Sunday, August 16, 2009

Dr. Alex Lickerman: A Prescription for the Health Care Crisis

Dr. Alex Lickerman, practicing physician and blogger extraordinaire, has just written A Prescription for the Health Care Crisis. I enthusiastically recommend it for anyone with an interest in health care reform. In particular, I think it should be required reading for all of our U.S. Senators and Representatives.

Here's how it begins:

With all the shouting going on about America’s health care crisis, many are probably finding it difficult to concentrate, much less understand the cause of the problems confronting us. I find myself dismayed at the tone of the discussion (though I understand it—people are scared) as well as bemused that anyone would presume themselves sufficiently qualified to know how to best improve our health care system simply because they’ve encountered it, when people who’ve spent entire careers studying it (and I don’t mean politicians) aren’t sure what to do themselves.

Albert Einstein is reputed to have said that if he had an hour to save the world he’d spend 55 minutes defining the problem and only 5 minutes solving it. Our health care system is far more complex than most who are offering solutions admit or recognize, and unless we focus most of our efforts on defining its problems and thoroughly understanding their causes, any changes we make are just likely to make them worse as they are better.

Though I’ve worked in the American health care system as a physician since 1992 and have seven year’s worth of experience as an administrative director of primary care, I don’t consider myself qualified to thoroughly evaluate the viability of most of the suggestions I’ve heard for improving our health care system. I do think, however, I can at least contribute to the discussion by describing some of its troubles, taking reasonable guesses at their causes, and outlining some general principles that should be applied in attempting to solve them.
By all means, go read the whole thing.

For what it's worth, I did, then left Alex this comment:
Alex, this is an excellent, thoughtful, apolitical discussion that ought to be required reading for all of our U.S. Senators and Representatives. Perhaps a few of them would get the message that the subject of health care is far more complicated and interdependent that they realize. Therefore, they need to tread very, very carefully – because any well-meaning “reforms” they enact are far more likely to result in adverse unintended consequences than in real improvements.

Indeed, Congress’ past track record is replete with examples of laws passed with the best of intentions, but that nevertheless ended up causing far more, and in many cases, far more serious, problems than they solved. As just one recent example, consider the case of the Consumer Product Safety Improvement Act (CPSIA). One year ago, it was enacted with the universally approved aim of stopping the importation of dangerous lead-laced toys from China. Only later did we learn that among its myriad other unintended side effects, the law also bans the distribution of children’s books printed before 1985.

CPSIA was intentionally written in such a manner as to give the Consumer Product Safety Commission no discretion in determining whether or not the law applies to a given situation. At the same time, its specific requirements are so nebulous that in reality, the specific requirements of the law are, basically, whatever the Commission says they are. The perverse end result is to make it impractical or impossible for thousands of small, specialized companies with limited resources to remain in the business of furnishing low-volume items intended for children, while rewarding the very same huge, big-box store chains that caused the problem in the first place by importing cheap junk from China – since they are the only ones with sufficiently deep pockets to comply with the new law.

Oddly enough, the exact same House committee chairman, Rep. Henry Waxman (D-CA), who is primarily responsible for the disastrous, gotcha-filled CPSIA is also the prime mover behind the House health care reform bill, as well as the even more disastrous cap-and-trade measure already approved by the House, but thankfully not yet passed by the Senate.

In view of their abysmal record, why should we have any confidence that Rep. Waxman and his myrmidons will do a better job with the infinitely more complex task of health care reform than they did with the CPSIA and the cap-and-trade bill? On the contrary, it seems to me that we would be well-advised to keep these arrogant know-it-alls as far away from our health care as possible.

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