Friday, February 1, 2008

Reece, personal musings - Thoughts of a Non-Apocalyptic Thinker

"Amid the myriad social transformations, corporate reorganizations, and policy innovations that have shaken the U.S. health care system, one great puzzling constant endures. For roughly 40 years, health care professionals, policy makers, politicians, and the public have concurred that they system is careening towards collapse because it is indefensible and unsustainable, a study in crisis and chaos.”

Lawrence Brown, PhD, professor in the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, “The Amazing Noncollapsing U.S. Health Care System – Is Reform Finally at Hand?” New England Journal of Medicine, January 24, 2008

The world and the woods are full of apocalyptic thinkers. Their thinking goes,

• The United States is going the way of the Roman Empire.

• Global warming is upon us and will doom us all.

• A deep recession or world-wide depression is drawing neigh.

• Medicare, spurred by greedy babyboomers, will eat the federal budget alive.

• Health care costs will drive millions of more Americans into the uninsured ranks or into bankruptcy courts.

• Health costs will make American business non-competitive.

• Safety net hospitals will disintegrate.

• The hard left will triumph, and we will have a rigid, centralized command and control “socialized medicine” system.

• The hard right will win, and we have a dog-eat-dog competitive system without an ounce of compassion.

I’m not buying any of this. I believe in the American people will come down on the side of a centrist system. I believe in the checks and balances of the Constitution. I believe costs will moderate, as

• the public, health plans, and government shift to generics and other reasonable options;

• innovations such as retail, urinary, and worksite clinics, and flexible open scheduling by doctors give wider, quicker, less costly, and more convenient access to care;

• doctors and hospitals develop new practice models such as Big MACCs (multispecialty ambulatory care centers), surgicenters, and outpatient diagnostic and imaging centers;

• Combined effects kick in of Health Savings Accounts, more transparent information about cost and quality, tax equity for all, portability of health plans across state lines, lower costs premiums for the young and healthy, and realistic subsidies to those who can’t afford care;

• Preventive and wellness movements take hold in the workplace, toxic effects of smoking and obesity become known and countered, and more people realize they are prematurely digging their own graves with their teeth and bad habits.

The U.S. health system will adjust, innovate to make necessary changes, and collaborate to produce a better, more affordable system. The system will remain stable and will not collapse from within. It will surely change, and business, health plans, drug companies, and doctors will have to take some hits, adjust, and innovate. But the health care apocalypse will not come, reasonable reforms will take place, and the frontiers of medicine will remain open.

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