#651 Musings Beyond the Bunker (Thursday May 4)
Good morning,
TWO HEALTH CARE IDEAS—ONE BIG AND ONE THAT IS SURPRISINGLY SIMPLE
At the risk of oversimplifying the complex (seemingly intentional) conundrum of health care systems and attempting broad-brush solutions in a single Musing, I have a couple of ideas about healthcare. The first is major. The second is one that would seem to a rational third party completely doable and fair (and therefore, unlikely of adoption)…
Big idea.
Most of Western Europe and other developed economies have a “single payer” system that seems to work (albeit with longer waits for elective procedures—and that’s no small problem). It’s not perfect but at least better than the current system, controlled by insurance companies, with policies that benefit big Pharma, and laws that take power from doctors while incentivizing private equity. Moving toward a single payer system, with options to purchase more personalized care, is a “big idea,” with far-reaching consequences, some good and some not so good. A not-so-good issue is the wait time in the U.K. and Canada for elective surgery, which continues to rise under the National Health Care system. Presumably, however, these kinks can be worked out prior to application to the United States.
In the meantime, we have something resembling a “single payer” system already. It’s just that the “single payer” for people over 65 is Medicare. And the “single payer” for people employed by companies with benefits is called “the insurance industry” (which begs the question why health care benefits are dictated less by need, the free markets, and optionality, but rather by who one’s employer is). Then there are those who are unemployed, underemployed, or not in a health care plan. Their “single payer” is themselves, which needs either no one pays (and healthcare results are bad) or one can go bankrupt trying to pay.
Simple idea.
But there is another possible remedy for much of what ails the healthcare system here. One of the biggest complaints about the current healthcare system is the repeated, sometimes, irrational or inhumane, denial of benefits from the insurance companies. They are the ultimate arbiter of what is paid for and what is not. The presumption seems to be that physicians are trying to game the system and demand treatments, pharmaceuticals, and tests that are unwarranted. The system by all rights should begin with the premise that physicians actually know what they’re doing and are doing it for the benefit of their patients.
I find it remarkable that we have built a system that educates physicians for 10 to 12 years (and sometimes more) after college, yet presumes that they don’t know what’s best for their patients. The presumption of the insurance companies are that virtually any test or procedure is not yet warranted. The presumption is that they are being “had” by overzealous physicians trying to placate over-demanding patients or line their pockets with fees for unnecessary procedures. But ought not the presumption be quite different? Ought we not assume that doctors actually know what they’re doing, and the vast majority of them are doing the job to the best of their ability, for which they have been exhaustively trained?
The system is broken because the insurance companies make more money if claims are denied (or even delayed). If denied, the process of appeals is time consuming and unduly complex, while the “appellate court” is none other than the very insurance company that denied the claim.
Why not have a nonpartisan group of experts determine what is or is not a necessary therapy or procedure? They can “spot audit” physicians to ensure best practices. But the process of paying physicians and hospitals for needed medical treatment ought not be delayed or intermediated by people who often are not even medical professionals. Let us assume that the bad medicine and the fraud is practiced by only a few and work to ferret them out. In the meantime, let’s elevate the physician, clean-up the process, and eliminate the profit-making incentive for insurance companies that puts people at risk.
The party paying for the care ought not be the same party that has the fiat to deny the care. Incentives need to be realigned.
COLIN POWELL AND HIS JEWISH BACKGROUND?
Colin Powell grew up in a “mixed” neighborhood, as many New York neighborhoods were in his childhood. His first job was in a Jewish-owned market, where the proprietors befriended him. When asked whether he picked up any Yiddish along the way, he replied, “No…..well, maybe a bissel…” The meaning of that last word, in Yiddish, translates to English as “a little bit.”
APOCALYPTIC LITERATURE
We are in something of a golden age of stories of the end of the world and an intrepid group (generally of societal misfits) who ply their way through the carnage to create a new society. I’m currently plowing through The Last of Us, which involves the infection of humans into zombie-like creatures, which fortunately spends little time on the zombies and more time on the survivors. I love both apocalyptic and dystopian literature or film because the author is allowed to ponder our own humanity, society’s failures, and hope. Some highlight a massive catastrophe, others the dystopia of government gone awry (Brave New World, 1984), some alternative history (e.g., The Plot Against America, Fatherland) and still others are about a contagion (e.g., Contagion, Andromeda Strain) Here are a few books worth considering:
Nineteen Eighty-Four. Government control, the party, newspeak, Big Brother. It’s all here. From a 2017 New York Times review, worth quoting at length: “In ‘1984,’ Orwell created a harrowing picture of a dystopia named Oceania, where the government insists on defining its own reality and where propaganda permeates the lives of people too distracted by rubbishy tabloids (“containing almost nothing except sport, crime and astrology”) and sex-filled movies to care much about politics or history. News articles and books are rewritten by the Ministry of Truth and facts and dates grow blurry — the past is described as a benighted time that has given way to the Party’s efforts to make Oceania great again (never mind the evidence to the contrary, like grim living conditions and shortages of decent food and clothing).”
Handmaid’s Tale. This story of Gilead, by Margaret Atwood, has become a classic. From Goodreads: “Funny, unexpected, horrifying, and altogether convincing, The Handmaid's Tale is at once scathing satire, dire warning, and tour de force.” The first season of the TV show follows the plot of the book. The subsequent series do not meet the brilliance, novelty, and imagination of Ms. Atwood.
Alas, Babylon, by Pat Frank. Not nearly as famous as the others, but this is the book I read in high school that got me worried about thermonuclear war. It’s considered in the top 100 science fiction novels; think along the lines of Seven Days in May or Fail Safe (both also classics).
Fahrenheit 451, by Ray Bradbury. I reread this book, named for the temperature at which paper burns, after visiting the square near Humboldt University, where books were burned during the rise of the Nazis. What a book—the “firemen” burn the books. It’s about books but so much more—the triumph of technology and banality.
Station Eleven. This is a recent work, which I thoroughly enjoyed. Here’s a summary from BuzzFeed: “Twenty years after a mysterious flu wiped out nearly the entirety of the human population, sects of survivors are rebuilding some kind of civilization in various settlements. One of those survivors travels among the settlements as part of a group called the Traveling Symphony, who have committed themselves to preserving and presenting the arts. But when they land in a community led by a dangerous prophet, they find their lives at risk.” For the world surviving (well, not entirely) another cataclysmic event, try The Hopkins Manuscript (a marvelous 1930s story that was an early entrant to the post-cataclysm genre) or The Andromeda Strain (an early entrant to the contagion/pandemic genre).
Have a great day,
Glenn
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