Who Is In Charge Here?

It sounds like an innocent question. But with health care the question is profound.

Is it the government? Perhaps. Government pays the health care bills for roughly half of Americans - 55 million or so in Medicare, 70 million in Medicaid, and assorted other government programs, including the VA. It’s estimated ObamaCare has already added 32 million more. In the future, if government has its way, the rest of us will join the government-dependent crowd. This may make sense. As everybody knows, he who pays the bills calls the tune.

Is it the marketplace? Is it health consumers, who will soon or later be patients? Many of them believe that they ought to be able to choose their own doctors, that they ought to pick the health plans that fit their needs and the needs of their family, that doctors and hospitals ought to compete for their business. The marketplace is the keystone of American capitalism. But do these people know enough about what ails them, who the best doctors and hospitals are, and how to get the biggest bang for themselves and their personal and taxpayer dollar?

The, there’s the trust factor. Can online information be trusted, or for that matter can physicians and hospitals be trusted? ObamaCare say no. Only impersonal megadata, assembled by teams of cooperating, coordinated health care teams in large organizations feeding input and outcome data into vast computer networks, can be trusted. Gathering this data requires computers with health information records in every doctors’ office and every hospital with sharing of personal information between computer.

But what if the computer system don’t talk to one another? What if they don’t have common standards? What is patients do not want their personal information shared with others? Ah, therein lies as a dilemma (Eric Whitney, “Digital Dilemma for Medicine: How to Share Records,’ Montana Public Radio, March 6, 2015.)

Where are we now on a scale of 1 to 10 of getting computers to share records with each other, of developing a universal standard, of protecting that information from prying eyes, of paying for it ? Despite $30 billion from the government so far since 2009, the answer appears to be about a 2 or 3, according to the experts.