Yesterday I reported on a community health care approach that rewarded doctor’s for keeping patients well, comparing it to Chinese approach related to me during our walk across the country. That drew the following concern in response:
Interesting, but what happens when a doctor is treating someone with a terminal disease…do they get penalized when someone can’t get better? Don’t get me wrong, I’m all for positive results, but it isn’t always that easy.
This is a fair concern. In general there are three types of problems that get in the way of wellness: health problems that are nobody’s fault, such as terminal illness from a genetic condition; problems that are the patient’s fault, such as smoking; problems that are the health care system’s fault, such as misdiagnosis or unnecessary drugs and treatment. A community health care system, at least the Chinese version, aspires to distinguish problems that are a health care provider’s fault from the other two.
There should be three goals for a community health care approach that rewards wellness, and may even penalize failure to maintain health. One is to determine the main cause of the health problem; two is to target those problems that are the health care system’s fault; three is to have less damaging flaws with this approach than with alternatives. Terminal illness from a genetic condition easily can be identified and avoided as a penalty to the health care system. A more problematic example would be something like accurately determining unnecessary and expensive tests.
Unfortunately, there likely are flaws with every health care approach; we are human after all. The challenge is to find the health care system where those flaws can be best minimized. A point in favor of any approach, apart from minimizing the flaws, would be meeting a necessary/sufficient test. For example, hospitals are necessary for some types of health care. Regular check-ups with both responsible providers and patients can sufficiently maintain health for many people.
I’ve yet to find anything desirable that our system of corporate bookies and stockholder gamblers satisfies with a necessary/sufficiency test. Our corporate insurance system is not sufficient for all to be insured, with at times a quarter of Americans uninsured; it’s not necessary for people to obtain or maintain health care. It’s not even necessary or sufficient for heroic medicine, as eliminating university research would quickly reveal. One of my brothers of modest means spent 66 days in a hospital being treated and cured of a variety of inflictions, all without health insurance.
I welcome you to challenge me with something for which even a flawless corporate insurance system is either sufficient or necessary. Meanwhile, a community health care system is at least sufficient, if nothing else, for eliminating all the extra health care costs involved in paying corporate bookies and stockholder gamblers. Considering that we are now 38th in the world in terms of life expectancy, while leading in per capita health care costs by almost 50% over the second place country, that’s a worthy goal at this point.
