Thursday, July 02, 2009

Obama Wants You to Have Less Health-care

That is really the only way he is going to drive down, costs, and he states it pretty clearly. Obama Addresses Health-Care Reform at Virtual Town Hall Meeting - washingtonpost.com
And it turns out that every study shows that the question is, are you getting the right care, are you getting the best care, the high-quality care, rather than are you having a whole bunch of tests ordered that are unnecessary, getting a bunch of treatments that are unnecessary, staying in hospitals longer than may be necessary all of which drives up your costs but doesn't make you better.
First off, what universe is he living in where people spend too much time in the hospital? Procedures that used to involve at least an over-night stay, have turned into out-patient at a great rate since the 80s and 90s. All the doing of those eeeevil insurance companies. So he wants to further reduce people's hospitalization. OK.

So tests will be reduced? Well, tests are how doctors figure out what is wrong with you. They often don't know what is wrong, just by talking to you or looking at you. So how are doctors supposed to figure out what treatment you need?

But then treatments will be reduced too. Sometimes doctors try things as a stop-gap to keep you alive, while they try to figure out what is wrong.

Do doctors do unneeded tests and procedures? No doubt. It is usually done under the heading of "Insurance Fraud."

He cites how things are done at the Mayo Clinic. They do good work there, I am sure. They call in all the specialists at one time to consult. OK. That sounds expensive in the 90% of cases where only 1 specialist is needed. On problem cases - the kind that get referred to the Mayo Clinic - I am sure this makes sense. Is it a model for the average health-care interaction? Somehow I doubt it.

Of course a lot of medicine is done with an eye toward malpractice suits. "Defensive medicine" because people expect good outcomes.
We've got to create a simplified, more effective system where they are reimbursed for quality care as opposed to having to distort their practices in ways that don't actually make their patients better.
But we aren't going to do anything about malpractice, because that wouldn't be fair.

So which way do you want to have it?

Do you want doctors to be able to determine what is wrong and treat it? That may involve a lot a testing. Do you want doctors to ignore the threat of malpractice? That might involve some other changes.

I know the man isn't stupid, I just wish I knew what he really was trying to accomplish. (I have my suspicions, but they are only suspicions.)

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