Socialized Medicine is a good idea...

[Linette]

...according to James Kroeger

From his June 17 blog entry Universal Health Care:

"...I tend to think it is far more important that Democrats determine which kind of idealized health care system they would bring into existence if they could, giving special attention to the key principles upon which they would base their ultimate choice."

"This discussion reminds me a lot of the “Economics of Health Care” course I took in graduate school, possibly the most enlightening economics elective I ever took. It was the term paper in particular that I found especially challenging. We were asked to “solve” the health care crisis in America, given all that we had learned about America’s health care industry and the comparative health care systems found in Canada, England, France, Germany, and Japan. The model I ended up embracing was certainly not one that I had originally thought might be among the final two contenders."

"...What led me to my ultimate choice was discovering that there were a couple of fundamental principles I could logically base my choice on. Indeed, I eventually realized that there was one principle above all others that Democrats should be basing all of their reform proposals on. We need to fix the incentives that drive our health care providers...

"...Total health care costs were being “brought under control”, but they were only being limited through a reduction in the quality of health care being received. Seeing this evolution in the incentives of America’s health care providers focused my attention on the need to create a system that gives primary care providers the right kind of incentives. How might it be possible to set up a health care system that gives providers a natural incentive to give patients the best care possible while not also tempting them with financial incentives to over-prescribe care? The answer is to put doctors on a salary."

"If a physician gets paid a generous salary for “just being a doctor”, for “doing what a doctor does” then she will not receive any extra revenue if she prescribes extra tests & procedures. Nor will she be rewarded financially for under-prescribing care. When physicians are on salary, they are freed from their concerns about financial matters and are able to fully invest themselves in the most idealistic inspirations of their calling. They can simply focus on healing people and not worry about all of the administrative crap."

"Once it became clear to me that incentives should matter more than any other variable when Americans are discussing health care reform, I was led by logic to the “Socialized Medicine” model that Great Britain has embraced for over 50 years. In spite of the bad press that the National Health Service has received in this country (by the same people who give bad press to Democrats & Liberals) it has actually proven itself to be perhaps the most efficient provider of health care in the free world..."

"...Perhaps the best long-run strategy is to try to win over the doctors, first. Tell them that we’ll freeze their current average salary (in different markets) and then take all of the “non-medicine” burdens off of their shoulders. Then, with hopefully the support of a majority of physicians, we could take on the insurance industry, perhaps proposing an AMTRAK-type of transition to them. The pharmaceutical industry may be the most guilty of running up our health care costs, but it may be best to take them on last..."

I left out the parts where he provides links to published data. I really don't know how it's possible to disagree with him about the incentives. Anybody?

[EVDebs]

1. ...and when the 'Free Market' fails, it's better than no medicine at all !

[evilkumquat]

2. The Major Problem With Our Current Health Care System...

...is that it is being run for profit.

Granted doctors should not be expected to work for free, but a huge problem is that an industry that should be (at its heart) purely altruistic—HELPING PEOPLE—is being run in a manner to maximize profits... something that helps no one except those reaping the cash.

Barring a huge shift in the mentality of those seeking a career in medicine (unlikely, because 95% of those in med school are in it for longterm wealth; the other 5% because they are on a crusade to stop whatever it was that killed their mom, dad, brother, sister or best friend-see whatever crappy movie is probably playing on Lifetime right now), universal governmental insurance programs with penalties against doctors who overcharge may be the only solution.

Barring that, everyone who has ever lost everything due to the costs associated with a major medical catastrophe should band together as a desperate group of desperadoes going from town to town, barging into hospitals and private clinics, dragging the doctors outside and lynching them.

It would make a great movie: Uninsured.

Clint Eastwood could direct it.

Evil Kumquat

[clovis29]

6. Didn't they do a film with Samuel L. Jackson...

or similar? He had a kid with a disease and they wouldn't operate??

[evilkumquat]

7. Oh Yeah... Die Hard With a Vengeance

Just kidding.

It was Shaft.

Evil Kumquat
________________________________

PS. God I'm a card. Actually, you're thinking of Denzel Washington's John Q

[Jackpine Radical]

3. This is a very interesting notion.

I thik he's right about the key lying in the realm of incentives, but I'm not sure about the specific ways in which he implements the incentive scheme. Thinking as I type here--one problem I see is that health care is not exactly a commodity in the way the ins. cos & economists like to think. There are differences between providers, some being better than others, etc. You would want your bypass from someone who has a 0.5% mortality rate, not a 5% rate. At a base and crude level, why should a salaried person stive to be better than other salaried people if he/she isn't going to profit from it? Kroeger seems to rely on the good will of the physician, but what about all the marginal or incompetent types hanging on here? There would at least have to be some sort of quality control.

Let's think of it in terms of psychotherapy because that is a relatively low-tech service, because it is the least "commodity-like" of health care services, & because a weird sort of "free market" exists there, at least in my geographic area, where the big guys haven't driven us all out of business through capitated plans & the like. (We aren't a big enough profit target.) If I have a small OP clinic, how can I get it to grow? Right now, I would do it by providing better services, building a reputation, getting known among potential clients, etc. In Kroeger's world, would there even be a place for a small clinic like mine?

[EVDebs]

4. Hmmm. How about incentives tied to performance and dropping loan

paybacks. I'll bet writing off student loans tied to measurements of excellent practice (how do you measure that ?) could be effective.

[Jackpine Radical]

8. My student loans have been paid off for at least 25 years.

Maybe a straight incentive of cash bonuses.

And there are a lot of ways of measuring excellence in health care; there is a whole literature on that topic within the field of program evaluation.

[EVDebs]

9. That sounds excellent. Even non-cash bonuses too (green fees ? that's a

joke btw).

[Jackpine Radical]

11. You wouldn't believe what the drug cos. already do for docs.

Free Caribbean cruises disguised as in-service training, for example. The interesting result is that, not only do the docs get all these freebies from people seeking their favor, but the drug cos. control medical continuing education, so the docs never hear about any non-drug interventions, for example.

[EVDebs]

12. "Free" ? You mean consumer paid add-ons to price of drugs...

[bvar22]

5. The cold facts:

* The World Health Organization "ranked the countries of the world in terms of overall health performance, and the U.S. ...37th." In the fairness of health care, we're 54th. "The irony is that the United States spends more per capita for health care than any other nation in the world" (The European Dream, pp.79-80). Pay more, get lots, lots less.

* "The U.S. and South Africa are the only two developed countries in the world that do not provide health care for all their citizens" (The European Dream, p.80). Excuse me, but since when is South Africa a "developed" country? Anyway, that's the company we're keeping.

* Lack of health insurance coverage causes 18,000 unnecessary American deaths a year. (That's six times the number of people killed on 9/11.) (NYT, Jan. 12, 2005.)

* "U.S. childhood poverty now ranks 22nd, or second to last, among the developed nations. Only Mexico scores lower" (The European Dream, p.81). Been to Mexico lately? Does it look "developed" to you? Yet it's the only "developed" country to score lower in childhood poverty.

* Twelve million American families--more than 10 percent of all U.S. households--"continue to struggle, and not always successfully, to feed themselves." Families that "had members who actually went hungry at some point last year" numbered 3.9 million (NYT, Nov. 22, 2004).

* The United States is 41st in the world in infant mortality. Cuba scores higher (NYT, Jan. 12, 2005).

* Women are 70 percent more likely to die in childbirth in America than in Europe (NYT, Jan. 12, 2005).


Acording to these figures, there are 37 HealthCare packages in the developed World that perform better than the current program in the USA. Adopting ANY ONE of these would be an IMPROVEMENT and a step in the right direction.

[EVDebs]

10. Interesting things. I'm reading The Magnesium Factor and find that

for a plethora of maladies, magnesium supplementation at the rate of around 2.3 X body weight = # of milligrams, would help alleviate or ameliorate high blood pressure, heart arrythmias, 'metabolic syndrome X', kidney stones, and a whole lot of other things. This would save tons of money now being spent on pharmaceutical companies blood pressure drugs...which is probably why such vitamin and mineral supplementation isn't being done through medical channels.