Wednesday, February 12, 2014
An Economic Conundrum
Is our outsized health care system an economic plus or
minus?
The conventional wisdom, which I have tended to accept, is
that our unusually costly system places an undue financial burden on
government, makes our industry less competitive internationally and unnecessarily
consumes resources that would otherwise be devoted to something else. Thus, the economy would benefit if we spent
less on health care.
In contrast to that, columnist Benjamin Applebaum argues in the
February 9 Sunday New York Times that during the last two years the health care
system has been a drag on the economy because it has grown more slowly than the
economy as a whole (Will Saving on Health
Care Hurt the Economy?).
He also points out that “The health care sector has
repeatedly helped to pull the economy from recession in recent decades….” Certainly, it seems likely that unemployment
during the recent recession would have been higher if it were not for the large
number of people employed in health care, which is largely recession-proof.
The stubbornness of unemployment, attributed in large part
to globalization of the labor market and information technology, poses the
question of whether in the foreseeable future there will be enough jobs to
employ all our unskilled and semi-skilled people. Health care employs a lot of them. Maybe that is a good thing.
Applebaum’s column ends by quoting Harvard School of Public
Health Economist Katherine Baiker who favors a more efficient health care
system. She said “….for a given outcome,
if you could get it with fewer resources, that would be better for
everyone. You could get more
health. You could get more stuff.”
Well, maybe. But then
again, maybe not.
Sunday, February 09, 2014
Malpractice Prevention
For years I have been of the opinion that the problem with
medical malpractice was that there was too much of it and that prevention
efforts would be more effective as a remedy than attempts to reform the legal
system.
I now sense a slight movement in my direction. The January issue of Health Affairs featured
several articles on the subject. The
introductory column by founding editor John Inglehart reported that the
designers of Obamacare considered including medical malpractice reform but
decided that the political risks involved in getting in between the personal
injury bar and the medical profession were too great. They punted by including an appropriation of
$25 million to fund a search for new approaches to medical liability and
demonstrations of evidence-based patient safety programs.
Judging from the articles, most of the effort has been
focused in the area known as Communication-and-Resolution. Under this approach, medical errors are
reported to the patient as soon as they become known and compensation offered
for damages. This is in contrast to past
practices of sitting tight and fighting the matter out in court.
One article dealt with “safe harbor” legislation, which
limits liability if the physician can demonstrate that “designated guidelines”
have been followed. In other words, if
there is an established protocol for a procedure and it has been followed, the
legal liability for adverse results will be reduced. The authors doubted that the “safe harbor”
approach would have much effect on malpractice settlements but speculated that
following protocols could improve patient safety and, thereby, the number of
adverse events leading to malpractice claims.
Prevention may not yet be popular but perhaps some people
are starting to think about it.
Friday, February 07, 2014
The Logic of Obamacare
Here is the logic of Obamacare as best I can figure it out:
Because:
- Everybody who needs care should get it.
- People should be able to receive care without incurring undue economic hardship.
- Most people are not financially able to pay for care at the time it is received.
- Universal national health insurance cannot be achieved politically in this country.
Therefore:
- Everybody should have health insurance that will cover most of the cost of the care they receive.
- Health care for the non-senior, employed population and its dependents should be funded in the private sector.
- Government should subsidize care for those who can’t afford adequate coverage.
Opponents of Obamacare apparently do not accept this
logic. It would be interesting to know
what logic they would put in its place.
