Reply To: Health Care

Home Forums Politics Health Care Reply To: Health Care

#671592

As the one who actually depends on people having insurance so that they pay me for the medical care I give them, there are a few remarks that do not seem clear from the other posters. First, “A Healer who charges nothing is worth nothing.” (Bava Kama, I think) The professionalism of medicine enables the quality to remain high, though serious prospects of recovery from life threatening illness is really a phenomenon of the last century. There is very little divergent opinion that doctors like myself derive a personal and professional satisfaction from taking care of patients who benefit from the specialized skill and that fair payment is expected for having acquired the skills and for being available when needed.

Over time, in America at least, that basic Talmudic principle has gotten distorted. Accessibility of people who need care has become haphazard and payment to those who provide care has become inconsistent as well. There are three elements to reform: Accessibility, Affordability and Quality. Most of the world, including Eretz Yisrael have corrected the first two elements, everyone struggles with the third. It is only in America that cost does not run in parallel with quality. There are data from Medicare that show detrimental results of profligate care and better outcomes with less intervention. There are patients in my community who get all sorts of imaging studies of dubious benefit, expensive patent protected pills when $4 monthly generics will serve the purpose. Medical care is generated by the doctors but currently there is no means of restraining excess. Medicare has been a total failure in this. Universal accessibility has been achieved for Americans age 65+ via medicare. Quality is fairly good though inconsistent.

The other elements of the population score largely a zero in the elements of Accessibility, Cost Effectiveness, and Outcome data. For that reason, pretty much anything the elected officials do to intervene will serve as something of an upgrade. For those old enough to remember, there were privately generated cost containment efforts in the early 1990’s that sacrificed accessibility to achieve and created an overhead that really limited too little care to justify the expense of hiring case managers to oversight this. For the most part, what the doctors requested for their patients was reasonable and it was cheaper to let some extra expense go through than to hire people to contain them. The government is not likely to contain them either, nor are patients as consumers, even if medical insurance changes to a high deductible form.