Posts Tagged ‘Health care reform’

Health care reform according to Gordon

February 28, 2010

Democratize medical education

Then insurance deregulation

            Then slowly with torts

            That clog up the courts

And raise tobacco taxation


Frequently people ask me what I think of health care reform.  I give my ideas.  Most people don’t want to hear what I have to say, declaring “We have to do something!” without realizing that the situation can be made worse.

Here’s what I think we should do, and for the most part these are not my ideas.

Reform medical education.  As a wonderful article in JAMA (Journal of the American Medical Association) pointed out, the current premedical sequence wastes two years, mostly to weed out the field because too many people want to be doctors.  At a time when we’re going to need a lot more doctors we shouldn’t be discouraging potential candidates.  If we need to weed them out, let’s democratize the first two years of medical school, which are the classroom years.  Put the content online, and let everyone who can pass Part One of the Boards apply for positions in the clinical years.   Those who don’t learn well from online courses could pay existing or specialty educational institutions.  The current educational sequence (four years undergraduate, four years medical school) could be shortened to four years undergrad followed by five semesters of clinical teaching.  You would need to have more medical schools and you would need to have more residency slots.  The resulting doctors would be willing to work for less money, but they would not want to work as many hours.  Which is OK, because there would be less burnout.   

A lot of people starting the sequence wouldn’t go on to clinical training.  They would be an asset to society on a lot of levels.

Reform the tort claims system.   The medical malpractice industry is alive and growing, and sucking time and money from the health care system.  Money that should be used to cure and heal is being used to pay plaintiff lawyers, defense lawyers, judges, and insurance premiums.  The vast majority of medical malpractice suits filed are dropped, but not before the doctor has lost a week of production, on average.  Lawyers currently name every doctor associated with the case with impunity, hoping that each one will settle for a nuisance amount.  I saw a case where the doctor performing the autopsy was sued (I’m not exaggerating). 

Lawyers need to have the same degree of accountability that they demand of everyone else.  While they get sued all the time now, they don’t get sued for very much.

But the change needs to be slow.

Health insurance needs to be health insurance.  My friend, Mike Bernstein, gets credit for this idea.  Car insurance doesn’t cover gas, oil, or spark plugs.  Home insurance doesn’t cover vacuuming the carpets.  Health insurance should be catastrophic coverage.  Instead of putting the money into the pocket of the insurance company to pay for things like bronchitis and athlete’s foot, we should have Medical Savings Accounts paid for with pre-tax dollars  and earn interest; the funds should carry over from one year to the next, and could be used for anything health related.  If you wanted to, you could use it for cosmetic surgery or gym memberships.  Such a plan would bring the idea of ownership of health and health care back to the individual, which would improve the influence of market forces in medicine.

Raise tobacco taxes.  Every year at the federal level, cigarette taxes should be raised by a dollar a pack per year.  Wait, you say, such a tax is unfairly imposed on those least able to afford it.  Yes, I say, and it should.  Because if you can’t afford your health care, you shouldn’t be smoking in the first place.  As a society we can’t keep pouring money into the largest single cause of death and disability.  The money we raise could go to pensioning off the oldest five or ten percent of the tobacco farmers, per year.

The Libertarians will scream Slippery Slope, if you do that to tobacco, what next?  My answer would be alcohol.  Or maybe high fructose corn sweetener. 

I can’t decide which.