Healthcare Efficiency

As the campaign rhetoric heats up, the issues become more sharply defined, at least on the Democratic side.  One key emerging issue seems to be whether or not to force everyone to purchase insurance.  A individual mandate, a la MA.   But even MA has exceptions, and some still prefer to pay fines.  Obama seems to recognize Wthat we’re talking about adding health insurance for a lot of people, and that’s going to cost a lot of money.  The Washington Post today refers to this as a defining question in the health debate.  

Common elements for both candidates include tax subsidized coverage for the poor, mandates for employers to provide insurance, and help for those in between--those who would see health insurance as a serious hit to their budgets, and, of course, the invincibles who don’t need it.  The actuarial fear is that if the young and healthy bow out, that will raise rates for the rest of us mortals.  The big unanswered question is how to pay for it, and no one yet is looking inside for the internal efficiencies that would probably generate enough savings to pay for everything.  


And speaking of costs, on NPR today was a story about people waiting for organ transplants.  Want to see how technology increases healthcare spending?  Look at the organ transplant business.


Lisa (see comment) is right--up to a point.  If everyone led healthy lives, the need for healthcare would diminish.  At least, that’s what health promotion is all about.  The missing link is motivation.  There’s plenty of information out there, just do it.  When I complained about my pants getting tight, a friend said, “So, who’s fault is that?”  The people I know  who have made dramatic changes in their lifestyle all have strong personal motivation, usually for a specific reason.   Perhaps a luxury tax on obesity would help.


And yes, I did simplify the healthcare cost equation to make a point.   “Healthcare” is conventionally defined as what health insurance pays for, well, at least pays some of.  There are other things.  I have three accounts  in my personal accounting system:  Health, Healthcare, and Health insurance.  The insurance bit is easy--premiums.  Health is what I spend to stay healthy, including prevention and surveillance: flu shots, teeth cleaning, gym membership, colonoscopy, etc.  Healthcare is what I spend when health fails: hernia repair, crown for a broken tooth, etc.  These distinctions are not important when considering the amount that Americans spend on healthcare annually or how to diminish that expenditure.  Be aware.  Healthcare expenses for the country will increase after the election.  The unanswered question is where the money will come from.