Seven steps to better health care
Post-Dispatch file photo.
With health care near the top of its agenda, the administration of President-elect Barack Obama is planning to hold a series of town hall meetings across the country in coming weeks. The purpose is to solicit ideas and build support for health reform.
Fixing the system is no small task. One reason is that there is no single U.S. health care system. What exists are a series of patches designed to solve earlier problems; that patchwork has been worn threadbare by a completely different set of challenges.
Former Senate Majority Leader Tom Daschle, Mr. Obama’s choice to head a new White House Office of Health Reform, has promised to attend at least one of the hearings. In the spirit of Mr. Daschle’s request for ideas, we offer the following suggestions:
• Fixing health care is a huge and expensive undertaking, but doing nothing or postponing action is probably more expensive still.
The situation as it stands makes American companies less competitive globally. It wastes billions of dollars on heath care that could be used more productively elsewhere, say, for education or infrastructure. And it’s causing tens of millions of Americans to go without cost-effective care that they need.
To his credit, Mr. Obama seems to understand this. “If we want to overcome our economic challenges, we must also finally address our health care challenge,” he said last week.
• Insurance works best when risks are pooled among a large group. The bigger the pool, the lower the cost per person and the more predictable price increases become.
A large enough pool would make it feasible to cover all people who don’t have insurance now. That should be the ultimate goal of any health system reform.
• Cover children first. On the campaign trail, Mr. Obama promised coverage for all children through a combination of expanded government programs and an insurance mandate.
Children are relatively inexpensive to cover because most of them are healthy. Investments in childrens’ health pay off over the remaining decades of their lives. The savings are huge.
• Correct problems in the system of incentives to improve quality. It makes no sense to spend hundreds of thousands of dollars treating someone for lung cancer or heart disease caused by smoking, but spend next to nothing helping them quit. Yet that is how most insurance works. It’s wasteful.
• Focus on what really is driving up health care costs.
Americans don’t get more medical care than the people in Germany or France, but we spend much more on it. One of the reasons for this is that Americans get more intensive care with the latest, high-tech, expensive technology and drugs. But “newer” often is only marginally “better,” and it almost always is much more expensive.
America also spends much more on paperwork associated with health care than other developed countries do — three times as much as in Canada. Princeton University health economist Uwe E. Reinhardt estimates that total excess administrative spending was about $150 billion in 2008, enough to pay for health insurance for everyone who lacks it.
• Don’t break the existing system before we have something better. Most people still get coverage through their jobs. We’ve got to do everything possible to protect that.
• There is no single, silver-bullet solution for our health care mess. Keep tinkering to improve the system we have.
You say it makes no sense to spend huge sums on cancer and heart disease due to smoking, but nothing on “helping them quit.” How about this: If we go to the P-D’s revered “single payer” system, it should not pay for treatment of self-inflicted injury at all. Or, those who smoke and want coverage for cancer and heart disease should have to obtain supplemental private coverage at their own expense.
The same should apply for those who are obese due to dietary and lifestyle choices. I’ve met plenty of obese people who have Medicaid and food stamps. So, we buy the pork rinds, they eat themselves into heart disease and diabetes, then we pay to treat the diseases and give them SSI disability. How about this: Anyone who receives food stamps should have a semi-annual “weigh in.” If you are more than 10% overweight, your card becomes restricted, and you can buy no soda, chips, or frozen prepared foods until your next weigh-in.