Healthcare Reform - Your money and your life

Two interesting healthcare questions have emerged in the healthcare debate recently that are important as we step into 2014. Forbes magazine (@PaulHsieh) asks “Is it your doctor’s job to save money for ‘the system'?” and the Atlantic (@MeghanMcCarthy_) “Should doctors be paid if they don’t keep people healthy?” I will address Meghan in another blog, Paul provided too much fodder to cover them both in one. 

Is it your doctor’s job to save money for ‘the system’?

Hsieh opens with the scary anti-socialist interpretation of publicly funded healthcare (Medicare in Canada and Obamacare for you guys to the south) with dire predictions that your government will decide what health care you may receive.  I think, Paul, the AMA (American Medical Association), will have something to say about that if even a faint whiff of government control seeps in (which it never will).  Canadian Medicare was created to provide all citizens access to reasonable care.  If you compare our two great nations, we have higher taxes in Canada (get used to it) but we don’t have crippling insurance fees and we have a much more accountable system, lower per capita spending and better health outcomes.  Canada is far from a perfect system but the American model, under any level of scrutiny, is worse.  Let’s address your four (4) points and highlight some questionable assumptions:

1. Doctors will be increasingly expected to save money “for the system” – good grief, I hope so and you should too.  ‘The system’ is going to be funded through your tax money and if doctors in the US continue to over serve and over bill their patients in the new system (lots of great articles in this New York Times Series ‘Paying Till it Hurts’) then yup, you guys will be in big trouble.  So, you need to put some safeguards in place; standardize the pricing for services; adopt a reasonable standard of care for patients.  ‘Appropriate Use Criteria’ is not evil but doctors bilking insurance companies for thousands of dollars for unnecessary tests (creating an increasingly illness focused, paranoid population) is certainly unethical.  If you can’t trust your doctor to put your best medical interests first, time to find a new doctor.  As a Canadian, it wouldn’t even cross my mind that my doctor wouldn’t put my best interests first.  What the hell is wrong with your doctors that you (a doctor) would even suggest that your colleagues would put government interests ahead of patient care?  And why aren’t they protesting outside the Forbes offices for an apology that you would even suggest such a thing? 

2. This will further fuel the nanny state – individual freedoms will be restricted if they are too costly to society.  This is Paul’s reference point: “As writer Steve Schweitzberger observed: “If Michael Moore has a toothache, it is not my responsibility to pay for his dentistry. If it were, then I would have the right to tell him not to eat sweets. I don’t want that kind of government-paid medical policy. Do you?””  @Forbes, do you guys not fact check?  Steve Schweitzberger wrote a Letter to the Editor of the Rocky Mountain News in 2007 that doesn’t make him a writer.  And, the letter was in response to Michael Moores documentary on Columbine and gun policy in the US.  Mr. Schweitzberger’s daughter escaped the gun fire and is an advocate of more liberal gun laws so citizens can protect themselves which makes him a perfectly credible (albeit biased) reference for an article on gun control but healthcare??  Shame on you Paul for misleading your readers with 7 year-old quotes from gun-rights advocates, couldn’t you find a relevant quote from, gee, someone who is actually talking about legitimate impacts of Obamacare?  Don’t make up fear mongers, there are plenty out there and it stains your credibility. 

3. Health benefits will become increasingly politicized – we agree.  We experience the same in Canada with each province controlling the ‘menu’ of insured services and some level of differentiation between jurisdictions.  While you highlight a few variances (and there will be more), what constitutes ‘essential health benefits’ can be identified and put in place, that is the meat of it.  Lobbyists will abound and policies will be impacted – report on that it’s an important debate, it just hasn’t happened yet.

4. Sooner or later, government spending Other People’s Money means the government taking your money – agreed.  Your taxes will go up.  Paul likens access healthcare to cell phone coverage implying that a free market approach to healthcare makes for healthy competition and lower costs.  Paul, you do realize that Americans have the highest per capita healthcare costs in the world (and some of the poorest health outcomes)?  The Organisation for Economic Co-operation and Development (OECD) reports on health spending and health outcomes globally (they kind of rule the evidence in this space).  “In 2011, the United States continued to outspend all other OECD countries by a wide margin, with the equivalent of USD $8,508 for each person.  This level of health spending is two-and-a-half times the average of all OECD countries and 50% higher than Norway and Switzerland, which were the next biggest spending countries.”  And if that isn’t bad enough, the health indicators used to measure outcomes globally show the US performing below the OECD average in most areas.  Here’s a few snippets:

a.       Life expectancy at birth OECD average = 80.1  US = 78.7 (best is Switzerland = 82.8)

b.      Life expectancy 65+ OECD average = 20.9 yrs US – 20.4 (best is France = 23.8 yrs)

c.       Mortality Ischemic Heart Disease OECD average = 122/100,000 pop. US = 122 (best is Japan 39/100,000)

There is a lot more evidence out there Paul that proves that your adored free-market model is broken, but you have to stop covering your eyes and look up.  The healthcare systems that are producing results for their citizens are blended private public models.  If I were an American I would be asking why my outrageous healthcare costs are not giving better results and why a doctor, who is a contributing writer to Forbes, is not shouting from the rooftops about that!    

What’s up with that Paul?  Don’t your patients deserve to live longer healthier lives? 

Perhaps you are focused on: Your money – and Your life – at stake.  

Health.  Information.  Managed Well