My healthcare credo to date
As an amateur healthcare student, every now and then I like to pause and take stock of the convictions I've picked up by osmosis -- by deciding, consciously and unconsciously, what (and whom) to credit in what I read and hear. Here's a short set of hypotheses (and suspicions).
1. The single most important means of healthcare cost control is uniform or at least coordinated pricing: single payer, all-payer, or, maybe in the U.S., private as a fixed percentage of public. The U.S.'s unique every-payer-for-itself system is the main reason Americans pay far more per procedure than citizens of any other developed country.
2. The evils of market consolidation are likely to outstrip the virtues of coordinated care.
3. Which treatments and drugs are covered by insurance, and to what level (ideally by all payers in concert, and. by Medicare and Medicaid in our current system) should be informed by outcomes research and price/benefit calculations.
4. The wisest words ever spoken by a public health official: "We cover everybody, but not everything."*
5. Payment incentives probably work best when they're negative -- penalties for high infection rates, or possibly high discharge rates, or for not using checklists, or for overprescribing certain treatments.
6. Positive incentives are likely to a) not measure what really matters and b) be gamed (I'm most open to being convinced I'm wrong on this one, and hope I am).
7. Significant new investment in the social determinants of health -- decent affordable housing, equitable education, environmental protection (e.g., against lead), new mother home visits -- might be the most effective way to bring down healthcare costs.
8. Consumer-directed health insurance is a scam -- a tax shelter for the wealthy, a barrier to physical and financial well being for the not-wealthy.
9. Narrow networks are only necessary in a dysfunctional system where it's every payer for itself.
10. Balance billing is a sign of deep societal dysfunction.
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* Former British health minister John Reid, as quoted in T.R. Reid's (no relation) The Healing of America (Penguin Press, 2009, p. 221).