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We Need Health Care Reform, Even if it’s Bad

Posted Dec 14 2009 8:41pm

It is shocking to me that one Senator, in this case Joe Lieberman, can bring something as important as health care reform to a halt. Clearly everyone has worked very hard to compromise on this bill, and blowing it out of the water this late in the game, especially when you are now refusing to vote for something you championed just a few years ago, seems selfish to me. We need this reform, even if it’s bad.

Why bother with a bad bill? Why not go back and start from the beginning and get it right, as the Republicans argue? Because anything that dislodges old ways of doing things, no matter how slightly, forces us to reconsider, shakes things up, changes the picture in the kaleidoscope.  I read Atul Gawande’s article in last week’s New Yorker and I believe he’s right. We can’t have real reform through legislation, public option or not.  We can only have that when all the players involved decide to change their attitudes toward health care.

Right now, the provider is being blamed for most of the cost increases. But most health care providers I know are in business to heal people, and if they were left to their own devices, they could lower their cost of care by themselves. Do you think they want eight or nine employees to support each physician, each with taxes, benefits, and all the issues that come with employees?

Of course not. But a lot of their costs come from compliance: with insurance companies, with government regulations, with absurd CYA efforts to avoid being sued. That, rather than anything else, raises the overhead of the individual provider.

For the hospital, it’s a bit more complex, because many hospitals have boards, and shareholders, and pressures to generate revenue.  They also have to deal with the “cost shift” : treating the uninsured free and charging the insured $10 per aspirin.  That takes a lot of paperwork and administration,  and then they also have  to contend with  the things that cripple doctors –regulations and insurance companies.

For the payer, the incentive to increase profits and provide “shareholder value” is paramount. Nothing else matters. The insurance company is in it for the money, pure and simple.

For the patient, it’s getting the newest and best treatment, whether useful or not. (This morning I heard Deepak Chopra say that most of the prescriptions Americans take are of marginal utility, and that we endure horrible side effects as a result).

We are overcharging, over-diagnosing, and over-treating. Our health care system is as soft and obese as our population. We could lower costs just by putting the entire country on a health care diet: less care, rather than more.

But we will never do that without the impetus of some regulatory change. It’s a shame, because we should. We should be able to change ourselves without a crummy law.

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