Thursday, February 07, 2008

Putting the Cart before the Horse

Yesterday I had three related experiences that seem to me to speak volumes about the current situation in health care.

One was a short Internet video forwarded to me by my friend Bill Busby. It told the story of a Canadian who went to Buffalo for an MRI and, later, surgery for a malignant brain tumor in order to avoid a three month wait for the MRI, another three-month wait for an appointment with a neurosurgeon, and then goodness knows how long a wait for the surgery itself. Canada has single payer universal coverage and prohibits private medicine.

Another was an article in H&HN Online (the Internet journal of the American Hospital Association) by well-known health writer Emily Friedman in which she related her recent experiences of seeking treatment for a failed root canal and a creaky joint. Being self-employed, her health insurance is on the skimpy side and covered neither the tooth problem nor office visits to the orthopedist. Without going into detail, suffice it to say that her experiences were not happy ones. At the end of the article she concludes that “As high-deductible health plans, underinsurance and lack of insurance spread through the middle class, a great many more people who thought they were safe are going to experience the same thing.” She then went on to say “And people wonder why I refuse to use the term ‘consumer-directed health care.’”

The third was a column by Steve Bailey that appeared in the Business section of the Boston Globe. The column was in response to the recent announcement that the cost of the newly enacted Massachusetts program of universal health insurance coverage is now projected to be twice the original estimate – quite possibly beyond the financial capabilities of the Commonwealth.

In preparing for his column, Bailey had interviewed Jon Kingsdale, head of the Massachusetts department responsible for running the new program. Kingsdale was quoted as saying that “This [the Mass. Program] is not sustainable if we don’t deal with affordability.” Paraphrasing, Bailey wrote “Broadening coverage without slowing costs is not a sustainable model….In the end it will break the bank.”

The three experiences confirm what I have been saying all along. Something has to be done about our economically unsustainable system of providing health care. Focusing on coverage puts the cart before the horse.

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