Brother, can you spare a trillion?
Bob Laszewski sums up the universally agreed upon solution to the health care crisis: everyone believes he needs to be paid more. Insurers, hospitals, physicians in general and primary care physicians in particular, durable medical equipment companies, and Medicare Advantage HMOs all say they need more money. Says Laszewski:
There is no provider of health care or health care services that I know of that doesn’t strongly believe they are underpaid for the work they do.
The past few weeks have been filled with one press release after another from the health care stakeholders telling us they are ready for health reform and want to work with the new Congress and President to get it done.
But they all want more.
How do we accomplish health care reform by giving everyone more?
I’ve argued that paying more to primary care physicians will increase the number of physicians in that profession and thereby hopefully result in fewer expensive ER visits and less need for specialty referral. I don’t know anyone who would seriously suggest that revitalizing primary care is a panacea, though. Certainly the usual suspects — malpractice costs, administrative overhead costs from private third party payors, paperwork secondary to excessive government regulation, et cetera — are major driving factors that need to simultaneously be addressed. But there are probably a couple of even more fundamental causes at work:
- Historically, the life expectancy of the average person has never been as high as it is now. Civilization has never before had to deal with such a large percentage of its population being this old.
- Humans weren’t built for this world. The genetic “default setting” for the human race is for a world where food is relatively scarce and only obtained at high metabolic expense. Our post-industrial world, where “work” consists of typing on a keyboard while seated behind a desk for hours on end and food is both plentiful and cheap, predisposes us to many maladies.
- We now possess a huge amount of medical technology. When doctors could fit medical science in a Gladstone bag, health care was inexpensive (as well as ineffective and frequently counterproductive). Labs and imaging studies now take much of the guesswork out of medicine, along with much of the money from the pockets of patients and the coffers of insurance and government.
- Prices no longer ration health care. Most goods and services are rationed by their price. Most health care in the U.S. is paid for by third parties. The wage controls that followed World War II incentivized companies to offer health insurance to entice people to work for them. Health insurance is now an expected benefit with employment. The Great Society programs of the 1960s added the government as a third party payor. We spend somebody else’s money much more freely than we spend our own.
I’d like to say I’ve got a solution for all this. But I haven’t. And neither has anyone else.