June 26, 2009

A Novel Idea: Health Care for the Masses

Health Care Faces the 'R' Word -- by Michael Kinsley

Even though more and more Americans have no health insurance at all, Americans consider health care to be a right. Not just that: We consider the best possible health care to be a right. Few would find it acceptable for a poor person to die of a medically curable disease for lack of money. Even fewer would find it acceptable that they themselves should die because the system won't spend the money to cure them. This is all in theory, of course. In practice, people die all the time because some effective treatment is too expensive. But whenever an issue gets drawn into the political system and becomes explicit, it becomes harder. That is what health-care reform will do to the question of rationing.

The Obama administration believes that health care can be made cheaper without any reduction in quality. It has evidence to back this up. According to the famous Dartmouth studies, health care costs two or three times as much per person in some places in America as it does in others, with no measurable difference in results. Atul Gawande's deservedly admired recent essay in the New Yorker makes a similar point. So in theory it's easy: Just figure out how the cheap places do it and apply this knowledge to bring down the cost in the pricier places.
The administration is investing great hopes (and $1.1 billion of stimulus money) in "comparative effectiveness research." Because we don't collect and compare in any systematic way the vast piles of data we have about individual patients and their treatment, we know astonishingly little about which treatments work and which are a waste of money. The administration is touting the figure of 30 percent of all health-care costs as spending that may accomplish nothing.

I suspect that what a billion-plus dollars' worth of research will find is that perhaps 30 percent of what we spend on health care is almost entirely worthless, or just barely better than a much cheaper alternative. Or it might be better and no one knows for sure.

Click here for the complete text.
Being one of those who has no health insurance ['the great unwashed' as I call us uninsureds], I'll be glad when this thang is settled--though it'll be too late to benefit me. Next year, I become eligible for Medicare.
Still, it's about time the rest of the population can see a physician without breaking the bank, don't you think?


Ramonas Voices said...

Great article by Michael Kinsley. Loved this:
"Here is a handy-dandy way to determine whether the failure to order some exam or treatment constitutes rationing: If the patient were the president, would he get it? If he'd get it and you wouldn't, it's rationing."

Interesting that he doesn't mention his own health issues:


I remember when he first came out with the news, and later he became very frail, but he's back in action again and I'm happy to see it. I suspect his own excellent, expensive care made him more sensitive to the needs of those who don't have that kind of access. Too bad there aren't more like him.

two crows said...

"Too bad there aren't more like him."
agreed, Ramona--
more specifically, too bad there aren't more _in_Congress_ like him.

EVERY year, for years and years, Ted Kennedy brought up health care. And every year it failed.

they have THEIR excellent health care package. the rest of us can go f*** ourselves, I guess.

I hadn't known Kinsley had MS. no wonder it's so dear to his heart.

libhom said...

If politicians weren't subject to purchase under our current campaign financing system, we would have had single payer decades ago.

two crows said...

ain't that the truth, libhom--

how I wish the O were passing ONE plan for all people including Congress. but I have to be realistic, here. such a plan would never get past Congress.

LeftLeaningLady said...

Great post. I am always constantly amazed by the fact that there are so many in this country who do not have access to basic care.

I have an aunt who started going blind in her early 40s. She received disability and Medicare, but did not qualify for a supplement until she turned 65, by which time she had health issues and could not qualify for a supplemant. Craziness.

One of the reasons I voted for Obama was because of his promise for health care for all. We will see.