Tuesday, June 23, 2009

Health Care Debate


Things should be made as simple as possible, but not any simpler. - Albert Einstein


The health coverage debate rages on with talk of trillion dollar costs, market competition, public options, socialized medicine, co-ops, triggers and a variety of other things. What is lacking is discussion of what the actual goals and needs are.

It seems to me that there are two high-level categories required for health care coverage:

1. Basic Care
2. Catastrophic Care

Currently we incorrectly call basic care coverage “insurance.” There is no need for insurance for basic care. These are basic services and goods like any other. Everyone needs basic care just as we need food, shelter, and love.

“Insurance” is the proper term for catastrophic care. Most of us will need catastrophic care at some time in our lives. It is a broad category that includes things such as chronic illnesses, cancer, end-of-life care, etc. These are generally very expensive, catastrophically expensive, and usually unpredictable. For these things we need insurance.

Basic care on the other hand includes things like regular periodic check-ups. Treatments for minor accidents, everyday passing illnesses, and a certain level of diagnostic procedures.

Diagnostic procedures need to be discussed further and perhaps even create a third category of coverage as many of these wonderfully useful and helpful, modern high-tech diagnostic procedures are very, very expensive and part of why health care costs in America are sky rocketing.

Basic care should also include individual, child, and family health education; family planning services, pre- and neo-natal care, nutrition services and the like. Properly fed mothers make for healthy mothers. Healthy mothers in healthy homes make for healthy children. Healthy children make for healthy and productive adults. Healthy and productive adults need fewer health care services and therefore lower health care costs.

Forget for a moment that we are the richest nation on earth. Ignore that we already spend more than any other nation on health costs. Consider that you are designing a health care system for your people from scratch. Consider that you have limited resources. What do you do first?

First, we must provide basic care coverage for everyone. That is the starting point. Everyone is covered. Everyone gets the kind of basic, preventive, and educational care that:

a. everyone needs
b. lowers the likelihood of other problems
c. catches problems early
d. lowers overall needs, risks, and costs

Ok, let’s say you’ve designed a basic care system that provides that for all your citizens. What do you do next? Next, we create an insurance system that provides coverage for catastrophic health care costs.

Third, we tackle the problem of those in-between needs and costs. With whatever resources are available we expand up to include more in basic care and we expand down to include more in catastrophic insurance as resources allow.

What else is involved? Research and development. One of the reasons we have such good health care in the United States is the sort of R&D work that goes on in our high-tech society. This is very expensive but very worth while. The question is how do we encourage R&D work and how do we compensate for it? That is a discussion for another time but one to keep in mind as the discussion moves to costs.

What is missing from the above? Ummm… market competition, cost containment, co-ops, triggers, public options, socialized medicine and the like. Those are secondary concerns, secondary considerations having to do with politics, profit margins, and some very real concerns about cost. Some of that will come into play during a discussion about costs. But before we move there doesn’t it make sense to perform a needs assessment? To agree on what the problem is? To agree on what the goals are? Only then can one truly move on to system design and cost/benefit analysis.

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