20 August 2009

Healthcare: Values versus Administrative Process

It occurs to me that many of the debates currently waging in the US media about healthcare fail to distinguish between three questions:

1) What is the principle upon which we wish healthcare to be based?
2) What are our desired goals for healthcare?
3) How do we best administer a healthcare system?

I have some ideas about my own personal answers to the first two questions. I have less of a concrete idea about my answer to the third question - basically because I'm not expert either in US healthcare administration or in US governemental administration.

Here are my thoughts:

1) Our current system is based on the principle of 'patients are a source of profts for healthcare providers and healthcare insurance companies'. I want our healthcare system to be based on the principle that 'healthcare is a human right.'

I wonder if anyone would actually like to argue the principle that healthcare is not a human right? I wonder if anyone would like to argue the principle that 'those who cannot pay for healthcare deserve to become ill and die'? Possibly a few odd eggs, but I'm going to assume that, actually, most people agree with this idea.

2) Based on this principle, some of my desired outcomes would be goals like providing effective, preventative healthcare to everyone in society as well as providing effective specific care for specific illnesses and injuries. Such healthcare should be accessible, efficient and timely.

Broadly speaking, would anyone want to disagree with any of these things? I suspect not, although if we were going to start compliling a list of specific outcomes, there would probably be some disagreement. But let's say, broadly, we want everyone to have good, effective healthcare.

3) Now the big question. Given that we want healthcare to be a human right and we want everyone to have good, effective healthcare, who is going to pay for this? And how will this healthcare system be administered?

This actually seems to be the area where people with the least knowledge and experience have the strongest opinions.

I won't claim to have a definitive answer to this. What does seem clear to me, however, is that there are many ways to administer such a system and it's not simply a question of 'Nationalized, socialized healthcare based on the values of healthcare as a human right versus entirely privitized healthcare based on the value that patients are profit centers.'

But I think we DO need to be clear about the value that healthcare is human right and we have to fight for this principle to be articulated and to be the foundation of healthcare insurance going forward.

Given that our current system is based on the principle of 'patients are a source of profits', I wonder why people aren't afraid of insurance companies pulling the plug on granny? Or maybe more precisely insurance companies pulling the plug on mom and dad or sister and brother? If you have a long-term health condition that looks like being expensive and something that the insurance company is going to have to pay for over the course of decades, you'd better worry about having your insurance plug pulled or your access to treatment restricted. Either that, or hope your spouse has fantastic group insurance and that s/he isn't at risk of being laid off any time soon.


Judy said...

A very thoughtful summary. The problem is, I think, that healthcare administration has changed so quickly in the past 50 years that people are confused. When we were young, it was more of a "pay as you go" - bills were lower, "women's" problems, like pregnancy, were never covered, and frankly, people died sooner because there was less that could be done for them. Then we had Medicare, a cost explosion tied with major increase and success in research and development of drugs/procedures etal. So then there were HMO's, which limited choice. Short version of a long story - now we have many different plans, but certain things are seen as a standard now in group plans that NEVER would have been thought of fifty years ago - pregnancy, birth control, prescriptions, dental, well baby/child/adult care to name a few. Combine that with longer lives, many more interventions and we get the implosion we now face.

So if you have the good insurance, you get the latest and greatest thing without question. Does anyone ever stop to ask if that is the right thing to do? If you have a catastrophic illness, then you simply hold fundraisers (you see them everywhere and that works, especially if the sick person is a child, cute and white. The poor have Medicaid, which in some states is pretty decent for coverage, but loads of limitations. The person who makes too much for Medicaid but not enough to pay for a policy? They die. Then of course there are those whose policies exclude what we need - several meds that would enhance my QOL are not covered, for example. So I do without.

Frankly, I think underlying all the screaming is racism. Let those of color have none. And Granny can have knee replacements and transfusions and chemo till she is 114.

Of course, also underlying the screaming is the desire to humiliate Obama. You can try to argue this reasonably and rationally all you want. But Fox News has spread such misinformation with the express goal of derailing Obama that the chances of reasoned debate are slim to none.

jay said...

Love your neighbour as yourself and do unto others as you would them do to you comes to mind.

I believe there should be universal health care available through both private insurance and government provision but with the ethos on universal rather than selective provision.

Hope you are settling in Pam. Keep on blogging as I enjoy your posts immensely.

toujoursdan said...

I don't know if you "know" Grandmére Mimi but you should read her experience with healthcare reform.

Wounded Bird: Democracy in action

The sad thing is that many Americans don't consider healthcare a human right. 30 years of Reaganesque propaganda have convinced a significant part of the population that the poor are "deadbeats" and deserve to be left behind and die. It's the downside of the American self-image that this country is a meritocracy where it is believed that your financial status is solely determined by how hard you work. So the poor are deadbeat who deserve their fate.

I also think a lot of people, mostly in the lower end of the middle class, believe that they are on the edge themselves and are afraid that any tinkering of the status quo will push them over the edge. So it's every man/woman for themselves.

I don't hold much hope that things are going to change in a meaningful way in this cycle. I think the system has break down even further for that to happen. But that is in process. Every year my company raises premiums or the deductible or cuts what is covered.