Facing Up To Reality

TW: This piece frames up pretty well the reality of health care reform, which I go back to frequently. Some how, some way Americans will likely need to consume less health care. Either lower quality or less quantity. The current system is the most innovation and providing the best quality (which is much different than most effective) in the world. The system is also utterly unsustainable.

I think people understand the simple math behind social security and as folks age fewer are working to fund those retired. But the same math applies to things like Medicare and health care generally compounded by the rate at which health care costs per capita are expanding.

The article says government provided health care and innovation tend to be exclusive. It is not government provided health care it is universal guaranteed health care and expensive highest quality care which conflict. Right now our health care is informally universal (i.e. if someone shows up at a health care provider in dire need they will receive treatment one way or the other.etc.), guaranteed for some (senior citizens and the very poor) but not others.

This lack of universality and guarantees creates inequity. Addressing those inequities will alter the status quo meaning those benefiting from the inequities (older folks and those covered by stronger private plans) will need to sacrifice all things being equal to expand coverage. Are those better off with the status quo willing to sacrifice, of course not.

Furthermore and far more importantly the status quo is heading toward oblivion, even without universality and guarantees our health care costs are going through the roof. Will digitizing medical processes and better preventative care be enough? No way, not even close. Privatization? Absolutely not, point me towards evidence other than boilerplate "we need Fed Ex not UPS" drivel. Health care is not the mail sorry.

The Dems are underplaying the costs of universality and guaranteed health care. The Republicans are ignoring how inequitable and ultimately dysfunctional the current system is. What are the solutions? Am still thinking about that one...

From Economist:
"The American government only provides direct health care to the elderly (Medicare) and the very poor (Medicaid) [TW: and vets I believe]. When Medicare was created in the 1960s it was meant to emulate a Blue Cross plan which was, at that time, one of the most comprehensive insurance plans available. Then this may have made sense, but lawmakers likely did not know just what they had committed to. Research by Amy Finkelstein found just the introduction of Medicare can account for as much as 40% of the real increase in health spending between 1950 and 1990.

In hindsight there seems something rather perverse about only providing the best care to retired workers. In theory, the government should make private insurance cheaper for everyone else because then the young won't have to subsidise (at least through their health-care premiums) the old. The main problem, which European countries have learned, is that sustainable, government-provided care and timely access to the most innovative treatments tends to be mutually exclusive.

The administration wants to find ways to spend money more efficiently to reign in the budget. This should be applauded. But, as the size and scope of the government grows, wasteful spending will probably become an even bigger problem. Trying to cut costs is insufficient; rather, the administration (and the country at large) will need to fundamentally reconsider what the government aims to provide."