How American Health Care Killed My Father - The Atlantic (September 2009)

How American Health Care Killed My Father - The Atlantic (September 2009):

I stumbled on this Atlantic story referenced by David Brooks' Friday, September 4, 2009 NY Times column. While stimulated by the death of his father caused by an infection received in the hospital, Mr. Goldhill has spent extraordinary effort to research and understand the perverse incentives in our health care system. This sytem gobbles up 18% of our nation's economy and it continues to grow at twice the rate of inflation. He argues that ObamaCare is not the right answer because it tries to revamp a broken system without the sort of long-term restructuring to make the patient the focus of health care rather than the the payer.

I agree with Mr. Goldhill that the government cannot control costs. A bureaucracy has never shown itself capable of cost control when politicians are pulling the levers of 'reform' and placing government in charge of our citizens' health.

I have quoted from the article, but please read it for yourself for a full understanding of his analysis and recommendations.

"Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value."

The government's record of cost control is dismal.

"In designing Medicare and Medicaid in 1965, the government essentially adopted this comprehensive-insurance model for its own spending, and by the next year had enrolled nearly 12 percent of the population. And it is no coinci­dence that the great inflation in health-care costs began soon after. We all believe we need comprehensive health insurance because the cost of care—even routine care—appears too high to bear on our own. But the use of insurance to fund virtually all care is itself a major cause of health care’s high expense."

Insurance in the health care arena has been distorted from the purpose that insurance should serve.

"The unfortunate fact is, health-care demand has no natural limit. Our society will always keep creating new treatments to cure previously incurable problems. Some of these will save lives or add productive years to them; many will simply make us more comfortable. That’s all to the good. But the cost of this comfort, and whether it’s really worthwhile, is never calculated—by anyone. For almost all our health-care needs, the current system allows us as consumers to ask providers, “What’s my share?” instead of “How much does this cost?”—a question we ask before buying any other good or service. And the subtle difference between those two questions is costing us all a fortune."

And more good stuff about why government controlled health care won't work as well as a competitive marketplace.

"Cost control is a feature of decentralized, competitive markets, not of centralized bureaucracy—a matter of incentives, not mandates. What’s more, cost control is dynamic. Even the simplest business faces constant variation in its costs for labor, facilities, and capital; to compete, management must react quickly, efficiently, and, most often, prospectively. By contrast, government bureaucracies set regulations and reimbursement rates through carefully evaluated and broadly applied rules. These bureaucracies first must notice market changes and resource misallocations, and then (sometimes subject to political considerations) issue additional regulations or change reimbursement rates to address each problem retrospectively."

Here are the fundamental problems...

"A wasteful insurance system; distorted incentives; a bias toward treatment; moral hazard; hidden costs and a lack of transparency; curbed competition; service to the wrong customer. These are the problems at the foundation of our health-care system, resulting in a slow rot and requiring more and more money just to keep the system from collapsing."

And in conclusion...

"All of the health-care interest groups—hospitals, insurance companies, professional groups, pharmaceuticals, device manufacturers, even advocates for the poor—have a major stake in the current system. Overturning it would favor only the 300 million of us who use the system and—whether we realize it or not—pay for it. Until we start asking the type of questions my father’s death inspired me to ask, until we demand the same price and quality accountability in health care that we demand in everything else, each new health-care reform will cost us more and serve us less."

ObamaCare is a failed approach to remedy the health care crisis facing us. I have read little from others that is so on target as what Mr. Goldhill, a Democrat private business person, has laid out here. His solutions are not quick fixes, they are apolitical and they address the fundamental problems in today's health care boondoggle. Is TeamObama listening?