Monday, October 19, 2009

A different possible approach to medical reform

Ross Douthat, writing in the New York Times, describes an alternative approach to medical reform, and in the process has some acid comments about the legislation currently pending in Congress. A very interesting article!

Douthat's key paragraph summarizes the proposal well:

"But there’s another path, equally radical, that’s more in keeping with the traditional American approach to government, taxation and free enterprise. This approach would give up on the costly goal of insuring everyone for everything, forever. Instead, it would seek to insure Americans only against costs that exceed a certain percentage of their income, while expecting them to pay for everyday medical expenditures out of their own pockets."

Sunday, October 18, 2009

Another complication in medical billing

It's not just airlines and banks that are hitting unwary customers with "fees" in order to make their prices seem more reasonable. Now some medical offices are tacking on "facility fees" for a visit to the doctor. See this interesting article that ran in the Washington Post.

Since it is often impossible to find out ahead of time what a doctor or hospital visit is going to cost, medical offices and hospitals can't be doing this to make their services seem cheaper to people who are reading the right hand side of the menu. But it certainly complicates our efforts to understand medical costs.

A First Comment on T.R. Reid's The Healing of America

I just finished reading The Healing of America by T.R. Reid last night. The book has been much praised and much discussed, and I recently broke down and bought a copy after rising only from 21st to 18th in the waiting list for it at the Corvallis Public Library.

Reid compares the medical and insurance systems in a number of industrialized countries and proposes that the U.S. draw on their experience in designing reform legislation here. This is such a no-brainer that one would think even Congress might think it is a good idea. But ....

No doubt I will comment further on this book, especially after I finish reading an older work that examines the unsuccessful efforts to reform the U.S. during the Clinton administration. But for now I just have one observation:

Reid claims that "every developed country except the United States has designed a health care system that covers every resident." (Page 237) As a result of email discussions I recently had with a former student of mine at Adrian College now living in Taiwan and a classmate at Willamette and Johns Hopkins now living in France, I do not believe that Reid is correct here.

Lisa, who lives in Taiwan with her family reported that their daughter "had surgery to have a deviated septum fixed and because she was no longer a dependent was not covered by insurance and cost us 1700 USD for the surgery and the 3 day hospital stay. " Of course this sounds pretty good compared to $1357 a day for 3 days at our local Corvallis hospital, plus whatever the surgical fees would have been here. But clearly not all residents are covered by the Taiwan insurance system.

Maureen, living in Paris with her husband, reported that they are not covered by the French system and had to furnish proof before they were allowed to live there that they have insurance from the U.S. She also noted how hard it is to get their American insurance to pay for anything. (They are both retired, but Medicare does not pay for treatment abroad, so they are relying on insurance from their former employers.)

Despite this criticism, Reid's book is exceptionally interesting and useful and I urge anybody interested in health care reform to read it without undue delay.

Thursday, October 1, 2009

Outstanding Medical Reform Analysis From Washington Post

This columnist has done a great job of analysis and of writing. I urge everyone to read it and spread it around to friends.