Buyer’s Choice – Top-Down or Bottom-Up
your money – and you takes your choice.
proverb meaning you must resign yourself to taking risks. Everything costs money but paying something
does not mean you will get it.
This morning I read
2 articles relating to health care choices.
The first was in the Wall
Street Journal. It was by Yuval Levin, editor of National Affairs, “The
Next Conservative Movement.” Levin opined that the best thing conservatives could
offer to the health care world was bottom-up decentralized solutions to match today’s diverse
culture. In his words, “The new
conservative approach would liberate insurers and providers to offer many
different models of coverage and care and empower consumers to choose (including
financial assistance to those unable to afford insurance) and let their choices
matter – making the system more efficient from the bottom up.” Examples of this approach would be retail
clinics, walk-in urgent care centers, facilities
offering focused care for specific diseases or symptoms, work-site practices,
and direct-pay primary care or common, ambulatory surgeries
The second was in the New
England Journal of Medicine. Its author was Jonathon Oberlander, PhD, a
health care policy expert at the University of North Carolina and a frequent commentator
on ObamaCare. (“The Virtues and Vices of
Single-Payer Health Care. ” April 14, 2016. His take was “Preserving and strengthening
the ACA, as well as Medicare, and addressing underinsurance and affordability
of private coverage is a less utopian
cause than single payers. I believe it’s
the best way forward now for U.S. health care.”
These 2 points of view got me to thinking about my own point of view.
The old rule of writing is “ Write about what you know. This is what I know after 40 years of writing
about health reform.
I know health care reform is fiendishly
complicated, and no single answer exists in a pluralistic , diverse,
multicultural society , and vast continental nation like the USA.
I know health care reform gets more complicated and contentious and
expensive the more medical technology advances and the older the population grows seeking solutions to aging and chronic disease.
I know there are no easy solutions on either the
liberal or conservative sides of the
social justice or ethical sides of the reform equation.
that the Internet and social media are not the answers and do not and cannot capture the humanistic nuances
of patient-doctor-health system interactions or transactions.
I know patients and doctors will continues to
seek the best technologies, online and offline, that medicine has to offer for
life-style and life-saving purposes.
I know people want high-tech, high-tech care in equal doses.
I know Americans are impatient people who want action not talk from doctors - a prescription, a laboratory test, a CT or
MRI scan, a procedure; anything, something concrete, something they can touch,
feel, take, ingest, inject, point to, biopsy ,
grasp, identify, undergo.
I know people will always seek alternative or supplemental solutions to medical care – vitamins,
supplements, herbs, something outside the realm of “scientific medicine“ and given a choice , will choose prefer, private, personal , home, and decentralized care.
I know more centralized care, as administered and managed by CMS and government, health care corporations, hospitals,
and other organized third parties
will become dominant and control most
physician practices, subject to the good of the organization.
I know that there is no “free lunch,” that government
policies covering the general population always have a 10% fraud and abuse
price tag, and that once instituted government programs never go away and always have constituencies.
I know that America’s tort system, which promises huge casino-like rewards for successful
cases, drive up overall health costs, especially
for physicians who must pay exorbitant malpractice premiums.
I know that the present ObamaCare health exchange policies, which raises costs for covering those being subsidized
by 25% more than the general population, are unsustainable and means insurers have 2 stark choices –
jack up premiums or exit the market.
I know not where this is all going, but my best bet
would be that a dual system will emerge – one top-down with fewer choices, and one bottom-up with multiple choices.
Post a Comment