21 May 2009

Dialog on Health Care Reform

This may possibly be of interest to some in the vast throng of Gyromantic followers. A friend has an unusual philosophy, one I can't quite make out, which seems to have some elements you might term environmental minimalism and some elements that are almost libertarian. Just goes to show that you can't always categorize human thinking. Anyway, on the subject of health care reform, in response to my plea for support for the President's efforts to get something done this year, he wrote back to me:

There should be a significant incentive / reward for people who take care of their bodies and eat well. There should be a significant consequence for those who fail to care for their bodies and who eat all the wrong stuff. There should be pretty tight limits on what kinds of health care are supplied for free. (Broken bones, lacerations, infections, hearing aids, eyeglasses, day to to day stuff should all be covered. No transplants. No joint replacements.) There should be an excellent hospice care program.
To which I replied that we'd have to agree, in significant measure, to disagree:
I certainly agree, as do most thoughtful people, that our health system should be reoriented to emphasize prevention. But you can't punish people for bad habits by denying them health care; and saying they'll have to pay for it is denying it, because the poor we always have with us, and it's often they who are the least healthy. Punitive policy doesn't work, and isn't even a worthy goal. And health care should not be unduly restrictive by proscription. Medical artisans should be free to practice their art, without too much undue restriction, and within reasonable limits. Health care is simply something the burden for which must be shared if we are going to be a decent and humane society. I think Elizabeth Edwards's comments in this area are a model of clarity and wisdom.

Unneeded testing is an area where significant reductions can be made, and I agree people shouldn't receive purely elective things like cosmetic surgery (mostly they already don't), but otherwise, I think the Canadian, French, German, Japanese models should be the norms we strive for. What you describe, it seems to me, is puritanical and extreme. Transplants and joint replacements have become part of normal first world medicine everywhere in the world, even in countries like Thailand and India. To pretend otherwise is unrealistic, in my opinion. Ask yourself, if you were down and out, and needed a kidney transplant, and the hospital said, no, National Health Insurance doesn't pay for that, would you think that fair? Maybe so, but I wouldn't and don't.

Interesting you mention eyeglasses and hearing aids, which are virtually never covered by today's forms of health insurance. I agree they should be, (again, perhaps, subject to a necessity and "reasonable basic" limit), but your priorities seem a little odd to me. Long term and hospice care, too, are virtually never covered, but need to be. All of these things, (incluidng long term care), incidentally, are covered, and have been for over a quarter century, by the health care system of Taiwan. We like to pretend we're the richest country on Earth, but in many key and meaningful respects, it just ain't so.

Perhaps fancy rich people medicine could be taxed to help pay for ordinary peoples' necessary care.

1 comment:

  1. Just randomly happened upon this blog in a search-driven query to confirm tidbit of info, but quickly lost 15 minutes to old posts, and I look forward to returning more often!


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