ok first post: healthcare
all the talk about healthcare makes me sick. ironic, right?
thinking about supply
what is fascinating and concerning is that discussion seems myopically concerned with demand side. we want everyone to have access to healthcare. okay. in many cases we want someone else to pay for it. okay as long as it is not me [you], right? lets just tax the rich [richer than me and you]. problem solved. or is it? if there are people who need incremental medical service, do we have spare capacity sitting around somewhere? who is talking about increasing the number of doctors, hospitals, research funding, etc? who is talking about scientific innovation [starting with immigration policy so we can get some more doctors who actually want to be here]? oh well perhaps there is enough aggregate healthcare, and we just need to spread it around like president change suggested so thoughtfully. and who would not want to join the medical profession? one can enjoy the satisfaction of supporting social justice via top marginal tax rates and maybe even a 'surtax' to pay for the very services they provide. or one could become a banker, skip the medical school thing, provide unclear social value, and get a taste of that sweet bailout money [i will have a more thorough criticism of banking industry in future post]. hmm...
demand side
discussion of demand side has been more comprehensive, de facto. but as a society we seem incapable of substantive evaluation of some of the most critical and difficult issues. we have 'blue pill good red pill bad' [i like both types personally] straight out of Orson Wells, or was it president change? two pills that are more difficult to swallow: end of life costs and depressed wages.
-- end of life costs
a disproportionate amount of cost is thrown at folks who are almost dead. sorry but we all have to go. speak to sister morphine. the costs are outrageous:
"""
Thirty percent of Medicare's annual costs are spent on the five percent of beneficiaries who will die in a given year. Additionally, about one-third of those dollars spent in the last year of life are spent in the last month.
"""
http://www.reuters.com/article/pressRelease/idUS194058+19-Mar-2009+PRN20090319
so we need to fix this.
-- depressed wages
if your employer provides your healthcare, this is part of your total compensation. do you know how much? probably not though perhaps you pay a portion. oddly employers are not required to reveal this information. it is big, though, and growing. this means that more of your total comp is in the form of healthcare so the cash part gets squeezed. too bad because we all love cash - we need it to eat and pay taxes. here is the point: if you frivolously consume healthcare it comes out of all your coworkers' pay. if you consume very little then you are receiving less cash in order to fund the aforementioned frivolity. despite my pleas, doc will not prescribe pills - red or blue - and i happen to be in good health, so i unfortunately fall into the latter category. we have a social obligation to protect sick people, but folks need to be connected to their consumption of healthcare. who knows, they might even pursue better health if they have some exposure to the cost. meanwhile the rest of us are in the dark about costs. hmm...
-- obese people [rant]
according to CDC
"""
Obesity is a major risk factor for cardiovascular disease, certain types of cancer, and type 2 diabetes.
"""
and
>30% of US adults are clinically obese.
http://www.cdc.gov/obesity/data/index.html
so maybe we could have less obese people to reduce the demand for healthcare. just a thought for anyone who does not _need_ to be obese...
can we get real?
much of the debate is reduced to:
a) people have a fundamental right to healthcare... ok
b) (a) requires someone to provide care and payment for service
we already talked about the supply side problem, so setting that aside: does the above imply that everyone has the right to healthcare _and_ has the right for someone else to pay for it? okay i guess. plenty of folks do not mind working a little bit extra for obese folks who are entitled to healthcare but need expensive pills because 'diet and exercise are not enough'. happy to help out...
i am too tired and bitter to continue in a productive manner. wake up people. we have an important issue in front of us. get informed, even if it means skipping an episode of american idle [yeah intentional]. you do not need to agree with me, in fact you probably should not. just think please. it is not about red pills and blue pills though. and lose some fucking weight.
Posts
I think we should be careful about projecting cost benefits from reducing obesity. While this and other preventative health measures WILL reduce moridity and mortality, they will not reduce government expenditures. First, note that longer life spans = greater SSI payments. Second, note that healthy people still die (mostly cancer and heart disease, just like the obese), and utilize the same end-of-life care that you accurately characterize as the elephant in the room, cost wise. They just do so a few years later.
ReplyDeletea few things.
ReplyDeletere: doctors and supply- i was under the impression that the issue is not so much that doctors are in short supply as it is an issue of jobs not existing in the hospitals. i believe (though am open to being proved wrong) that newly graduated docs and nurses actually are having a difficult time finding jobs. the problem is hospitals do not have money and/or resources to hire new doctors.
i think one of the fundamental reasons this problem has become so intractable is that doctors cannot deny care without fear of being sued. right now, drs are obligated to provide the best care they can to whomever steps into the office. in order to avoid lawsuits, there are long protocols which are followed for each patient, and these are expensive in every sense. the cost is reflected in both hospital bills and in insurance (covering potential malpractice, overcharging, etc).
so your average low income person knows it's ok to use the ER as their GP, the paramedics will be forced to transport the low income person to the hospital, the cost will be incurred and paid by the rest of us, etc etc. if doctors and/or first line responders (paramedics etc) were able to deny care without fear of being sued, they could save time/money/resources. and malpractice insurance would hopefully go down (fewer anticipated lawsuits). and socialized medicine might move a small step closer to reality. (whether or not socialized medicine is the right thing is another issue)
however, there are some problems with this too. namely- the paramedics/docs still need to see the patient and determine if they are worthy of treatment, and that takes time/$/resources. also, is it possible then to let doctors determine the boundaries of what is "sick", what is "healthy", what is more deserving of attention? this sort of ties into your obesity point. does someone who is sick on account of their own poor life choices (too much mcdonalds) deserve less attention than someone who is sick from a congenital condition? what about old people? should doctors be obligated to keep someone alive, always?
and what, in all of this, is our social responsibility?
dunno hat, but i'm sure you'd use both red and blue pills..
i don't think there is a shortage of healthcare supply. the majority of medical visits that could be covered by universal heathcare are routine and preventative and cheap. nurses and physicians assistants can also treat patients. access to healthcare would reduce expensive costs of people going to the emergency room for routine medical care.
ReplyDeleteapple i thought you studied economics. there is a shortage apparently. supply and demand are primary determinants of price. reducing aggregate price has three components:
ReplyDelete(a) efficiency; i agree with your comments but efficiency gains are not sufficient to solve this problem. government involvement or 'public plan' will generally reduce efficiency gains. however we do desperately need regulatory and tax reform;
(b) reduce demand; this is not discussed enough, but providing incentives for americans to be healthy is important. i refer to this in my post. much of the discussion is about expansion of supply [hence the deficit problem].
(c) increase supply; encourage growth and innovation in the health care industry.
you essentially argue that demand reduction related to gains in efficiency will outweigh the structural increases [eg covering more people]. i just do not believe it but would love some convincing evidence/analysis. and if true, why the enormous increase in aggregate spending?
casey see my comment above. if there is pent up demand for healthcare and pent up supply, we have an easy problem to solve.
ReplyDeletei agree fully with your points on the need for policy reform and that this will lead to efficiency gains.
i can not add much to your larger questions around the health standard, if any, entitled to people; or the role of society in providing this entitlement.
you slightly misstated my point about obesity: i do not think they deserve less attention; i question the ethical construct they are entitled to a disproportionate share of a limited resource based on trivial, ignorant, and selfish life choices.
sug, i did not study economics, i majored in african american studies. it is not up to you to determine who deserves healthcare. healthcare is going to be unequally apportioned based on need. do you fault someone born with an illness or with cancer? you cannot judge someone's life choices and deny them access to medical resources. there is no way anyone can afford to pay proportionate to their use. what about the poor and sick? give us your poor give us your sick.
ReplyDeletepresident change! geezus christ shane! haha.
ReplyDelete