Healthcare Reform

Barrack won! Now we will all be able to afford our healthcare right? Maybe not.

Do we all get universal coverage? Not so fast. Beyond the obvious labeling of our government socialist by people who are in opposition, just take a second to think about the ramifications. According to data we saw in class the other day, about 25% (give or take) of your hospital bill is spent on administrative fees, that means this money is going to someone. Medicare has a much lower overhead, somewhere south of 10%. So if 25-10=15, than that 15 has to go somewhere (and not just into some rich CEO's pocket.) That extra 15% is going to support people who work at Blue Cross/Blue Shield, Aetna, etc. It is also going towards keeping the extra administrative staff at the hospital and doctor's office employed. So, the biggest ramification of socializing the system is that it would have the immediate effect of putting a whole bunch of people out of work. That is not such a good idea, especially in the middle of a recession.

One of the other big problems we have is cost. By now, most people have heard that most of medical expenses are spent on critical care during the last two years of life. So, what would the option be? Deny grandma an medical treatment once a doctor deems that she is not worth it? You can just imagine the uproar. But perhaps that is too harsh of an assessment. Maybe grandma doesn't really need to see so many specialists at her age. There was a landmark study done by Dartmouth a couple of years back comparing outcomes at top teaching hospitals in the US. It looked at what they spent on the last two years of a person's life. There were some big differences between Mayo Clinic and Mass General, specifically. They were on the order of hundreds of thousands of dollars per patient. To top it off, the outcomes were no better at Mass General (who spent much more) than at Mayo.

Personally, I feel like I am seeing this in action right now as I work with my urologist out in Oregon. He is very sensitive to the practical considerations of whether it is advisable to treat a patient given their age. If someone is 85 years old and appears with prostate cancer, it is not something he is concerned about. That might sound cold, but the reality is that they are not likely to die from that disease until the are about 105. Would other doctors treat this patient? I am almost positive they would. Should they?

Finally, the last part of this problem that is on my mind is the purpose of the healthcare system in the US. A lecturer we had discussed the "mission statement" of the US healthcare system. He went on to say that if the mission is to generate profit, than we are succeeding marvelously. However, if it is meant to provide for the public health, than it is an utter disaster. I think that this is a discussion that needs to happen. For comparison, we don't have for-profit fire fighters. We used to. If you go to look around olde city in Philadelphia, you will notice that there are some placards on the front of the townhouses. These placards were purchased from local fire companies and, if your house was on fire, they looked for the placard. If there was no placard, they let your house burn down. This is how the healthcare system is working today. If you have a raging inferno, than they will treat you in the Emergency Room, but they might bankrupt you as a result. If you have a slow fire burning, say a cancer, they are not forced to treat you at all. Addressing this mindset is key to reforming healthcare in the US in my opinion.

So basically, there needs to be: a solid plan in place to prevent not send millions of people to unemployment, a serious study of various health systems (both in the US and internationally) to learn how to handle costs, and some hard discussions about idealology and purpose. If these things actually happen, then I will be hopeful.