Breaking Up Healthcare

There are lots of problems with the current healthcare discussion, not the least of which is that it doesn’t seem to be a discussion, but my problem is the scope.

Healthcare, like many other problems,  is such a big topic that it really needs to be broken down to be discussed and understood.  The profession itself breaks it down several different ways, but I don’t think that fits our purposes either.  The healthcare debate today is about money

Different kinds of healthcare would seem to require different kinds of financing because each kind has its own economic structure.  Here is one way to do that breakdown that attempts to consider the possible financial structures.  It is by no means the only way, but this is one possibility.

Basic Common Problems

Each of the following could easily be taken out of the current health care debate.  We have excellent systems in place for both trauma and contagious disease, and the free market system seems to deliver the health care people are looking for.  Note that these are all problems with relatively small cost or at least costs which are spread over time

Preventive Care looks like the best place for the government to change things for the better.  Right now, you can’t deduct a gym membership and schools no longer offer Physical Education.  What about tax credits for getting fit and staying fit?  It’s not a cure-all, but even Republicans will like any health care reform that comes packaged as a tax break.

Medical Record Keeping is one place where the government is certainly going to have a part. Good-bye forever any real notion of medical privacy, but have we really had that since on-line medical databases became the norm?  A uniform medical database system will simplify lots of medical chores, but it also likely that it will be used for law enforcement chores at some point.  I don’t know if I like any of this, but there is no doubt that the possible cost savings from a uniform approach all but make it certain that this will happen.

It’s a nightmare to arrange an annual physical exam without applying for life insurance.  These need to be easy and cheap to get, and you might consider a tax credit for getting one.

Contagious Disease:is a common threat that we all face.  The government already deals with this to a large extent, and that seems appropriate even to most conservatives.  These days contagious disease and biological warfare generate many of the same concerns.  The costs of contagious disease are already born by the society as a whole.

Trauma is currently dealt with on a case by case basis.  If you break your leg or get in a car accident, our current medical system will fix you up and figure out how to pay for it later.  Some are covered by insurance, some pay for it themselves, and we all collectively pay for the rest of the repairs..  Note that the Defense Department already has to be very good at dealing with trauma.  It might be simpler to put them in charge of that as well.

Dental Care is a concern we all have, and it is very expensive.  However, my bad teeth don’t affect you in any way except aesthetically.  The government could solve it cheaply by removing everyone’s teeth and giving them dentures, but I don’t think anyone thinks that is a good idea.  It seems like there is an unexploited market for lost-cost dental care, but there will always be a market for those who want nothing but the best.  Dental care is not exactly optional medical care, but it is a portion of medical care with a lot of different choices and a lot of different costs.

Optional Medical Care

I would also remove these topics from the current discussion because they involve choice.  You get to choose when or if you make these decisions, and you should also be ready, willing, and able to take on the financial burden.

Cosmetic surgery and treatments are the best examples of something that is between you, your vanity, and your wallet.  This should never come up in the discussion.

Maternity and Childbirth are expensive, but they can be avoided, and some would argue, should be avoided, by those that cannot afford the costs.  Not being able to afford kids, however, is not a barrier to lots of people.  They just go ahead and have them anyway, and the society is expected to endure the costs of the maternity and childbirth.

This is a common problem because of the expense that is borne by all, but any attempt to include it in the general discussion on healthcare is going to be divisive and unlikely to be productive.  I don’t like solving a problem by pretending it doesn’t exist, but sometimes that has to be done so that you can concentrate on solving those that can.

Joint Replacement is also optional, though people who have had their joints replaced would argue otherwise.  Certainly, people got by without joint replacement until late in the last century, and it is not a problem that we share in common with one another.

The Most Controversial Segments

If all we were worried about was the issues above, this would be a simple and relatively inexpensive problem.  Chronic diseases and catastrophic events are both very expensive, and the medicines to deal with the diseases of aging are not cheap either.

Chronic Disease like diabetes, arthritis, Alzheimer’s, or anything else like AIDS that stretches on for decades are very expensive because the expense extends over the rest of the person’s life in most cases.  If you are an insurance company, you can’t picture a time when you are going to come out ahead with most of the victims of these conditions because their current expensive need for medicine is unlikely to lessen.

Catastrophic Disease like cancer, heart disease, or organ failure are also very expensive, and it seems, inevitable if we live long enough.  This also is tough to finance.  Medicare attempts to address this up to a point.

Setting that point is a matter of some contention, and there is no doubt that economics has to be a driving factor.  The real problem is that if you get a catastrophic medical event that you survive, you may be left in such bad economic shape that you will wish you hadn’t.

Action Plan

If you solve the easy problems and then focus on chronic and catastrophic diseases, a solution might be found.  I don’t have one in mind, but I am willing to bet that we have a better chance of finding one by taking this kind of a focus.

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