Friday, September 7, 2007

two ideas to deal with health care

there are some basic things that need to be brought to the forefront in this political climate. we need to stop being so inefficient and rigid about how we deal with problems.

to start, one solution to many problems, ranging from health care to college education, is to create an organization that gets young people to care for the elderly, in return for the government paying their education IF they study medicine. this will also help counter the effects in our culture of video games and other activities that isolate youth from adults. the current youth culture seems full of problems culturally and healthwise. there seems to be a new generation that's more communal and uninterested in the same institutions that have served us for decades. most of our institutions like social security, health insurance, federal student aid etc trace their origins to the 1930-1960 period. its time for new solutions.

for the first time perhaps ever, our problem is not a lack of overall wealth. even the poor in this country have more than they ever would have imagined even 50 years ago.

our problem is the way we organize the work for millions of people, and the way we deal with our needs. our system grew incrementally over decades. like the NYC subway, it was built over stages to deal with individual problems. it's remarkable how well it still works, considering how poorly it's planned on a macro level.

it seems to my less than fully informed eyes that health care's problem is that costs are paid by a separate party, preventing any kind of market forces from operating. instead of individuals making decisions and accepting prices, someone else makes it INCREMENTALLY free. in other words, each greater bit of service you consume doesn't cost you anything extra (yes there are co-pays, but they cover such a smart part of the overall cost...) people don't make decisions based on price. instead, the HMOs try to connive and bully doctors into cutting costs. instead of dealing with a sick person, they employ an army of clerks to deal with the insurance companies. they're not encouraged to behave like retailers, which do the best job serving people's needs.

as a result, the patient never knows that the doctor is charging $150 for a 15 minute visit. if he/she were to learn this, he might call the doctor a theif, until he learns the doctor must pay $80,000 a year in liability insurance. if the patient/vote were to feel the pain of this cost personally, it would hurt everyone enough so that politicians would quickly limit medical malpractice suits. but since we outsource the responsibility to a company that everyone hates and shouldn't even exist in the first place.

normally when a transaction is made, one person bears the cost and is fully aware of the pieces of the deal. if I buy a car, my money is being used to deal with somehting I need done. I alone know how much money I have and how important it is that I have a vehicle. I know whether I own a garage, whether I like the car, etc. all of the knowledge and money behind the decision is united in one conciousness. this is the way most decisions are made in the world.

our current healthcare situation, however, divides the decision making into peices. the cost is decided in a negotiation by a massive company by some complex method I won't even pretend know anything about. but the decision itself of the cost (will you as a consumer surrender x amount of your resources for a service?) is not made by the person consuming/needing the service. since it's officially free to them, they have no incentive to make sure the costs are resonable. the decisions about cost are also made by all of the employers who chose health care providers (along with 401ks, which is totally unjust). somewhere executives of giant companies hold sheets with hundreds of thousands of employees being maintained as if they were machines or the electric bill. it just becomes one more cost. again, the decision is made nowhere near the consumer, or by anyone remotely intimate with his situation.

health care is a noncyclical core service in the economy. other providers of necessities like food and clothing have been profitable businesses forever. for decades, we've managed to shop and make the decisions about most of the things in our lives by spending our money the way we chose. it's time to move healthcare into that sphere of activity. imagine if we had food insurance that would pay for our groceries ... after a co-pay of course .. imagine only being able to shop at in-network groceries ... the insanity of it is clear. but why, essentially, should health care work that way? the truth is that HMOs arise from a few tax decisions made by congress in the 1940s and 1970s. it all started during WWII and companies asked for permission to pay their employees health costs as a way to give them more compensation without giving them actual raises, which weren't allowed under the price and wage controls. it's a good example of how we're still living under the shadow of the new deal. so many institutions date to that time and are so obsolete. finally, I think HMOs make doctors less compassionate because it allows them to not be responsible for the cost of service. in essence, the HMO system looks a lot like life with a ration card in the USSR.

the solution doesn't involve more money. a good solution will solve many problems so that many people want it to happen.

one possible solution is to use this problem, healthcare, to solve another problem, youth culture. between video games and hip hop, it has grown terribly self-centered and belligerent. but there also seems to be a new kind of awareness of the need to solve problems. volunteerism is supposedly on the rise for many kids, according to cokie roberts and william frist on charlie rose... why not create a program for kids of 14-20 to care for the growing elderly population. part of it should be mandatory, like the draft. it should be added to school graduation requirements, like in jesuit schools. if they want to continue after high school, they should get paid at the low levels typical of the military, but will then have their college education provided if they stay in medicine.

this will solve one of the big disincentives for people becoming doctors: the fear of borrowing $100k-300k at the start of their careers. it will also give our kids a sense of community and service. the same way the draft brought together a nation with the colorful diversity of the proverbial WWII movie. the draft has been gone for more than 30 years now. young people have no uniting institutions. a call to service could do a lot of good. plus, it would allow them to learn from the baby boomers and make friends. some of them could become archivists, historians and writers about the baby boom generation.

how much help they could offer I do not know. but it is something worth exploring further. I will try to find the #s for healthcare workers and teenagers.. I imagine there are probably far more teenagers than health care workers.

secondly, they could create a system where medical offices have peple who arent doctors. one person could be trained merely to deal with knees, or sinus problems, etc. they could just study that one thing and treat those individual problems. they could then be overseen by a doctor who would review the info on all the cases in real time.

these people could also use flow charts, like the health care flow charts for doing STD interviews in africa.

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