Monday, November 17, 2014

Jesus and healthcare - Part 2

This is the second of a two-part post on Jesus and healthcare (to read the first part, follow this link). As always, I invite reader questions and comments.

Thus, from the perspective of economics, my reader posed the wrong question. The question is not whether one chooses a healthcare system characterized by capitalism and free markets but what constitutes the preferred form of socialism:

  • What resources (hospital beds, emergency rooms, ambulances, etc.) and how many of them does a community need?
  • How can society minimize administrative overhead?
  • What parts, if any, of a healthcare system lend themselves to free markets, i.e., is a hybrid system possible?
    • One possibility might be the choice of a primary care provider, especially if structural barriers to entry were reduced (cut the cost of medical school, encourage unlimited competition between medical schools, etc.) and non-physician providers (physician assistants, nurse practitioners, midwives, etc.) could easily and legally provide routine care.
    • Another possibility is to nationalize all healthcare research (including on drugs), eliminate patents on all healthcare devices and drugs, and then promote competition between manufacturers. Taxpayers would fund the research, eliminating the outsize profits that private industry demands for engaging in admittedly high-risk research that often has an uncertain payoff.
    • Another possibility might be to segment healthcare, socializing most of it but creating free markets for optional procedures such as most cosmetic procedures.

Of course, funding represents a major obstacle to moving from the cherished illusion of free markets to an openly socialized healthcare system. However, the change should cut the total cost of healthcare in the US, which is now the highest in the world and generally produces mediocre results, even though it occasionally produces exceptional results. The people who would reap financial gains from the change would include most taxpayers; among persons and companies who might lose are shareholders and employees in the nations for profit healthcare companies (hospitals, insurers, physician groups, etc.).

All of which brings me back to Jesus. The most important reason to change the US healthcare industry is Jesus' concern for the most vulnerable and least among us, i.e., the uninsured and underinsured, people who postpone seeking care because they cannot afford it and don't like charity. The second reason to change is that Jesus worked for health and healing, outcomes on which the US approach currently receives very mediocre marks. The third most important reason to change is that Jesus expects us to be good stewards of the resources entrusted to our care. Our healthcare industry is costly and needlessly wasteful. Finally, Jesus sought to create genuine community and honest relationships. Our healthcare industry is divisive and built on a web of misinformation and half-truths that mask the problems I've sketched above as well as others.


George Clifford said...

A reader sent this link ( to an article in USA about the high cost of gunshot wounds to taxpayers. The charts are worth a look!

Anonymous said...

After spending 30 years in healthcare at hospitals with trauma centers, I definitely believe more guns=more shootings, accidental and intended, and more shootings=a huge and unnecessary cost burden, regardless of who is paying the bill.

I also believe a big contributor in the US costs is our litigiousness, something far less common in western European nations than here.

There is definitely a lot of waste in the system including that in hospitals and that caused by competition for patients --competition for the "good payer types". I don't even think in many cases the waste/costlness is due to greed, at least in the case of not-for-profit entities; our payment system with its crazy incentives contributes.

I've often thought if we could eliminate the vast army of people who code and audit, both those in hospitals and physicians' offices and those on the side of payers such as insurance companies and the government, we would have enough savings to cover everybody. I'm guessing of course but eliminating all that effort would go a long way toward covering more people. Gordon's medical chart after 10 days in a Catania hospital, 4 stents, emergency vascular surgery and blood transfusions was 12 pages, one for each day, a history and physical and a page of discharge instructions. His medical bill was on one page of paper and was about 12 line items.

The power of the health insurance lobby is a big factor to reckon with as we are forced to transition to a single payer system (which I think is inevitable but perhaps not in my lifetime). The insurers are making a lot of money and have a lot to lose if we go to a government system. I think their entrenchment will complicate our transition without something like regulation of their profits. (And I truly believe Blue Cross of NC which is still a not-for-profit will make another run at becoming a for-profit entity with the current politics of the legislature; a few years ago when they tried they were not able to get approval.)

25 years ago in a European airline magazine (of all things!) I read an article that I'm sorry I didn't save. It made the case that a nation's culture affects how they make medical diagnoses and treat. I don't remember the details accurately but, for example, it talked about the fact that the French tend to think medical problems are related to the liver and diagnose and treat accordingly, the Germans focus on hearts, etc. I may not have the body parts matched to the countries correct anymore but it explained why the French system pays for weeks at spas for cleansing, for example. The thing I DO remember from that article is that it said the American belief that drives our diagnoses, treatment (and costs) is our belief in technology; we believe in investing heavily in technology and use of technology versus investing in preventive lifestyle incentives, solid prenatal and postnatal care for all women, child nutrition. I was fascinated that in Cuba the moment a woman is pregnant (and of course they can force her), she is required to report for prenatal care, take vitamins and do other things to nurture and protect the baby. There are extra rations and there is in-home care for the mom and the infant for several months post delivery. Their infant mortality is lower than ours.

I think one of the best books I ever read about health care costs (though it is a bit older now) was by T. R. Reid, who compares some of the systems and cultural aspects of health care delivery.
The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care. The Penguin Press. ISBN 978-1-59420-234-6.

Anonymous said...

Thank You. In summery my take on part II. Jesus cared for the welfare of the poor and disenfranchised. He would think ill of those who take profits while large numbers in his flock suffer.