Sunday, August 9, 2009

The misguided debate that is health care reform

The health care problem that we have now is complicated - many aspects of it needs to be fixed. The current debate focuses so much on the payer that it misses other points, such as supply and demand that drive costs. Ultimately, only individuals pay for the costs of health care, through premiums if they pick private insurances, taxes if the public plan goes through, etc. The money comes from you and me, and right now most of what we are debating is on how it will be channeled to the payees. In the end, this debate is moot if we don't fix inflating costs driven by many factors, including the fee-for-service system, which is a major agency problem where agents (physicians) are also suppliers, and they almost always decide whether products are consumed (I can't imagine patients negotiating with doctors whether they need an MRI or a surgery).

Even a debate that focuses on reducing costs or on health care in general is still limited. Health care is in no way equal to health. Considering that the majority of health costs today stem from managing chronic diseases, health care is really a bandage on health already lost. By the time patients first present with a stroke, there is little medicine can do, when if only a fraction of the same resources is spent on public health initiatives affecting various root causes of health, we can prevent people from getting sick to begin with and improve health much more effectively. Similar points are put forth in this testimony

The testimony also make a salient point about individual vs social responsibility in terms of health - it really speaks for people who most likely do not have resources to blog or explain to people that matter why they continue to consume unhealthy food and do not exercise.

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