Healthcare and Health Care

I have to revisit this subject in light of recent news and developments. It pains me to see the confusion that has caused the pollsters and pundits to be able to take shots at something that everyone wants.

There is concern about cost that is well founded. The problem is that costs come in a variety of disguises. Now discussions of cost have assumed inordinate importance in the questions of access. Once again, healthcare is about cost and health care is about access. These are two distinct issues.

There is virtually no one who advocates the denial of medical care on the basis of inability to pay. The entire health insurance industry emerged in response to a rise in costs driven by improvements in the science and technology of medicine. These improvement demanded better education for medical practitioners (added cost) and the technology has become more complex resulting in increased cost for both development and support.

While all this was happening, we became a nation of sedentary, over-eating, narcissists who believe in the idea that modern medicine can fix whatever we do to ourselves and make us all(well, me anyway) into beautiful people. We have learned to game the system to get the plastic surgeries we want and the pills we want and the therapies we read about.

Insurance coverages have been broadened continually in response to forces too numerous to mention with the result that more premium dollars go out requiring more premium dollars to come in. The insurance companies have developed bureaucratic defenses, requiring second opinions, demanding justification based on diagnostic testing, even making a practice of denial of the initial claim to filter out those who aren't really serious. The additional staffing and data handling is paid for by premium increases and forced out to the medical providers who increase their charges. Rising costs are everywhere and no one can join the debate with clean hands. Everyone wants someone else to absorb the costs.

In the midst of all of this, we sometimes lose sight of those who simply stay away from health care because they don't have enough money to pay for the other, even more basic necessities. We always lose sight of those who try to take care of themselves by buying health insurance, which they can afford only by accepting caps and deductibles or limitations on coverages. These people looks good in the statistics but rarely show up in the doctor's office because paying the premiums has put them into the same category as the uninsured in that they have no financial resources left over to pay for the visit. Further, they now have to live within the insurance bureaucracy that demands diagnostic justification, turning what might have been a $100 office visit into a $300 one.

Access to health care for everyone should be the sole topic in Washington. Access has relatively simple solutions. Let's solve that problem first, and, by the way, we have already agreed that ability to pay will not limit access.

Costs are a completely different issue and one that will require all interested parties to make substantial changes in thinking, planning and delivery.

It is deplorable (to use a word employed by a past President in a slightly different context) that we continue to allow doctors, administrators, insurance CEOs, technology vendors, pharma, and politicians to continue to point fingers at each other while the full cost of inadequate health care is borne by me and you, the patient/consumer.