Thursday, August 16, 2007

Sick people are the problem, apparently

Jon Herring writes in the eNewsletter "Early to Rise" (Tuesday, August 14, 2007) about the U.S. health care system (www.earlytorise.com). The bizarre movie, “Sicko,” prompted Herring’s piece. He praises Moore for illustrating what’s wrong with the U.S. health care system, but disagrees with Moore’s solution. Moore, of course, wants more government care, while shutting down a market-based system.

Herring, however, goes on to repeat yet another tired mantra: He says that what’s wrong with the health care system is that it’s geared to treating sickness. Well, as my children used to say, “duh!”

Herring, quite properly and effectively stresses good health as the best antidote to what ails the health care system. In this, he joins the other billions of people on the planet who have common sense. If all of us took better care of ourselves, we will need less medical treatment, fewer prescription medicines, and perhaps, will avoid artificial organs and other medical devices. No one can fault him for that logic: Its just lacks scope.

Imagine yourself after a lifetime of good diet, vigorous exercise, low stress, and a lot of rest, lying in a hospital dying of nothing. Everyone dies. Everyone dies from something (two incontrovertible laws). And accidents happen, as do communicable diseases. People get sick. People suffer.

The U.S. health care system exists for these specific purposes: to reduce pain and suffering, and to extend human life. In its truest sense, then, its purpose for existing is to treat sick and hurting people.

Herring, and others like him, want a health care system that cares for healthy people, investing more heavily in preventive medicine. Preventive medicine is cheap to provide, except when it discovers a previously-hidden chronic illness, or a benign fatty tumor that results in surgery. Then it can lead to pricy, life-saving treatments.

We can all advocate for good health. We can even shape up our own bodies. We can buy all the preventive health care services imaginable. But in the real world, we still need a health care system to treat sick people, and treating sick people costs a lot of money - a lot more than not treating healthy people.

One last point about Jon Herring’s harangue: He writes, “But don’t expect changes in this broken system. The drug companies like it just fine the way it is…” Beware the salesman who must blame others in order to sell his products, as does Jon Herring. It's just plain dumb to accuse pharmaceutical companies of wanting people to be sick. That's like blaming gas stations for selling gas to people with empty gas tanks.

The fact is that if we are to force the health care system to change in positive ways, it will take the combined efforts of millions of Americans engaging in the purchase of health care services. It would also help immensely if those millions of health care consumers lost weight, quit smoking, drank less, ate healthier, and walked every day.

Thursday, August 9, 2007

Single Payer and Nurse Shortages

Nurses are pitching universal health care. By that, they mean that we should move toward a single payer health care system. They want this because they believe there is a nurse shortage: About this, they are right, and it will get worse, especially with government run health systems.

Now I know that rank and file union nurses are smart people. They have to be to make it through all that training. Of course, all smart people are ignorant about some things, like politics and economics. That’s why they rely on their union leaders to make good decisions for them. So I excuse the rank and file from my criticism here.

The U.S. spends about 16 percent of its Gross Domestic Product (GDP) on health care. A good deal of that goes to health professionals, like physicians and nurses. By contrast, Canada spends about 10 percent of its GDP on health care.

Of that 16 percent, 45 percent is paid by government programs, and 55 percent by private insurance, and out of pocket payments. Or, it could be stated this way: About 7.2 percent of GDP is spent by governments to provide health care services (for 25 percent of the population), while 8.8 percent is spent by private insurance companies and people paying out of pocket.

Very few Americans feel undertaxed. Government health care is paid from tax revenue. In most Canadian provinces, health care spending already reaches 47 percent of all provincial tax revenue; plus the national government tosses in billions more.

If the U.S. decided to move to a government-run, universal health care system, the dollars available through tax resources would be less than are available today. That is, unless governments are prepared to raise tax rates by astronomical margins, or cut other vital programs to the bones – like bridge repair, for instance.

The end result of government-run, single payer health care is this: There will be fewer nurses than today, not more. Unless government health managers decide to dump physicians and replace them with less expensive nurses to deliver health care, and that, my friends, is not a step in the right direction.

Nurses, of all people, should be pushing to reduce the government’s role in health care (and I didn’t even touch on the low, low reimbursement rates they now receive, the rates that make it less possible to employ more nurses).

Nurses, work on your skills. Carve out a niche in an emerging, free market health care system.

Monday, August 6, 2007

Why ask the president to solve health care's problems?

Several months ago, in an article about the U.S. health care “crisis,” The Economist asked the question, “…what is President Bush going to do about it.” My immediate response was, “Why is it even his business?”
Providing and paying for health care ought to be a local and personal issue, not one in which the federal government plays a central role. It is the idea that the federal government had to solve health care crises that got us into this mess.
That, however, is not the thrust of this message. Rather, it has to do with the questions surrounding health care. Should our focus be to:
  1. Reduce overall health care spending? And if so, is that in real dollars, or a percentage of GDP, or both?
  2. Or is this about reducing per capita health care spending in wealthy states, while increasing it in less wealthy states? Or cities? Or neighborhoods?
  3. Increase access to all health care services for everyone? Or about reducing services for some, so that others can have what they now lack?
  4. Reduce the rate of those without health insurance to zero? Or those without someone else paying for their health care to zero?

Whichever question moves to the top of the list will leave the others unresolved. For instance, if our overall goal is to reduce health care spending, while maintaining access for everyone to quality health services on an equal basis (sounds like single-payer to me), then we will not accomplish any of those goals.
If we squeeze provider reimbursements believing it will reduce spending, it will also reduce the supply of providers. Many will quit.
If we open the floodgates so that everyone can have everything, it will send health care spending through the roof.
Try taking services away from Hollywood, California and give them to Hayward, Wisconsin.
I believe that the best way to get a handle on this is not to look to Washington, D.C., but look to Washington Street, Lane, Avenue, Blvd., Way, Court, or on any other street where health consumers live. Put them in charge of their own lives. They are up to it.
The president has far more important issues to tackle than where I get my next blood test, who pays for it.

Thursday, August 2, 2007

Mississippi River Bridge Collapse

This is an unusual post to a health care blog, but I wanted to share it with you. I can say that the response of the health care provider community is amazing, and a great testiment to the high quality of U.S. health care.
The I35W bridge is about 10 miles west of our home, just on the west of the U of MN campus. The Humphrey Metrodome, where the Twins play, is about 4 blocks west of the freeway. It is likely that some of those cars were on the way to the Twins-Kansas City Royals game.
But here’s my story.
My sons, Dan and Dave (and his wife Alicia) had a softball doubleheader tonight. The first game was to start at 6:15, on the ballfields at 20th Ave and 2nd Street, roughly three blocks from I35W on the west, and two blocks south of the Mississippi River.
I arrived at the ballfield at 6:05, and walked across the field. About the time I got to the ballfield where the boys would be playing, I heard the first sirens. And there were many sirens. Son David came about five minutes later. All I knew was that something big was going on, but felt it could have been police chasing someone, as squad cars drove past the ballfields on my left and right, and to the west of me, they were parking at the foot of a bridge that leads north, parallel to I35W.
Then I saw black smoke in the NW, and fire trucks started to appear. And more cop cars. One of the ball players called his brother, and that’s when we knew the bridge had collapsed, but we knew nothing else.
Dan came about 6:20, and he had crossed the bridge that parallels I35W. He saw the bridge down in the water, but had no details. I tried to call people to see what they knew, but cell phone traffic stalled out. Around 7:10 I walked two blocks north to the river and could see one of the spans laying at a 45 degree angle down into the river. I walked west and looked north and could see another span hanging down from the north, into the river. But I still had no idea that so much of the bridge had collapsed flat into the water.
I finally left the ballfields after 8 p.m. and listened to radio reports. Still, it wasn’t until I got home at 9:20, after picking my wife up from work, just how devastating this was.
Okay. My irony, and evidence of God working to protect me and my family: When I checked directions to the ballfield, I saw that I could take I94, to Riverside and so forth, or I could I35W and exit, and so forth. I chose I94. There is absolutely no question that I would have been on that bridge, or very near to it (within 5 minutes one way or the other, or on it) when it collapsed.
My writing partner, Greg Dattilo, had left my office just past 5 p.m. He drove across that span around 5:30 p.m.
Of course, we will hear many stories like this. This morning we learned that a family friend lost her daughter in this tragedy. Joy Blackhawk’s youngest, Julia. We do not know details.
Now we watch and see.
This ranks right up there with Hurricane Camille (we lived in Gulfport, MS when it hit), and the Twin Towers.
We have checked with our own family members, and everyone seems to be accounted for.