Thoughts on the Healthcare Plan

Healthcare in the United States is incredible in many ways.  For many major diseases, your chance of a favorable outcome here is multiple times what it is in other first world countries.  For some things, like infant mortality rates, we lag some first world countries.  Healthcare innovation in the U.S. has been driven by a free market, both in treatment protocols, drug development, and new technologies.  There’s a reason that people literally from all over the world come to the U.S., and Houston in particular, for treatment.  So know that I’m a major fan of and grateful for our medical system even as I make the following statement.

I believe that healthcare in the U.S. is broken in some major ways.  A few of the problems I see are:

1. Insurance , including Medicare, strongly dictates what treatment an individual can receive.  What’s allowable varies from plan to plan and from company to company.  Often people don’t receive the treatment that’s available because of this, and it seems unjust.
2. The cost of bringing new drugs to market is almost prohibitive, so only drugs which will have a sufficient payback are even tested and put through the approval process.  Drugs which have been shown effective in clinical studies for rarer diseases often are not submitted for FDA approval.  Unless they are also effective for more common diseases, they will not be available.  Even if they are available, Medicare and often insurance companies will not pay for them unless they are specifically approved for the specific disease you have.
3. A portion of our population is uninsured, and their treatment is often paid for by the taxpayer.
4. For a variety of causes, emergency rooms end up handling a lot of primary care cases.
5. Then there’s malpractice insurance necessary because of malpractice lawsuits.  This also dictates how doctors, hospitals, etc. practice medicine, and adds significantly to the cost.  Risk avoidance has become a driving force in providing healthcare.

There is no doubt that changes are needed to address these issues.  But the question is how these changes should be caused to occur.

The healthcare bill currently being pushed and debated is to some one way to attempt to cause these changes to occur.  If you haven’t looked at the bill, you can by following this link.

If you at least scan the bill, you’ll see that many of the things I’ve listed above are addressed in some fashion.

But as I read through the bill, I became increasingly uncomfortable with what I was finding.  Here are a few major things that I find very disturbing:

1. It creates a whole new new level of bureaucracy to create regulations, to enforce regulations, to gather information, and on and on.  Since this bureaucracy will be overseeing one-sixth of the total U.S. economy, it will have to be very large.  Think about the size of the IRS, and then multiply it several times.  Bureaucracy has never been an efficient way to fix things, and there is no reason to believe that it would be for fixing the complexities of healthcare.  And it will create a huge tax burden just for the bureaucracy.
2. It requires an incredible amount of reporting and compliance on part of every segment of the healthcare industry.  This will carry a hefty price tag, which in turn will increase the cost of healthcare significantly.  Think Sarbanes-Oxley.  It will be a boon for lawyers and accountants, as all such government programs are.
3. It doesn’t address several of the major issues that currently are driving the healthcare cost crisis — tort reform and FDA approval.
4. Relatively little of the funding will actually address providing healthcare for those currently without insurance.
5. It drives all coverage to the lowest common denominator, and also drives care to the lowest possible denominator.

And my final objection is a simple one.  The government itself is broken.  Creating more government will create more brokenness.  How can something that is so broken, that does such an inefficient job of its own functions, think that it can fix something else?

Let him who has a beam in his eye remove it first before trying to remove the splinter from his brother’s eye.