Thoughts on Health Care

I’ve made the rounds and made quite a reputation for myself regarding health care. I’ve gotten deep into it with quite a few bloggers and commenters, and have picked up a bit of wisdom here and there. Just a few more thoughts:

One, despite accusations, I do not “hate” Senator Max Baucus. (I made a sarcastic comment to that effect at 4 and 20 Blackbirds, and as per usual in this medium, the sarcasm was taken at face.) This reminds me of the days when legitimate criticism of George W. Bush was marginalized as “Bush Bashing”. Baucus does, however, embody much of what is wrong with the Democratic Party – he is under the spell of power and has been in office so long that he has adopted the objectives of those who keep him there, and ‘those’ are not voters. Beyond that, I have no patience with Democrats who automatically endorse anyone with a ‘D’ by their name. That’s been standard with me for many years. We don’t get “80% of what we want” from them, and the “good” that they want in opposition to “perfect” ain’t so hot.

I accept all that is good with the American medical system – our technology is superior, and those who have access to it get very good care and mostly positive outcomes. We are innovative – a healthy mix of government and private-funded research.

Insurance is a workable model only if the profit motive is removed from the picture. If treated as a public utility and forced to offer its product to everyone who applies, it can be an effective rationing agent for care. Furthermore, if treated as a utility, subsidy would be in order. Those countries that rely on private insurance – Switzerland and the Netherlands – subsidize and heavily regulate it. I hear nothing about regulation of our health insurance industry in this debate.

The debate process is not a ‘give and take’ where there will be a good outcome where everyone walks away somewhat happy, somewhat disappointed. From the beginning, when Baucus took single payer “off the table”, the objective of the debate framers has been to guide everyone to a predetermined destination. Though I am not prescient, it is clear that destination does not hold a viable public option for us, nor regulation of insurance companies. Participation is dangerous, disruption is the best tactic. As with Medicare D, no change might be better than the change envisioned by those who are manipulating the debate boundaries.

Something has to be done about costs. We are wild and spinning out of control. That ‘something’ will not be pleasant, and must include some form of rationing; it must include a system to offer fair, but not extravagant outcomes for malpractice; cost controls; reimportation of prescription drugs and negotiation with pharmaceutical companies on drug prices; a meaningful public option, and uniform national standards for health insurance policies. For starters. Why is it that we spend twice as much per capita as other countries on health care?

And finally, Medicare must address it’s fraud problem. Why they haven’t is a mystery to me. I suspect that in addition to bureaucratic, there is also a political explanation.