I've been participating in an excellent conversation on healthcare reform between healthcare providers, patients, and others, which has been taking place at this link. In this post I summarize the conversation and share my thoughts.
The original post, written by Dr. George Lundberg and titled "How to Rein in Medical Costs, RIGHT NOW," describes an immediate strategy for saving money by:
While no one rejected the basic premise of the post, our conversation has focused on examining the scientific, economic, and ethical challenges of implementing that strategy. The many comments readers made can be divided into 12 strategies for dealing with these challenges; they are:
I discuss each of these issues below. I've included snips of a sampling of comments that were made (the screen name of each commenter is included so you can go back to original posts and read them in full). I added some remarks in italics.
The most important strategy, I contend, is #1: focusing long and hard on getting and using the scientific knowledge need to guide decisions based on cost-effective care and prevention. This is because such knowledge would help to deal with some of the top issues by helping to:
However, unless our country begins to evidence greater empathy & compassion, a "me-only" mentality by those how have decent insurance and don't care about those who are suffering will make healthcare reform more difficult, as well as making it even more problematic to deal with greed and dishonesty (#6).
Cutting administrative waste and getting people to work are certainly valid strategies. Finally, legalizing marijuana and using the tax money to help pay for healthcare reform is also worth consideration, although likely a hard sell (#s 10-12).
What should be done right now?
First, anyone with empathy and compassion could not tolerate the fact that many tens of millions of Americans lack health insurance or are underinsured. Sadly, unlike European, Canadian, and other societies, many in America have little concern for the wellbeing of less fortunate Americans because:
Such beliefs, attitudes and emotions are, in the long run, very self-defeating since our current healthcare system is simply unsustainable (i.e., doing nothing is bad for everyone), human nature is such that we are too easily driven by irrational fear, ignorance, self-deception, and ego (e.g., "me-ness"—greed & selfishness); these are just natural human fallibilities. And when conservative organizations hire clever lobbyist-run groups (such as Americans for Prosperity and FreedomWorks) to disrupt rational dialogue by manipulating human fallibilities and spurring irrational fears, meaningful reform becomes ever more difficult.
This means proponents have to present a healthcare reform plan that is easily understood by all and refutes people's irrational fears. The plan, I contend, should include a publically funded option, and can include private insurance options, so long as everyone is covered, regardless of their income, age, and health. The cost of such a plan, the coverage if provides, and the means of paying for it should be spelled out clearly, so that everyone knows what it means for them. This includes directly and convincingly dispelling all falsehoods propagandized by the opposition.
Equally important is for the plan to have a sharp focus on these two goals (as I discussed i n a previous post ):
That requires doing whatever is necessary to work diligently toward answering these three questions about value to the consumer:
Enabling and rewarding clinicians and consumers/patients to do these things would save huge amounts of money, continually improve care quality, and vastly improve the health and wellbeing of all by: