Speaking of Healthcare

Both Hillary and Barrack are strong advocates, as I am, of reimbursing preventive services as part of health care reform in the United States. Unfortunately, the economic realities of such a policy are not positive. It is easy to assert, as each of them does that preventive services saves money because we all like to hear that message. But in a today in a closer examination of that issue a Washington Post story reveals how preventive services mostly drive up costs, even though thsy save laws. It is all about the statistics of prevention whereby a fairly large number of people have to be screened with preventive tests to prevent one person from actually getting the disease. Not that prevention is always more costly than the disease. Quitting smoking, for instance, does prevent significant disease and early death in a cost effective way. But other measures can be more costly not less in the long run. I think this article is helpful because it describes how complicated the health care debate is in just one fairly straightforward area, prevention. There are no simple answers in the debate on health care in our country. If you think universal health care coverage is the answer ask someone from Canada or England. We Americans are spoiled by the degree of access most of us have to high priced technologies like CT scans , MRI's and sophisticated lab tests. The ultimate future of health care in our country is going to involve ever increasing costs which still continue to grow at rate many times that of inflation. It is true that insurance companies are greedy and that most doctors are too. On the other hand people continue to demand antibiotics for colds that are expensive and do nothing for them. As an example of such behavior multiple randomized controlled trials have shown that sinusitis cannot be diagnosed by symptoms or a physical exam alone. No matter how much ugly stuff is coming out of the nose it does not mean you necessarily have sinusitis. Only a CT scan of the sinuses can tell for sure. Only then are antibiotics truly indicated though they may not shorten how long you have your symptoms at all. I know, I know, your symptoms are much worse, you're different except not really. Medicine is now a science and the most well trained doctors practice it that way. The rest would rather write you the Rx you don't really need than to have to fight with you. Then when you get the expensive medicines that you are prescribed how many of you take them until they are all gone? Imagine the billions of dollars that could be saved by not wasting that medication. So you see, we are all part of the problem of substandard heath care in our country. The answer is to make every player in the game more accountable. In other words, yes the drug companies and insurance companies are evil but on the other hand most of us are lazy and avoid doing the simple things we can do to prevent our own illnesses. I think this simply points out what experience tells us, from the outside of every issue the answers look easy but from the inside where the details reside every issue is more complicated. The best most of us can do is to get educated, talk to people who are knowledgeable and try to make informed responsible decisions. Rhetoric is easy, taking real actions on our own behaves is hard.