Thursday, October 23, 2008

Big Spenders

Financial excess is certainly in the air these days--Wall Street, Vice-Presidential garb, and a topic for today, health care. This week's issue of The New England Journal of Medicine features two very straightforward and useful summaries of health care's systemic problems and potential solutions. Here are some take-away points as I understand them:

1. The most dire problem is not the uninsured, but rather the unsustainable growth of health care expenses.

2. Rising expenses are due largely to technical (and very costly) medical advances, although inefficiencies of care delivery play a role as well.

3. Resistance to change comes not only from partisan points of view, and from traditional American opposition to government administration, but also from the fact that the health care industry is itself a massive part of the economy. Millions of health care workers (including yours truly) depend on the status quo for their livelihood.

Potential solutions:

4. An independent oversight organization (such as Great Britain and other nations have) to assess effectiveness and cost-effectiveness of medical interventions.

5. Greater governmental involvement in the system to mandate efficiency, including wider use of electronic records.

(Basically, in order to have a system we can afford that provides adequate treatment for everyone, there is no avoiding elements of both rationing and (financial) compulsion).

The consensus on the campaign seems to be that neither candidate's plan seriously addresses these fundamental problems. Obama's is more generous but cannot realistically be paid for, while McCain's threatens to increase the numbers of the uninsured by undermining traditional employer-based coverage without providing reliable and affordable substitutes.

It all makes me glad I brought an apple for lunch.

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