Kling on Health Care

He hits four key points. Don't go looking for earthshattering new arguments. The interest to me is that he put together key points in one place. Maybe I just like lists. Here are key elements of the argument against a free market in medicine.

  1. The U.S. system is flawed.
  2. Other countries' systems work much better.
  3. The U.S. system relies on the free market.
  4. There are two systems of health care in the developed world--ours, and the one every other country uses.

1 is true, 2 - 4 are myths. So far the main point of contention in his comments seems to be (2). I've argued elsewhere against 2 and 3, while the falsehood of 4 is a fresh point I've not seen explicitly made but is something that has become clear recently as closer attention has been paid to the subject.

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No One Loves Healthcare

Health care creates more discussion by people who know less than any subject I know. It amazes me that there is so much bitterness about an institution which produces so much human benefit. Unbelievable scientific and technological advances since Galenic medical theory which was practiced for hundreds of years, and was basically utter quackery has been replaced by stunningly complex and often successful modern medicine. But people find fault.
They say it costs too much. It is not delivered equally to all. It requires drive and intelligence to comply with, thus discriminates against those lacking in these areas. It does not correct for all unhealthy lifestyle behaviors, environmental insults or genetic happenstances. It does not deliver happiness or a pain free existence.
It does not prevent death.
But, largely because it concerns everyone and cannot be provided inexpensively it is chronically used as a political football by people with various agendas. The arguments rage on but are usually unperceptive, off the mark and stale.
I don’t know anything about foreign health care except that every time I go to another country, I read in the local newspaper complaints about healthcare shortages, and delays.
My observations about health care in this country are as follows.
1.)Really good healthcare is available in almost any medium to large sized city in America.
2.)The health care that the poor get is better than it used to be. They used to be cared for by volunteers who got paid little or nothing. (Charity care.) Now billions are paid by the government to take care of the poor. The law requires that all acutely ill persons be cared for without regard to the ability to pay. The care must be to the same standards as anyone else. Free maternal and infant care is available to all without regard to income. They do have to go sign up for it, which they sometimes omit.
3.) There is a giant web of interlocking government and private safety nets through which some people slip. An all government finances plan would probably eliminate some of this slippage, but other problems would supervene. They always do.
4.) Massive investment in technology, pharmaceuticals and sciences has resulted in better diagnosis and treatment of many individual patients. The same modalities have been applied to people with no yield of better care just to rule out something that used to be diagnosed with simpler methods. As a result incredible costs have been generated. The benefit that individual patients get is obvious to the patient but is difficult to document statistically. It is obvious that a person with a severe gall bladder attack, appendicitis or gunshot wound would have died in the past but in terms of overall mortality tables this is hard to demonstrate. Life expectancy has, however increased and continues to do so.
5.) The talk is about mortality rates but the untold suffering that would have occurred without modern medical care is not counted. Delays in care in more centralized systems are not acknowledged as serious.
6.) As people get older they are likely to develop many conditions that are not life threatening but which do cause immense suffering and disability. These include cataracts and severe arthritis, of the hip and knees. Many people end up becoming bionic people with multiple artificial joints and pace makers, stents, defibrillators and lens implants. Many people get severe musculoskeletal injuries, such as rotator cuff, back and knee injuries. Treatment for these conditions, if you count orthopedic, hospital and physical therapy costs about 10 to 12 thousand dollars.
7.) Comprehensive care for chronic conditions such as diabetes, renal failure, heart disease and other conditions eats up similar or even higher amounts over time.
8.) Many people suffer from chronic pain or other symptoms of unclear etiology and use up huge amounts of money in diagnostic tests that yield no helpful information.
9.) Elderly, feeble and demented persons cost billions in custodial and high tech hospital care.
10.) Huge amounts are spent on dying patients in there final years or months of life some of it merely prolonging the dying process. Hospice care can ease suffering but is very expensive, profitable to providers, and is just as bureaucratically insensitive as regular care, according to some people I have talked to.
11.) A large number of patients get complications from diagnostic and therapeutic efforts. Many of these could have been avoided. When I hear people talk, it is stunning how often glitches like this happen, but mostly due to the inherent toughness of people they don’t get hurt.
12.) Many people who are very weak or frail are pushed over the edge by these glitches. Some of this has been addressed, but there are so many things that can go wrong that they will always happen. So don’t ever go to a hospital unless you have to. Get out as fast as you possibly can. This has nothing to do with any healthcare system, the reputation of the hospital or anything you can do anything about. Getting a relative to stay with you can help. The problem is that everything in healthcare is a two edged sword. So beyond some point it is worse than doing nothing.
13.) The health care problem will never be solved. Any big change will result is different problems. Any major cost saving scheme, other than just plain rationing and denial of some available care to some people will result in one time savings that will be soon be surpassed by rising costs

Little points


1) Try to figure out how to get the formatting to work, e.g., a blank line between paragraphs. It's hard to read otherwise.

2) Thanks for another thoughtful comment. Keep them coming and ignore (1) if it makes you reluctant to write.


Thanks.I will do that