Wednesday, February 20, 2008

Reaching for Bad Medicine

Reach Upwards penned a post about how the health care system came close to failing his father. When his father was in the hospital for a stroke, the specialists and nurses seemed were so wrapped up in filling out all of the forms and following procedure that they almost killed the patient.

The implication of the post is that this gaffaw was somehow a failure of the free markekt. I think it is actually a better example of the failure of employer funded health care.

The health care practicianers were attentive to the needs of the buyer ... the insurance company.

It neglected the needs of the patient.

The product of insurance dominated health care, after all, is a transaction between the hospital bureaucracy and insurance bureaucracy.

The free market is doing what the free market does. The sellers of the product were attentive and optimized for the buyer's need.

If fewer people had insurance, and bought health care directly, then the system would be optimized for the needs of the people.

Unfortunately, since humans aren't part of the equation, we, the people don't get the care we deserve.

Mr. Hinrichs' health care experience would be completely different if people were the buyers.

I slammed a smarmy little retort on the blog entry: In a system where bureaucracies pay bureaucracies, the patients come out dead last.

After writing this post, I learned that one of my neighbors died a few days ago after back surgery. I have no doubt the paperwork was handled in a very professional manner. We are being processed through the machine quite efficiently.


Scott Hinrichs said...

I'm sorry that my post made it sound as if I was blaming free markets for our health care crisis. I was trying to address that exact concept.

I was trying to say that what we have today is not a free market, and that until the patient becomes the customer rather than the product, we will continue to have problems in the medical industry. Costs will go up and technology will increase. Patients will get lots of medical care, but it won't actually adequately meet the patient's needs.

Even giving the patient medical vouchers would be preferable to the semi-private nearly fully socialized system that we have today.

y-intercept said...

I didn't think you were against the free market. The article seemed to be implying that it was the natural division of labor that takes place in a free market that created the problem.

It is my opinion that the natural division of labor in health care would lead to something more like the doula/obstetrician type of care where you have one person with a primary focus on the experience of the patient working with highly trained professionals.

The current division of labor has the highly trained medical profession and a legion of medical coders and claims adjusters focussed on the needs of the insurance company.

Obviously the system is misconfigured.

Scott Hinrichs said...

I have no problem with division of labor in the medical industry. The problem I have is that the disparate players in the system, as you have pointed out, do not serve the desires of the patient, but serve the desires of the bureaucrats at the (public and private) agencies that are footing the bill.

Right now, politicians and medical industry folks are demanding electronic health records (EHRs). The claim is that these will increase efficiency, decrease errors, and decrease costs. But a study released last year shows that EHRs do not positively impact actual medical outcomes. They might save money -- after 15 years, but not necessarily for those firms that make the huge investment in EHRs. EHRs would help satisfy the paper pushers, the real buyers in the system. But they would not actually help patients.

Similarly, politicians and medical industry people are clamoring for universal health insurance coverage, despite the fact that another recent study shows that amount and level of health insurance has no actual correlation to real medical outcomes. This is because providing more insurance merely exacerbates the problem of patients being products rather than customers.

Market based reforms that would recognize the patient as the customer would help our specialized health care professionals cater to the desires of the patients rather than to the desires of the bureaucrats. Would such a system be perfect? No. Would it be better than our current socialized mess? You bet!

y-intercept said...

I believe that the secret to good health is to "Know Oneselve."

Medical records could help us improve our health. The problem is that the records are not geared to us.

If the individual was seen as the customer of medical records, then they would provide us with information on living healthy happy lives.

When bureaucrats are the customer, then the monstrosity they create is designed to serve bureaucrats.

They key to health care reform is to find a way to make the patient the customer.

The paperwork flow, the division of labor and the quality of the healthcare establishment is all geared toward the desire of the customer ... which is the bureaucracy. If people were the customer, then it would be geared toward improving the health of the people.