How American Health Care Killed my Father

I highly recommend this article that appears in the current issue of The Atlantic: How American Health Care Killed my Father, by David Goldhill.

After what the author describes as “the needless death of his father,” he began a personal exploration of “a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost.” It is a system, he argues, “that is not worth preserving in anything like its current form.” The author argues that the health-care reform now being contemplated will not fix it and offers “a radical solution to an agonizing problem.”

This is a lengthy piece and may take up to an hour to read and absorb, but for anyone who wants a better understanding of the health care problem facing this nation, this article is well worth reading.

It is my hope that the current proposals for health care reform are defeated. Defeating what is before us however will be a hollow victory unless defeat of the current health care proposals is followed by an effort at other reform.

The current system is simply unsustainable and must change, but the system in place is complex and any meaningful change will be difficult. If some form of the proposals that are before us is passed, it will do little to fix what is wrong with the current health care system and will only be a temporary patch and cost will continue to escalate. So, whether the current proposals are defeated or pass, our health care system will still need radical reform. We will either move in the direction of nationalization and rationing or toward a more rational market-oriented system that is significantly different from the mixed system we have now. The author advocates an overall of our health care system that makes the system consumer-centered and moves away from fee-for-service pricing. He explains what is necessary in order for that to occur.

Below is a summary of some of the points discussed in this article and some selected excerpts. Please share your thoughts on the article.

• We spend about 18% of our GNP on health care and it is growing and crowding out almost everything else.

"In 1966, Medicare and Medicaid made up 1 percent of total government spending; now that figure is 20 percent, and quickly rising. Already, the federal government spends eight times as much on health care as it does on education, 12 times what it spends on food aid to children and families, 30 times what it spends on law enforcement, 78 times what it spends on land management and conservation, 87 times the spending on water supply, and 830 times the spending on energy conservation."

• Health insurance is not health care.

"Health insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. "

• "Cost control is a feature of decentralized, competitive markets, not of centralized bureaucracy—a matter of incentives, not mandates. "

• Medicare is a Ponzi scheme

"The Medicare tax rate has been raised seven times since its enactment, and almost certainly will need to be raised again in the next decade. The Medicare tax contributions and premiums that today’s beneficiaries have paid into the system don’t come close to fully funding their care, which today’s workers subsidize. "

• The market does not work.

"In competitive markets, high profits serve an important social purpose: encouraging capital to flow to the production of a service not adequately supplied. But as long as our government shovels ever-greater resources into health care with one hand, while with the other restricting competition that would ensure those resources are used efficiently, sustained high profits will be the rule."

• You are not the customer.

"But my father was not the customer; Medicare was. And although Medicare has experimented with new reimbursement approaches to drive better results, no centralized reimbursement system can be supple enough to address the many variables affecting the patient experience. "

• "It is difficult for consumers to find any health-care information that would enable them to make informed choices.

• Technology is driving up the cost of health care when technology should drive down the cost of health care.
  

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