http://reason.com/archives/2009/09/10/what-obama-should-have-said-to In other news, John Stossel is awesome.
"Free enterprise" translating in the usual way to mean state-assisted corporate control and gaurantee of speculator "rights", I presume.
One thing that to me makes health care different from other types of services is that consumers can't really know enough to know if they're getting screwed. If I go to my doctor and he says I have Leukemia, I don't know enough to even begin to tell the difference between a doctor who's bullshitting me for extra money, or whether I actually have leukemia. I don't know enough about medicine to know if a test is necessary or not -- I don't even know what the test is looking for in many cases. Add to that the fact that you need medical care to live, and you have a pretty good sellers' market. The customer needs you, and can't tell if you're testing just to test or if you suspect something serious, and will be unlikely to take many risks on you being wrong. Another problem is that you don't really want a cut-rate doctor. A bad mechanic might fuck up your engine, a bad surgeon could very well kill you. I just don't see a pure free market system working well. Health care is just too complicated, and short of sending everyone to some sort of mini-medical school, there is no way that the consumer is in a postion to make a sound decision.
Pretty amusing that in the article he chastises politicians for selling out the future population for a short term benefit in terms of the medicare funds, then proposes that they do the exact same thing to patch up the situation.
Which is equally true of the private and public sector. You may suspect your private sector doctor skimps on a test to keep costs for the insurance company low, but your public sector doctor can do the same because the existing budget for services is too low. I recommend getting a second opinion when the diagnosis is leukemia. The doctor will probably recommend that, too. Ask. The doctor does not make extra money by running more tests on you--in fact, the insurance company paying for the tests will ask him to explain if they think he's overdoing it. When you go to the doctor and the doctor tells you to take cough syrup for your cough, you follow his/her instructions. When the doctor tells you he/she suspects you have a catastrophic illness and many expensive tests are called for, you (1) ask questions and (2) consider a second opinion. Which doctor is better motivated to be responsible with your care: the private sector doctor who pays for malpractice insurance who owns his own practice or the public sector doctor who is an employee of the state, indemnified against most malpractice charges? And as for "cut-rate" doctors, consider this: which is better, the excellent doctor you cannot afford or the merely decent doctor that you can? Why not go all the way with this? If health care is too complicated for mere mortals to understand, why allow people to make their own health care decisions at all? If you can't understand the necessity of tests or treatments to the point where you can make informed decisions, maybe others should make those choices for you... I'll never understand the insistence on believing that when the government (rather than the private sector) performs a service, it will be more honest, cheaper, and of higher quality when history shows that is almost universally not the case.
I could be on board with something like this, as long as "wealthy" was safely defined. Nowadays, though, it is possible for people to go online and get some sense of what they might be suffering from, based on their symptoms. Or, for that matter, whether the medicine the doctor prescribed is actually relevant. Whether this is good or bad for individual cases is another matter. (I know, I know, it's the Internet. But there are some reasonably legitimate sites out there. If nothing else, take a consensus. Or just talk to friends.) (Afterthought: Same concern holds with the [other] sciences.) Even a good surgeon could kill or injure you, or even just fail to prevent you from dying. But, really, somebody's going to have to go to the unproven surgeons, otherwise how will the young surgeons improve their craft? Quite possible, but what impurities would you suggest, then? Then only one person could be iin such a position -- the doctor. The consumer has the right and responsibility to get sufficient information for a decision out of his or her doctor. If the doctor can't defend the proposed scan or whatever to the consumer's satisfaction, the consumer has the right to refuse and possibly go elsewhere. For all the fancy terminology that the medical professions use, you probably aren't going to need a lot of jargon to explain the situation to the average patient. "One of the ____ in your _____ may be torn." "I suspect your ____ has been displaced to the point that it ______, and this scan would let us get a good look at it."
You know that half the cost of the current bill floating through Congress, over $500 billion worth, is direct or nearly-direct subsidies to the insurance companies, yes?
Medical jargon is way too hard to parse, it makes legal jargon (res ipsa loquitur, in pari passu, parol evidence rule, equitable estoppel, rule against perpetuities) seem comprehensible and even simple by comparison. I know application of the legal rules can get a lot more complicated, but spend even a few minutes trying to determine, e.g., which medicated cream ointment should be applied to which bits of scaly skin to see how utterly incomprehensible even a simple medical question can seem because of the terms of art. Even the drug names are worse than those complex biological classifications in taxonomy. But like with auto repair or the law, there are good and bad doctors, some trustworthy, some not so much, so word of mouth, references, or recommendations, and second opinions are all useful. Government involvement should be limited to rules related to honesty, business practices, and anti-fraud, and agencies that do stuff like follow-up on complaints, and check licenses or safety standards.
So in other words, you didn't bother to look at a thing Stossel said, or has said, in this regard. Gotcha.
