they did last year about the causes and effects of the housing crisis that snowballed into the global financial crisis, The Giant Pool of Money (and an update a year later).

Today I came across their two-part series on the American health care - and health insurance - situation and how it got that way.  It's a complicated mess, in short, but not because anyone is clearly to blame.  It's mostly due to a series of historical accidents that, taken together, mean that no one sees the whole picture.  Including, apparently, President Obama, whose public speeches on the subject seem remarkably naive after listening to this two-hour presentation for laymen.

The patients want the best care possible, which to the average person means more care.  But more is not always better, and more procedures not only have health risks (like CAT scans that use a lot of radiation) but they raise everyone else's health care premiums because the cost gets spread around.

Doctors  like to think all they are worrying about is optimal patient care, but there are financial considerations, too.  There are a lot of doctors and a limited number of patients.  For doctors to rake in the money they expect, they have to do more procedures on their existing patients, or pull in new patients who may not need the care at all.  And, you know, they want to be helping people.  They want to be busy.

Insurance companies want to provide the cheapest care to the most people.  But they're not necessarily evil; they really do want people to get care, because it's cheaper in the long run to catch problems early.  But patients are totally divorced from the cost of things they want, especially medication.  They don't know the cost-benefit analysis, and neither do the doctors, because that's not their job.  To use a particularly apt metaphor for health insurance and why it's not a good plan;  imagine you had a grocery plan with your local supermarket.  Every time you go in, you pay your $20 copay and take whatever you need.  If everything is the same price, why get hot dogs when you could have steak?  Everyone takes what they like best with no regard for cost.  The premiums of everyone in the plan go up, and the prices in the supermarket go up because the customers with the plan don't care about the real cost, and soon people who aren't on the plan can't afford groceries.

Drug companies... well, I haven't heard a real humanizing story for their business model yet.  They make drugs and market them aggressively to doctors and patients both.  They constantly twist drugs very slightly to remove them from generic status and get a brand-name out there for six times the price.

I want to forward this to everyone I know.  I want to make my mom, a Registered Nurse, listen to it.  I want to make my friend who rants about how terrible Democrats are listen to it.  I want to make the President listen to it.

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