What The Democrats and Republicans are Missing About Healthcare

Let me briefly summarize the position of both parties relating to healthcare reform. I'm going to be somewhat simplistic, but the problems will soon be apparent.

Democrats:
Healthcare should be available to everyone. A government-run program that competes with the private entities is the best way to afford access to everyone.

Republicans:
Healthcare should be available for everyone to purchase. Private companies operating in true capitalistic fashion offer the best option where the market will determine the prices. A government-run insurance plan will lead to an unequal playing field and the private companies will be run out of business, resulting in only a government-run plan. This will result in government-sanctioned rationing and a limit in individuals' choices.

Both parties:
If the Democrats pass any major bill, they can lay their hats on it and benefit in the 2010 elections. Conversely, if the Republicans can stop any major bill from passing, they will benefit in 2010 by showing how ineffective the democrats are.

The problems with both sides:
The United States spends 17% of its GDP on healthcare. Yearly expenditures are also going up by at a rate of 6.9% a year - double the rate of inflation. NEITHER PARTY HAS ADEQUATELY ADDRESSED HOW TO LOWER THESE COSTS.

Both parties are simply debating who is going to be paying this same amount of money - neither has even discussed a feasible idea of how to lower the actual cost. (Rhetoric about electronic medical records saving us billions is ridiculous and won't be discussed in this blog post). At this point, I don't really care who is paying for healthcare - I want to know why we are paying so much.

Another glaring problem is that neither party actually will refer to "health insurance" as it really is - prepaid healthcare. If we want to discuss coverage, then let's do that, but let's be accurate and avoid the semantic fallacy that both parties are trying to pull. Let me reevaluate each party's postition

• Democrats: If everyone isn't insured they will not be adequately prepared for a health crisis.
• Democratic translation: If you haven't prepaid for your healthcare, then if you need a lot of help in an emergency you won't have already paid for how much you consume.
  

• Republicans: If everyone doesn't compete on a level playing field for insurance, prices will soar or government mandated rationing will result.
• Republican translation: If there's no competition among prepaid healthcare then the cost of prepaid healthcare will go up and/or what's offered on the prepaid menu will decrease.

Once you translate things, so what? I frankly don't care who wins this current argument. Neither side is actually working on making an improvement to the overall system, they're just arguing who gets credit for it. Risk-sharing, cost-cutting, changes in billing, reevaluating care and the overall goal of healthcare are simply being dusted under the mat as these two sides fight for a nearly worthless prize.



Solutions:

We need to actually lower the cost of our healthcare. There are countless ways to do that, but the most important is that we need to either implement true competition in healthcare or else implement some sort of cost-containment.

Here are a few ideas to cut costs.

Increase competition for procedures. Here's a very interesting post about the cost of CT scans in America compared to India. It turns out that for the exact same procedure with comparable equipment can cost 60 times less in India ($6500 compare to $115). It literally would be cheaper to fly to India to get a full-body CT scan (with contrast) and have it performed by a trained radiologist than it would be to get it in the states performed by radiological technician. As it is, there's a waiting list in America to get these procedures done. Why lower the price if there's a line outside your door? If there's only one choice for food in an area, the restaurant can charge whatever they want and people will pay it - ever been to a football game, ski resort or movie theater? Many procedures simply can be performed for less and will be if there is any competition. We need to encourage individual clinics to open up and specialize in offering select services for less and then let the market go to work.

We also need to increase the number of doctors. The US has 2.4 doctors per thousand people, which compares very poorly to Switzerland's 3.8 or Belgium's 4.0. Doctors currently don't have to compete for patients since there's a wait. Why should this one profession be competition free? It definitely isn't going to lead to better care, shorter waits and reduced cost. We need to increase the number of doctors who are trained in the US and make it easier to become a primary care physician. There's no shortage of people who want to practice medicine, just a shortage of programs who will train them.

Also, to cut costs, we must encourage people to live healthier lives. The fact of being unhealthy obviously isn't enough to dissuade many from leading unhealthy lifestyles, so we need to dissuade them in another way. I recommend we tax unhealthy behaviors. Cigarettes, alcohol, potato chips, most fast food and carbonated beverages could all be taxed and the money used to fund medicaid and fund anti-obesity campaigns. We wouldn't be taxing obesity, just the behaviors that are proven to cause it. People need to be spurred into action and since their health isn't enough encouragement, maybe their pocketbook will be.

Finally, to really spend less on healthcare, we actually need to reevaluate how it's provided. The 20th century has had a huge increase in the use of hospitals and hospitals are very expensive to run (thank you, JCAHO). Whenever care can be provided outside of a hospital, it should be. Smaller clinics, home-based care and services provided by non-doctor healthcare providers (nurses, PAs, etc.) should all be used. There's no reason that you need an MD to tell you that you are overweight and should stop smoking - a nurse is more than adequate to provide that important service.


Conclusion:

Health reform is an interesting and necessary topic that needs to be addressed. But, we actually need to address what matters - how to lower the cost we are paying. Right now, the major political parties are fighting for a prize that has no worth.