Saturday, August 11, 2007

Universal Care Is Not Life-Effective

Post lifted from Democracy Project. See the original for links

Health care cost savings do not require government-run universal care to accomplish them. All that government-run universal care adds to the equation is rationing and lesser quality care. David Leonhardt's column in The New York Times, "Free Lunch on Health? Think Again," dissects the claim that more preventive care will save health dollars.

In fact, studies have shown that preventive care - be it cancer screening, smoking cessation or plain old checkups - usually ends up costing money. It makes people healthier, but it's not free..

For a new program to work, it has to reach people who are not being helped by whatever exists now - and who thus will be among the most difficult and expensive patients to treat. The program would also have to treat a whole lot of people who never would have gotten sick..

Persuading people otherwise - persuading them that basic care is sometimes cheaper and better - will be difficult. Sometimes insurance plans will simply have to say no to questionable care, over the opposition of doctors' groups with a financial interest in the status quo. But it's the only way to "save money and improve quality and cover everybody," as Mrs. Clinton says.

She and her rivals, John Edwards and Barack Obama, deserve a lot of credit for laying out such detailed, promising reform plans. Mrs. Clinton has gone so far as to say that "too much of the money we spend is wasted on care that doesn't improve health." But the candidates are still avoiding the toughest part of the discussion: when and how to say no.

"Fundamentally, if you're going to control health care costs, it involves denying people care they want - or things they've been trained to think they want," Mr. Gruber [an M.I.T. economist who helped design the universal-coverage plan in Massachusetts] says. "There is no easy answer."

The Left's young booster of universal care, Ezra Klein, likes Leonhardt's column, because he sees it as affirmation of his meme, but adds his "easy answer" anyway:

Instead, the more achievable goal is to move towards a universal system that's more cost-effective, which is, in fact, very much the same thing as saving money, and towards an integrated system that readies the ground for tougher cost control mechanisms down the road.

In other words, the "tougher cost control mechanisms" inherent in universal care are rationing, a la other nations' universal schemes.

The Kaiser Family Foundation's latest primer on "Key Information on Health Care Costs and Their Impact," concludes that U.S. health care costs grow faster than our economy overall because:

* Wealthier countries can afford to spend more on health care technologies;
* The U.S. population is getting older and disease prevalence has changed;
* Insurance coverage has increased;
* Americans pay a lower share of health expenses than they used to.Between 1970 and 2005, the share of personal health expenditures paid directly out-of-pocket by consumers fell from about 40 percent to 15 percent.

The Kaiser report discusses various difficult efficiencies "such as increasing the use of electronic medical records, and other information technology, promoting evidence-based medicine, provider pay-for-performance, consumer-directed health care, or disease management":

Successfully implementing these policies, which is not an easy task, would likely reduce the amount that we pay on average for care, but they are likely not a longer-run solution for addressing the rate of cost growth.

Further, Kaiser's report says:

Over the long run, bringing health spending growth closer to the rate of overall economic growth would likely require finding ways to slow the development and diffusion of new health care technologies and practices..although such interventions present serious practical and philosophical challenges.

The report reminds us of the "widespread criticism" of Britain's national health system for excluding treatments. In short, the only promise that government-run universal care will deliver is rationing, not better care. At least Klein and Kaiser are (sort of) honest about it. Our presidential prospectives might try the same (at least sort of).

British patients leave hospital half-starved and the NHS is chucking food in the bin. Surely there is a solution

How lucky we are to have meals provided in hospitals. In some countries all you get is your treatment and the bed, and your family has to traipse in with your dinners. Bad luck if you don't have a family. But bad luck over here as well if you don't have a family, because droves of NHS patients are leaving hospital with malnutrition, particularly the elderly. Yes they get their dinners, but the food is either too ghastly to eat, or they can't feed themselves.

Nothing new in that; it has been going on for years. The bad news is that it's getting worse. The number of people leaving hospital starving has gone up by two-thirds and 13m meals worth 162m pounds have been thrown away over the past five years. Why bother to provide food in the first place if no one can eat it?

I had to slog into hospital with snacks for my mother, to make sure that something went into her mouth, otherwise she too may have pegged out from malnutrition. True, my mother was a fusspot over her food, it takes a lot of time and patience to feed a sick and grumpy person and the nurses are run off their feet, but it has to be done by someone, because when one is poorly, the most important thing to do is eat properly and get your strength back. You need lots of lovely chicken soup, or broths, or soothing rice pudding, or jellies for sore throats, tempting morsels to perk up the jaded appetite. If every parent or grown-up knows this, why doesn't the NHS?

Luckily, my mother was in hospital just up the road, so I could nip backwards and forwards, supervising her food and drink intake, and - even better - she was forthright. To be properly fed in hospital you need to speak your mind and have a bossy daughter or friend around to back you up. If you're on your own, heaven help you. And it's no good being too meek, polite and sensitive.

Rosemary's aunt was in hospital with an injured arm; she couldn't stretch it out, reach her food or get it into her mouth, but she was much too polite to bother the nurses. Rosemary was worried she might starve to death, but she couldn't feed Auntie, because she and all the other visitors thought Auntie didn't want to be spoonfed. "It's too humiliating," said Rosemary, and wouldn't spoon in the dinner. The nurses didn't have time, and if they asked Auntie why she'd eaten practically nothing, she would say very politely that she'd had quite enough, thank you. Auntie made it home. Just.

So it's not always the hospital's fault. And on an up note, not all of the food is bad. I know because I finished my mother's hospital dinners off, and the kosher meals were even better. You can always pretend to be Jewish.

Better still, the NHS could perhaps cut down on administrators and pay proper dinner ladies instead, who would have time to sit down next to people for five minutes, chat to them and help them to eat and drink, save their lives and save all that money on wasted dinners.


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