Health Care Reform

Sometimes I question my sanity. For example, on the subject of health care reform, I feel oftentimes that I’m the only person who sees core inflation and inefficiencies in the system as a bigger problem than those tossing around the “universal health care” buzz phrases.

Well, apparently, I’m not the only person. Specifically, check out this op-ed in The Day, written by an OBGYN:

One of the most insidious catalysts for increasing health care costs is the lack of a definitive standard of care. This opens the door to malpractice liability (“you didn’t do enough”), defensive testing and treatment (“I did do enough”), and the over-prescription of pharmaceutical treatments (“How could you say I didn’t do enough if I gave you a pill?”)

On the administrative side, a lack of standardization in care engenders a lack of standardization in billing, measuring, and accounting for that care. The permutations of systems of care with systems of accounting have lead to the exponential growth of overall system complexity.

Rather than enable individual physicians the flexibility to determine the most appropriate course of treatment or prevention, the system encourages reactive and defensive medicine, practices which only enhance the inflation of health care costs.

Of course, the logical next steps in that thought process are a discussion of what standard of care is to be provided, and are we willing as a society to pay that expense….

An observation made by Michael Tanner on the Cato Institute website caught my eye:

At a recent campaign stop in Iowa, Democratic presidential candidate John Edwards told an audience that under his plan for national health care, preventive care would not just be paid for by the government, it would be mandatory.

Every American would be required to get annual physicals and regular tests such as mammograms and colonoscopies. Although Edwards didn’t spell out the penalties, presumably scofflaws would face fines or worse. It’s easy to make fun of Edwards’ proposal. (Can we look forward to the spectacle of couch potatoes who miss their doctor’s appointments being dragged off in handcuffs?) But we should actually be grateful that Edwards has so clearly illustrated the fundamental question that should be at the heart of any debate over health care reform:

Who decides?

Note—I haven’t fact-checked Mr. Tanner’s interpretation of Edwards’ plan…but I think it is one possible portrayal of what could happen if we start heading down the slippery slope of increased government involvement in personal medical care.

If our tax dollars are at work, the government has (or should have) a vested interest in managing the expenditures. And, when it comes to medicine, such management could involve some obligations on the part of citizens (”you shall go to Doctor So-and-So at 8am on such-and-such a date to be evaluated for your federal health profile….or else”), and/or rationing.

Or, even worse, the government could decline to engage in such management, leading to an ever-increasing tax burden and/or adding to the drag of seemingly out-of-control deficits.

I agree that the idea of ensuring that everyone has the ability to access health care within the resources available to them is extremely attractive. I just get rather uncomfortable with thinking of all the ways a government solution could worsen what we have now…and a bit frustrated by all the discussion of attempting to expand coverage without the important discussion of long-term costs and potential cost-control measures that may be taken.