Medicine: the neocon revolution

This LA times article has been making some rounds as it outlines the neoconservative approach to revolutionizing how people pay for their health care. As a rule, treating health care like any other economic commodity seems like an absolute disaster to me, especially as most market worshippers seem oblivious to the idea that there are, in fact, other human values besides efficiency. Justice, dignity, and equality come to mind. And a transition to catastrophic insurance/health saving accounts seems to favor efficiency over any other human value.

Which isn't to say there might not be a place for this model, and that some aspects of a pretty complex plan won't have merit. Forty-five million folks in this country have no insurance whatsoever, and that's an American indignity. I see no mention of what happens to someone whose health savings account runs out and whose "catastrophic" insurance won't pick up the bill, just as I see no mention of what happens to a senior whose investments run amok and can't afford groceries under a social security privatization/private accounts/personal accounts/flowers and rainbows plan.

Which is scary, given today's report that hundreds of thousands of Americans file for personal bankruptcy each year because of medical bills - even though they have health insurance. This seems to suggest that the prognosis for American health care would suffer under the HSA/"catastrophic" insurance approach.

Here's the MSNBC version of the HSA story, along with smart rebuttals to the schema:

[F]orcing individuals to make payment choices about their health coverage will mean many poorer individuals put off a trip to the doctor, or skimp on important surgeries or check-ups to avoid depleting the funds in their accounts.

And younger, healthier people who use health services only occasionally will opt into these plans because it benefits them financially, leaving older, sicklier patients in traditional insurance plans, where they could see their health-care premiums rise.

And Rep. Pete Stark (D-Hayward), a leading lawmaker in California health care, has a pretty straight-to-the-point criticism of the HSA/"catastrophic" approach:

One danger with this is that people will not get needed care because they want to save a few thousand bucks. Healthcare isn't like buying a Chevrolet. You can go to Consumer Reports and read about the new Malibu, but if I asked you to describe a regimen of chemotherapy for someone who has colon cancer, you'd be out of gas. We are talking about highly technical services that 99% of the public doesn't even know how to spell the names of. Secondly, there is no uniformity within the medical community as to what services ought to be used. It's a 'by guess and by gosh' sort of practice.

We're making real headway in evidence-based medicine towards clarifying appropriate standard of care, but regardless, there's a reason why physicians train for ten to fifteen years to practice medicine. There's a lot of stuff to learn. And while health care providers do their very best to distill all of that knowledge into a ten minute clinic consult so that patients can make their own educated choices, something is always lost in translation.

Of course, maybe we shouldn't worry about everyone having health care. Besides, people should just work harder so they can afford these medical concierge services, right? I'd have no problem with rich people being able to pay for SuperCare if it weren't for the fact that, despite insanely high tuition at medical schools, the actual cost of medical education is still subsidized to a heavy degree by the public. And that, by nature, means that every doctor is a public servant to some degree bought and paid for by the American people. All of the American people. And specialized services that discriminate so heavily based on socioeconomic status will be appalling to me for as long as our country has one of the highest infant mortality rates among developed nations.

Priorities. We need them. We don't have them.

You can also find this post at BlueGrassRoots.