The concept of addiction is thrown around loosely nowadays. But when people seek more and more of something that is not benefiting -- and in fact is harming -- them, that can reasonably be called addiction.
Americans are addicted to health care. They demand more and more of it, at any cost, whatever the consequences. And the United States, with by far the most costly health care system in the world, is in the third tier in health among nations -- behind even some developing countries! Yet every idea for reforming the system that suggests modulating our demands is universally scorned and rejected.
It's obvious what Americans want. And thus both parties are running on more, more, more. President Obama hasn't suggested a single way in which Americans might be asked to sacrifice. Republicans, regarding any suggestions that we ask whether the care being delivered is effective, mock the ideas as "interfering with the doctor-patient relationship" and "bureaucratic health care." For their parts, Democrats maintain the glassy-eyed view that we will simply spread our same health-care-on-demand system (increasingly available only to government employees and TV journalists) to every single American.
When Republicans assert America has the best health care system, they cite the evidence that many people come from overseas for treatment here, as though high-end care for wealthy and influential plutocrats comprises a good health care system. Democrats, on the other hand, point to universal access to health care in European countries. But then Republicans scare Americans by pointing out that, in national health care systems, not everybody gets whatever they want -- horrors! More, more, more.
After my last post, about how Obama failed in his news conference to describe a single curtailment of America's appetite for more health care, I received the following comment:
He really expects 'managed care' to be operationally effective? The HMO's of the 1980"s -1990's were a disaster. They would deem what was necessary and pay only for that. Medical Doctors subsequently quit in droves. Doctors were precluded from involvement in traditional Doctor/Patient dialogue and remedy. This foray into HMO's is another reason why tort costs have skyrocketed.
Why is there so much emphasis on the 'demand' side of health 'care'? Also why is the government/HMO's so interested in restricting remedy for sick 'customers' of healthcare providers? How about instead increasing the supply side?
Yes, let's continue -- even expand -- our fee-for-service, let-the-individual-decide-and-everyone-pay system ad infinitum. This comment encapsulates exactly the American point of view -- more ready access to care for everyone without paying for it, more treatments and tests, more consultations with doctors and specialists -- we love health care so much, we can't get enough.
I could factually dispute the comment: Surveys uniformly find HMO members are highly satisfied, even though Hollywood always puts down HMOs. (Remember in as As Good As It Gets, Helen Hunt's asthmatic child only gets adequate treatment when a national specialist visits her home, as Hunt curses HMOs, the villains!)
Instead, I'll reveal to HuffPo readers the secret of what, actually, every health economist and reasonable (non-ideological, non-posturing) politician (a) knows to be true, (b) knows cannot be implemented in the United States.
The Times on salarying doctors:
Bassett -- like the Cleveland Clinic and a small number of other health systems in this country -- pays salaries to all of its doctors. No matter how many tests or procedures are performed, they take home the same amount of money. Medical costs at Bassett are lower than those at 90 percent of the hospitals in New York, while the quality of care ranks among the top 10 percent in the nation, surveys show. . . .
+ + +
"Everyone knows that the Bassett model is the right model," said Senator Charles E. Schumer, a New York Democrat involved in negotiations over health care legislation. "The question is, How do you get from here to there?"
And then there was David Brooks' classic Kill the Rhinos!
The rhinos are closing off your future. As the White House folks say, health care premiums have doubled over the last decade. The government is saddled with $36 trillion in unfunded liabilities.
So your only question should be: Where do you find a tool or weapon big enough to stop the rhino stampedes? You know the problem is big, and you figure the response had better be gigantic.
Then you look on Capitol Hill and you see a bunch of popguns. The politicians describe these big ugly problems, but when it comes time to talk about their remedies they tell you: Don't worry. Nothing's going to change. In other words, we're going to eliminate the biggest, hairiest, most entrenched problem in the country without fundamentally changing the system and without asking for sacrifice from anybody.
But Brooks actually understates the situation here -- we're not even firing popguns. Instead, Americans are feeding and goading the rhinos into a greater frenzy -- until they're more like a herd of godzillas attacking.
Good luck to the commenter -- good luck America! We'll only change when we hit bottom -- when our health care and economic systems collapse under the weight of our hunger for more, more, more.
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