I have alluded to the fact that the desire to make money motivates a lot of American health care.
I want to clarify. I don't think this is necessarily a bad thing, though it obviously has some less-than-optimal consequences.
Back to the medical history form - the one I turned in yesterday. It wanted to know if I've ever lived with anyone who had tuberculosis, and the answer is Yes. My father was diagnosed with tuberculosis in 1949, when I was 4 years old.
In 1949 this was a common disease. It had been around for uncounted centuries, and being highly contagious, accounted for hundreds of thousands if not millions of premature deaths. In 1949 there was essentially nothing to be done about tuberculosis. My father, like all such patients, was sent to a rest facility, given supportive care, and everyone just hoped that his body would overcome the infection (which it did). Now, of course, except for the new drug-resistant varieties, TB is cured by a course of medication, no muss, no fuss.
That medication was developed by a corporation which hoped to make a profit on it (and, I assume, did so). That there are other ways to develop medical innovations does not change the fact that this one (along with most of the "miracle drugs" we now have) was developed for profit. New surgical techniques and appliances, including the new knee I will receive next week, are developed here with the same motivation. And so on.
Like all other motivators, including government-sponsored research, profit has a good side and a bad side. (Those who think that such things will be done by purely disinterested beings for purely philanthropic reasons are, in my opinion, deluded.) Furthermore, doctors deserve to be paid, and they deserve to be paid well. Hospitals, nurses, the whole myriad of people and organizations involved in our health, the same. (I will observe here that while doctors and hospitals are doing all right, they are not getting rich off the current system.) I certainly don't mean to suggest the contrary, or to say that the profit motive is a bad motive, still less that it is the worst possible motive.
However, the downside of the profit motivation can result in what we may think of as "padding the bill." This factor seems operative in my case, though not to an excessive degree. But it remains true that there is little reason for me to have three pre-operative doctor appointments. Consolidation and data-sharing would save a lot of time and effort here.
Because of course the only professional who is involved in all three appointments isn't getting paid. That would be me.
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Oh, there's nothing wrong with a profit-motivated system, so long as we understand its weaknesses and guard against them.
ReplyDeleteMy point in the link I posted in the previous entry was simply that when a company gets a better return on investment for billing shenanigans than it gets from doing whatever it was originally incorporated to do, then that's what it'll start doing. What we reward, we see more of.
The counterbalancing story to your one about TB medicine is the one of the tailor who went into the chemical business and sold antifreeze as glycerine. It's gone all over the world, mostly into medicine, frequently for children. The dead (that we know about) number in four figures. That, too, was profit-motivated.
What we need to do is reward professionals for the work they actually do. Accept that water will flow downhill, and channel it in the right ways. Regulation, which has become a dirty word these last years, turns out to be a necessary check on the markets.
Something to think about in health care reform.
I think the current American system is rather more profit-oriented than it ought to be, so to that extent I'd agree with you, rooster.
ReplyDeleteHealth care is a public good. It is by its nature collective - for a simple example, consider infectious diseases, which endanger everyone, and vaccination, which aims at herd immunity.
It follows then that the community has legitimate, not to say essential, input. This is not or should not be every-surgeon-for-herself. We have lots of regulation here - and for that reason, by and large the Chinese adulteration scandals have passed us by. But I'm certainly thinking that we don't have enough regulation, especially where costs and the availability of insurance are concerned.
Health insurance companies seem to be much too lightly regulated, and as a result engage in outrageous cherry-picking. If we decide to retain an insurance-based system, these people will have to be brought much more sharply to heel. In my opinion.