Impossible Politics Options

[Merica]

I just wrote a blog called Impossible Politics [link removed], which discusses my uncertainty about politics in general. I thought some of you here might relate to my ponderings. If you're interested then feel free to read, and I'd greatly appreciate any comments (on the blog page itself, preferably).

In all honesty, I want Obama to rule England. Dude's cool as fuck. Obama, or Bruce Willis.

This post has been edited by Merica: Jul 19 2018, 8:36 am

[Existentialist]

Well, I'm not going to read through five pages of arguing so I won't reply to anything specifically, but I will lend my two cents regarding the health care bill seeing as how I will be an MD in less than a year. The health care reform will not really change a whole lot and will certainly not address the biggest problems we have in our health care system. The biggest three problems in US health care are limited access, outrageously high costs and disproportionately poor quality to show for it. I will address all three.

The reform mainly sought to fix the access problem. There are indeed well over 40 million Americans without insurance, but contrary to the target of the reform, the bottleneck really isn't at the level of insurance coverage. If anyone goes to an ER, they have to be treated and they will be treated the same as anyone with insurance. I have worked in a Level I trauma center for two years and probably half of my patients were uninsured, but I didn't know the difference unless I really looked for it in their chart, which I don't have time to do. So, on an emergency basis, health care access in America is the same for everyone. On a routine health maintenance basis, there is a difference in access. If you have good insurance, doors are open for you to see doctors anywhere in town. Without insurance, good luck. However, the reform will have the majority of the 40+ million uninsured going with Medicaid, which is not currently accepted by most physicians due to crappy reimbursement. What Blue Cross or Humana reimburses $200 for, Medicaid pays $10 for. There's not much incentive to take Medicaid patients, and the ones who see them are already overflowing with patients. We'll have a ton more people on Medicaid, and unfortunately that just means more people at the back of the line at the few doctors' offices who will see them. The real issue is not having enough primary care providers.

The main problem in US health care for the last 50 years is cost, and the reform will actually make this problem worse. In 1970, 5% of our GDP was spent on health care and this year it will approach 20%. The primary reason for this is that we have absurdly high administrative costs that other countries don't have. Since 1960, the number of health care providers per capita has about doubled, while the number of health care administrators per capita has gone up about 20 fold. All these paper pushers drive up the cost of health care big time. To repair an aortic aneurysm in the US costs about $15,000 while in Canada it costs $8,500. The difference is entirely due to administrative costs and has nothing to do with physician or hospital fees. By adding even more people onto the list of those insured and giving insurance companies more incentive to add administrators, the costs will only go up. Eventually this is going to collapse, because if we continue at our current rate, half of our nation's economy will be health care related by 2040. Disaster!

So, in summary, the reform will probably help a small subset of people, as just about any government action does. However, it really isn't going to solve much in the way of access to care and can only change costs for the worse. Most doctors agree that the first necessary step to real change is to take qualified health care administrators and retrain them as primary care providers. Primary care medicine really isn't too hard and a lot of people could do it with proper training, and with the exponentially growing complexity of medicine, it would be a waste to have MDs with 8+ years of post-university training doing primary care. I hate pretty much all politicians, Obama included, but I think this is a fair assessment. Not too much "change"!