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Improving Medicine While Containing Costs The Democrats vying for their party's 2008 nomination to run for President are out trying to sell us improved health plans again. The two proposals which I find the most intriguing are the one by former Senator Edwards to require every person to have a physical once a year and the one by Senator Clinton to require every person to have health insurance. Both of these proposals say two things about how these politicians feel about the American electorate: (1) We are too dumb to make our own choices and need the politicians to help us; and (2) Freedom is not important when it comes to improved health care. Former Senator Edwards' proposal ignores the desire of most citizens in this country to be able to make choices. Choices are reasonable, especially in areas involved with this proposal. When I was younger, my doctor recommended I have physicals only every five years. Now he recommends that, given my age and general good health, he recommends I have physicals every two years. Why should Mr. Edwards want to force me and many others to have physicals when such are not medically needed? Regarding Senator Clinton's requirement for insurance, I have talked with many people who do not have insurance for two reasons: (1) Given their age and health, they have little need for medical care; and (2) What medical care they normally need costs less than what they would spend on insurance. I have had a somewhat similar experience. I recently increased my deductible because I saved more in annual premiums than the additional potential out of pocket expenses which might be incurred with the higher deductible. The various proposals are attempt to attract votes by making people believe that they can get better care for less money. If we continue in this direction, including the recent effort to expand children's health insurance, we shall have a single-payer or national health care system. However, we cannot get better care at less cost through force. Various national health plans in other countries often provide poorer or delayed care in critical situations. Prostate and breast cancer survival rates are better in the United States than Western Europe and Canada. Such is true primarily because of earlier detection and earlier treatment. Such is a function of a medical system which allows for multiple choices leading to quicker diagnosis and treatment. Fifty years ago this country's medical treatment system was vastly different. Choices were made by patients in consultation with doctors. Slightly more than 60 years ago health insurance started to be a benefit provided by employers to employees. The main reason was that such was a means of providing raises without raising nominal wages, a problem during World War II. The costs began to soar with the early national health insurance programs of Medicare and Medicaid. Along with these programs and employer paid insurance came the belief that medical care was not a purchased service, but a right. At the same time costs were going up for many other reasons, including increased and more expensive treatment regimens, litigation and defensive medicine. With costs going up, medical plans became expensive, but not solely because of medical care. Part of the problem was the answer to which most turned to control costs, namely control choices. With more control of choice, the administrative costs went up. Even though controlled choices through insurance and forced reductions in costs negotiated with doctors and hospitals, the actual overall costs have continued to increase. Maybe we need another approach. Rather than moving more towards single-payer or national health insurance, maybe we should consider putting the patient back in control in consultation with his doctor. It would also be good to put caps on malpractice claims and to cut administrative costs by using reimbursement insurance rather than primary pay insurance. We consumers are not as dumb as politicians like to think. I also think we do not want to give up our freedom to make informed choices using all available information, including cost of treatment, especially when we are not really saving costs. |
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