Friday, December 18, 2009

A liberal case against single payer government run healthcare

On healthcare, here's what makes me a liberal democrat:

I believe that every American regardless of income should have access to quality healthcare.
Their medical options should be equal to that which a member of Congress enjoys today.

Yet, I don't support a single payer- government run healthcare plan for a simple reason:

It doesn't work as well as a free market.

We need to incentivize the brilliant thinking of as many people as possible to make healthcare better, cheaper, and a more pleseant experience.

If the government controls more of the healthcare decisions either directly as with the Veterans Adminstration or indirectly as with the single payer in Medicare, we wind up with big decisions that affect large groups of people, being centrally planned .

This by my definition is bad. For instance, should the "system" pay for mammograms for women between ages 40-49 even though the science says it is a net negative? What if you are a healthy 35 year old but want the safety of mind?

We need to set up a system where all of the professionals in the healthcare arena have to compete. This should include the people designing various delivery systems. The smartest people today don't know what the ultimate answers are, so they shouldn't pretend otherwise.

Let responsible people experiment.

There should be minimum standards as to what qualifies as quality healthcare, and of course
we would expect all doctors to live up to their oaths, but various doctors, plans, providers, etc. t could differ on other amenities, approaches, packages etc. for example:

-the number of hours available for regular-routine visits; the times available.
For instance what if there was a network of doctors who had 40 hours of "off peak" visits available per week:

mon - fri. 6 pm - 10 pm and Sat and Sun 7a.m. - 5 pm.

-alternative approaches versus traditional medicine.

What if you could buy a plan that was much cheaper but demanded that you live "better" according to the doctor's dictates. For example if you had respiration problems and you are a normal 250 pound man. The doctor might give you emergency medicine to stabilize the problem but insist you lose 40 pounds, eliminate alcohol , and change your diet. If you didn't you would either be removed from his patient list or be charged a much higher fee.

This as opposed to the current approach which would give recommendations to eat better, exercise more, and lose weight, but then proceed to treat the patient for whatever problem presented itself without any real penalty.

The list is endless and that's the point. Think of the things today that we "know" that just a short time ago it was conventional wisdom to think the exact opposite. Think about what has happened with anti-biotics and the over-perscription. Babies: to sleep on stomachs or backs? Are our children under or over medicated?

I would make it legal and commonplace for informed consumers to try experimental and/or non-mainstream approaches with the understanding that they or their heirs won't have any right to sue for any damages if things go wrong.

These are the kinds of ideas that take healthcare away from process type discussion and more into fixing the problems. Right now, many policy wonks are trying to find ways to transition to a healthiness and wellness model and away from a "sickcare" system. Why would we try to do this in any way other than market mechanisms. Everyday nearly 100% of Americans try to get more money, find the best bargains, and get the value for their dollar from their purchases. This needs to be the case in medicine. That is the magic cure. Freedom.

The government's job is to design a system that guarantees everyone will have the money to take care of themselves, that there's honesty in the system, and then leave people alone.

So I favor some minimum regulations and vouchers. Or refundable tax credits that turn into cash if you have been responsible in your healthcare.

Our system will improve if everyone along the line knows they have to compete for American's healthcare dollars person by person. The government's role would be full-time to root out fraud and abuse.

If you allow the governmet to design 1 big system, then all of these decisions are left to a single group of people, sometimes to 1 person.

No matter how good they or that person is, that is not America.

If you don't think this can work, just think what government agency is in charge of your dinner tonight?

No comments: