NEJM -- Primum Non Nocere -- The McCain Plan for Health Insecurity:
"By this standard, John McCain emerges not as a maverick or centrist but as a radical social conservative firmly in the grip of the ideology that animates the domestic policies of President George W. Bush. The central purpose of President Bush's health policy, and John McCain's, is to reduce the role of insurance and make Americans pay a larger part of their health care bills out of pocket. Their embrace of market forces, fierce antagonism toward government, and determination to force individuals to have more 'skin in the game' are overriding — all other goals are subsidiary. Indeed, the Republican commitment to market-oriented reforms is so strong that, to attain their vision, Bush and McCain seem willing to take huge risks with the efficiency, equity, and stability of our health care system. Specifically, the McCain plan would profoundly threaten the current system of employer-sponsored insurance on which more than three fifths of Americans depend, increase reliance on unregulated individual insurance markets (which are notoriously inefficient), and leave the number of uninsured Americans virtually unchanged. A side effect of the McCain plan would be to threaten access to adequate insurance for millions of America's sickest citizens."
As I've said elsewhere, I believe McCain's plan would blow up the current system fairly quickly and lead us to our much needed national debate on how we really want to do this, but the cost in every other way is too high to risk.
Saturday, October 18, 2008
NEJM -- Primum Non Nocere -- The McCain Plan for Health Insecurity
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3 comments:
Donna Smith video on single payer healthcare:
http://essentialdissent.blogspot.com/2008/09/donna-smith-healthcare-roadshow-excerpt.html
I take the author of the article is against consumer driven health care, and against personal empowerment? That makes sense, to a degree. But how much data is there to support the notion that someone else (single payer?) is responsible for person's health decisions?
The interviewee is right, there is not sufficient data to even say if this works!
The discussions about consumer driven healthcare usually assume that we have some kind of a market driven system in place. Just the opposite!
The current situation is far from consumer/patient friendly. It is all about big corporations/insurance companies, drug companies, and huge health organizations, all in bed with the big government, and their regulations. The regulations are carefully crafted not to hurt the major players, that is, the government, and the large companies.
Instead, the major players should be the physicians and the patients!
Whenever there is talk about consumer driven health, some commentators argue against the consumer driven healthcare, based on the assumption that people do not want to take responsibility to educate themselves sufficiently to be able to make their own health decisions. This clearly is a huge assumption, based on little data. Fact is, we, (US or the world) never had consumer or market driven healthcare. Never. If you want to call high-deductible insurance plans combined with an HSA or similar attempts in dentistry like Find a local dentist market driven health care, you ain't seen nothing yet. So basically, we never had consumer really make decisions so far. So there is no data. Get seriously started with it, collect your data, and then create opinions. Otherwise its all hot air and keyboard clicking. Also, keep in mind, in a true market driven health care, an average Joe does not need to take care of the health system, just of his own health, and his own choices for healthcare. Many of us are doing that today, successfully.
Hi, Katterine,
Thanks for your comment. I would recommend you read Malcolm Gladwell's "The Moral Hazard myth" as it explains the problems with consumer driven healthcare better than I could, though I can relate to you my opinion as someone who sees the tragedy of consumers trying to make choices without enough information and with a big financial disincentive to get needed interventions or preventive care or prescriptions.
The article is here:
http://www.gladwell.com/pdf/hazard.pdf
Cheers,
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