Saturday, September 12, 2009

Hopeless Health Care Debate

(News-Herald, September 10) The health care debate highlights how hard it is can be for Americans to get things done.
Health care is a complicated business, a highly technical field with a vast body of knowledge, plus a complicated delivery system and an entrenched business model that has become only more convoluted with time. And of course the health care biz is now smothered in the health insurance biz, one of the most deliberately complicated businesses in history.
The chances that an ordinary civilian can navigate this tangle, let along trim, cut and re-organize it – well, that seems as likely as chipmunks building a thermonuclear device in my back yard.
This type of work requires experts, people with years of experience with the ins and outs of the industry. Trouble is, these people have a vested interest in the industry. Getting these experts to help is like consulting a wolf on the best way to guard sheep.
Americans love the idea of gifted amateurs. In the movie, “Dave,” a small town shlub takes over the role of President and brings in his buddy, a small town accountant, to fix the federal budget in a day or two. That makes a swell movie, but is as likely as somebody being able to rebuild an engine because he’s always liked cars and he’s a good person at heart.
At times like these, some folks like to turn to the academics. Call in some college professors or think-tank whiz brains!
I’m not completely opposed to that notion. Academics have produced some fine results over the years (the internet is a good example), but experience in my field makes me suspicious. Education is filled with collegiate “experts” who wouldn’t last five minutes in an actual classroom but who can always land a government consulting gig. Then again, I may be an education expert, but I am heavily invested in my field and job. It’s possible, even probable, that my perspective makes some things very clear to me and keeps me from seeing other things at all.
That same thing is true of health care, but more so. If we’re going to pick apart the health care industry, whom do we trust? Who is in position to have good perspective on this monster?
Certainly some things are obvious to the average shmoe. Denying people health care because they’re ill is backwards. Spending a gazillion tax dollars we don’t have is unwise. Many businesses that I deal with keep track of me with stalker-like devotion. Yet the health insurance industry repeatedly makes regular customers approach like strangers. Do not tell me in this technologically advanced era that health care insurers need a system that is slow, cumbersome, inaccurate, and paper-intensive; surely it’s no coincidence that this system guarantees that they will pay slowly, hang onto money longer, and encourage customers to give up entirely. The health care biz is unique as an industry in which the economic incentive is to avoid doing the job that it’s there to do.
Democrats and Republicans are both historically happy to hand over the regulatory writing instrument to the industry facing regulation. I don’t automatically assume this proves corruption—inside the industry is where you’ll find the people who know it best. But we also can’t give the wolves the keys to the pasture. The economic meltdown is a fine example of how badly that can end.
And this balancing act must happen against the backdrop of the public shouting match loudly led by all the folks who have been suckered into shilling for the health insurance industry, and reform boosters with a seemingly-endless supply of Really Sad Stories.
How to navigate this mess. More actual thought and less noise would be good. It’s probably costing us too much as a country to just leave the industry alone; the wolves are already feasting on mutton daily. Market forces? Market forces say that a lot of sick unwealthy people should just die. Legislate a “right” to health care? Quick—go plant the money trees now. Put the feds in charge? Why think they can run the health care industry—it’s just putting more wolves in charge, though maybe dumber, slower wolves.
We could hire the wolves to watch the sheep and slap a good set of leashes on them. Course, then we need someone dependable to hold the leash. Maybe we just look for altruistic vegetarian wolves. Maybe I’d better keep a closer eye on the chipmunks in my back yard.


Dittman said...

You lie! (Sorry, but we both know someone was going to do it, and I wanted it to be me.)

Joe said...

I love this piece for its implicit point - that closedmindedness and angry fearful hectoring at town hall meetings are not helpful in understanding or addressing the various options we have for improving our dysfunctional health care system, which all come equipped with their own sets of issues.

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