Knows Best: The Quest for Equitable Health Reform
may think it knoweth,
is best for most of us,
the market often bestoweth,
is good for the rest of us.
Foreword, The Health Reform Maze (2011)
13, 2013 – Who knows what’s best for Americans’ health care?
And what is the most equitable way of going about providing that care?
politicians and experts?
Certainly that is the intent of the Affordable Care Act. At least that is
what the ACA’s proponents would have you believe. That has been the case since Alexander
Hamilton (1755-1804), one of our founders, said a government of elites could
best decide what is best for the rest of us.
President Thomas Jefferson (1743-1826),
another founder, disagreed with Hamilton. Jefferson maintained the will of the people
and free markets should prevail. There is no doubt the government has the
political platform – and the money to
fund the administrative, technological,
and information resources - to do the
job. But government control comes at a
price – personal freedoms and suppression of normal market forces.
Perhaps. But ordinary people may lack the requisite information to decide what is best. They may be gullible. Hucksters and those who profit from
providing care may mislead them. Still,
there is another school of thought among
those who back a concept known as defined contributions or vouchers. These folks say: give a fixed, tax-exempt
discrete amount of money, to every citizen, to spend as they see fit. People are smart, and given the right
information, they will decide what is
best for themselves and their families.
This school is led by those who advocate Health Savings Accounts for everyone and their
families to spend as the occasion arises
from birth until death.
include doctors, hospitals, and a host of other trained caregivers who provide
care. But, ah, say critics. These various professionals are paid on the
basis of fee-for-service. That is an open invitation to overuse services. Fee-for-service payment cannot be trusted. Only government oversight and regulations can
curtail inherent greed in a FFS
system. Only not-for-profit
organizations should be allowed to exist in a national health system. Physicians should be paid on salaries. Private options, and private contracts, outside
of government should be verboten. Market
forces, in other words, cannot be trusted to provide equitable “fair” care for
all citizens, regardless of economic status.
The cliché, “Doctor knows best,” is outdated, even as the drug companies
keep advising, “Ask your doctor before taking this medication.
- Integrated care
there are those who insist the answer lies in organizations providing “integrated,”
“coordinated,” “patient-centered, “ evidence-based care, “ “team”
care. The “evidence” in most cases
is data accumulated from mandated electronic medical records and
government-sponsored comparative outcome studies. Ideally, these organizations should consist of regulated
health plans, hospitals, and salaried
physicians under one corporate roof.
Kaiser Permanente, headquartered in Oakland, California, is the prototype of this type of organization. Its
CEO, George Halvorson says to make these organizations work:
“We must make online information instantly available at
the doctor’s offices, at the bedside, at policy levels, and to health
consumers; we must invest heavily in electronic health records, as Kaiser
has done by investing $4 billion in its electronic information system; we
must innovate; we must form ready-response
teams to respond to the crisis of hospital-acquired infections; and we must educate patients with diabetes and
heart disease and hypertension how to prevent and minimize complications,
from these and other chronic conditions."
Tweet: Quest for best
health reform revolves around who knows best: government, consumers, health
professionals, or integrated health organizations.
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