Tuesday, January 29, 2008

Worrying About Health Care

From Arnold Kling, a piece on why our current health care system for the elderly--specifically Medicare--is "pure evil:"
Medicare is wonderful for relieving the elderly from the burden of worrying about health care expenses. By the same token, it is wonderful for relieving doctors of the burden of worrying about the elderly as customers. You get paid for understanding the billing system, not for understanding your patients.

This fits pretty well with my mother's experience before she died from cancer. Her primary care physician chalked everything up to "getting old," despite her complaints of abdominal pain. The surgeon never talked to the radiation oncologist, who never talked to the PCP, and 'round and 'round we went.

But the hospice people were superb. They were caring, copetent, and matter-of-fact.

Hospitals have a term of art for a certain class of elderly patient: They're called "gomers," an acronym for Get Out of My Emergency Room. Granted, an emergency room is probably the worst place to treat an elderly patient in crisis but the crises happen because everybody's more interested in milking the system and maximizing billing than they are in improving the patient's life. The kind of integrated care that's necessary to help the elderly just doesn't make sense under Medicare. (NB: The type of integrated care we're talking about would dramatically reduce health care costs for the elderly, as well.)

I'm all for reducing the level of anxiety that most people--myself included--feel when confronted with the financial uncertainty entailed with dealing with health care. But you can't solve the problem without making patients accountable for their own treatment, right up to the point of financial ruin. It's only when patients know what they're paying for that the market will work its magic.

I continue to think that the right answer is a guaranteed enrollment in a catastrophic insurance system, coupled with a routine care system that the patient pays for. You can subsidize the poor to let them pay for the routine care and the insurance premiums. Meanwhile, the vast majority of patients will vote with their feet and drive up the quality of the routine care.

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