Thursday, March 12, 2015

Our Our Humorless and Incoherent Health System

I‘ve always prided myself on my sense of humor and my sense of the big health care picture.

But lately I’ve been stumbling on both counts.

There is nothing even remotely humorous about our health care sysstem. It’s a serious business conducted by serious professionals, needed by seriously ill patients, presided over by serious politicians, and requiring serious money to provide. And it’s seriously complicated.

Milton Berle, the comedian, once remarked, “When it comes to my health, money is no object,” but Milton is in the minority, and he had the money to pay his doctor.

In a feeble stab at satire, I once wrote of HMOs and managed care, “Once they have you by your wallet, your hearts and minds will follow.”

That wasn’t funny, then or now. The federal government now tries to manage most care, and it supplies half of health care dollars. The money comes with strings attached. Medicare and Medicaid pays providers what it wants to pay them and only then when they meet certain conditions and gather data and dispense drugs online.

As for the big picture of where the system is going, that too lacks coherence. Its future is fuzzy. It’s hard to make sense of it, especially when it comes to all that talk about coordinating the government and market sectors.

It comes down to market-based choice versus government coercion. If you want federal dollars, you obey the mandates – individual, employer, and religious – or else. If you want ObamaCare to survive, remember this: it will depend not that you think but on how the Supreme Court rules. If you want to get a subsidized health plan, you must bumble, bobble, bungle, or google your way through the bureaucracy or by filling out a nine page form called 1095-A.

We are headed towards a multi-tiered, multi-option, multi-dimensional system. That’s the way it ought to be in capitalistic, pluralistic, multicultural health system.

No comments: