Health Care - Another Point of View

My last two posts have been about the contradictory world views that impact our position on healthcare in general and on specific problems with the plan passed under cover of night in December 2010. I'll be the first to admit that a lot of it is tedious and depressing, but sometimes reality is just that. I'll summarize part of Dr. Gray's solution here, and put in my own two cents worth in the second part of this post.

Thankfully, there is a better way forward. Dr. Gray has written a paper entitled "Cutting the Gordian Knot" and I highly recommend you check it out at his website, www.CLGrayMD.com He describes five guiding principles that he thinks provide a way forward. They are: 1- craft a series of reforms, each addressing one clearly identified problem with the current system 2 - pass each reform separately. Don't try to change everything at once or you'll never know what really worked 3 - write understandable bills of a reasonable length whose proposals can be clearly communicated 4 - Keep each bill 'clean' and free of any payoffs, pork or other attachments 5 - make the final language public for 7 days before voting to allow for public viewing

Dr. Gray has listed 17 reforms on his website that he believes are essential. The one reform he mentioned Tuesday night was transforming Medicaid to a system of block grants to the states. He believes this one reform alone could save as much as $300 billion.

I believe that the current system we have of 'third party payors' through insurance of any kind contributes significantly to the problem. My own doctor can't tell me what a specific test will cost, for example, because it varies depending on what insurance company I use. If I choose not to use insurance, the price is higher. I can't think of any other area of commerce where using cash is actually the most expensive option, can you? Different insurance companies also cover different medications based on contracts with manufacturers rather than on patient need.

In addition, paying a flat rate for medical care leads to the "all you can eat buffet mentality." If someone is paying a flat rate whether they use a service or not, the human tendency is to get as much out of it as you can. Making the real cost of medical care inaccessible to the patient keeps all of us from recognizing its true value.

Medical Savings Accounts and limited insurance for catastrophic medical needs could go a long way toward curbing the abuse of the healthcare system. The price for services would likely come down for basic care, allowing greater access.

I believe we have a moral obligation to care for those in genuine need. Does that mean I am morally obligated to pay for an emergency room visit (the most expensive method of healthcare delivery) to treat an addict's non-life threatening healthcare needs? What if it is because the addict chose to rely on taxpayer funded healthcare that costs him or her nothing no matter where they go for treatment? I know this sounds harsh, but where does a civilized society draw the line?

A personal example: I have diabetes. This means I have to be more careful about what I eat, and my health in general, than someone without diabetes. Should I have the right to demand that you pay for my expensive medical needs if I decide not to take care of myself? If I develop heart disease because I decide eating candy is more important than maintaining healthy blood sugar levels, is it fair of me to send you the bill?

"Personal responsibility" is an awkward topic to bring up in a healthcare debate, because we all know that it is hard to draw a concrete line between personal habits and lousy genes or environment when our health fails. Some people who live extremely healthy lifestyles still get very ill, and some people live long healthy lives with terrible habits. But at some point we need to acknowledge that life just isn't always fair.

As individuals, we can come alongside those in genuine need, and make these difficult decisions on an individual basis. There is no way that a large government program can evaluate the difference between medical need and a lack of personal accountability.