Monday, August 3, 2009

Take Your Medicine

Where I can make a point about the current debate on healthcare.

Daily the headlines include news and commentary on a number of plans designed with a number of goals connected to medical services and their costs in the United States. I follow this discussion. I read each of the plans proposed by the candidates in the last election and an independent analysis done by the firm for which a colleague's son works. You could say I'm as up to date as much as a layperson might be.

The conflicts are not insurmountable. If medical care in all its forms is to be a market commodity then the time tested way of providing more of it is to increase its supply. We could fund more medical training with the caveat that this savings be reflected in the cost of care provided later. A greater number of doctors should provide for greater market coverage. This would eliminate the fear that care would need to be rationed to a greater extent than it is now and make no mistake health care is rationed now. We could also seek the prescription competition that is currently illegal. Surely there are countries with standards comparable to our FDA and we could import medicines from those countries and allow the market mechanism to lower price. These are a couple of ideas that would seem to be part of any solution that rests on a generally open market.

If on the other hand a collective decision was made that healthcare in the United States was not a commodity but rather was to be available to everyone regardless of means, and this is somewhat the case as no one can be turned away at an emergency room, then an attempt to control costs could begin with an emphasis on preventive care. Just as we require school children to be vaccinated in order to attend school, we could insist on standard screenings at appropriate ages that could interdict long term health issues. An example would be every thirty year old woman having the tests appropriate to her age and the tests being certified. The form would be included in a tax return. The results are kept confidential but that the test took place at all is an investment in lowering costs long term. Insurance companies are already rewarding proactive measures like this. A new designation of physician, a new means of providing medical service, emerges as a neccesity to replace the emergency room. The Nurse practioner model comes to mind. This would be the group who would carry out these new screenings.

The common point in either of these models is that there does not seem to be an incentive to become a doctor or nurse who provides medical services at a lower cost. This point was not addressed by either candidate in their platforms and it is not present in the current headlines and commentary either. That leaves this question for now:

How does the United States develop a policy that encourages people to be trained in medicine and act on that training at a lower cost short term and long term?

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