An essential task in reforming healthcare is to prioritize the goals of any such reform. It is not enough to merely assert that things like "comprehensiveness," "access," "fairness," "high quality," "affordability," etc., etc. be among healthcare reform outcomes. These need to be prioritized, with lower priority goals sacrificed in able to achieve more important goals. This process of prioritization is afflicted with the "stakeholder" problem mentioned in the previous post. In the process of reforming healthcare, oxen will be gored. Special interests will wail, epithets will be hurled about regarding how disadvantageous prioritization is "racist," "sexist," "greedy," "oppressive," "classist," "supremacist," and on and on.
It should be uncontroversial that healthcare services are not unlimited resources, and cannot be made so. From this follows the notion that an unlimited resources are not available to pay for healthcare services, and healthcare should not be reformed to make such services more expensive. Reform should result in more cost-effectiveness. It is unavoidable that healthcare reform be intimately concerned with cost, both societal costs and costs to individual people.Society cannot spend ever-increasing percentages of economic production on nebulous healthcare, nor should individuals have to exhaust their assets mid-way through dealing with illness.
The latter eventuality can be avoided by the generic use of health "insurance," or more generally by spreading risk of healthcare-related poverty among a number of people. Private insurance and public payment programs share the common attribute of creating a pool of funds from which which individual healthcare expenses are paid. Insurance companies create these pools through voluntary payment of premiums, and public pools do so through taxation. Both of these approaches are tenuous over longer time horizons because they are focused on buying and selling healthcare related services in individual transactions, without sufficient regard to the value of those transactions, or the ability of the system to accommodate uncertainty associated with those transactions. this state of affairs is largely a failure of prioritization.
A rational approach to prioritization would include certain desirable attributes of a flourishing society: a safety net that rejects societal indifference to individual misfortune; a recognition that processes (as opposed to outcomes) associated with distributing benefits should be insensitive to chance, or political and economic interests; and acknowledgement that because individual circumstances vary, benefits will not be distributed equally. In short, a rational prioritization will not allow the perfect to be the enemy of the good. To this end, the number one priority of healthcare reform should thus be: minimizing (it is unreasonable to think we can eliminate) the risk of healthcare associated penury for families. This should take priority over considerations of fairness, equality, or any of the policy-driven expenses mentioned in the previous post. The first question is thus how do we provide access to medical care for individuals while protecting their families from medical penury? What pool of funds should be used to pay for services that would otherwise bankrupt the patient, and under what conditions, and for which services should a patient have a claim upon these funds? This approach is consistent with the current rationale for "health insurance." Health insurance does no t insure health it insures assets against exhaustion that may result from paying for expensive healthcare services, and also maintains a measure of access by assuring providers that they will not get stuck providing uncompensated services. The priorities in healthcare reform will rationally start with these two purposes.
Once we focus on the priority of avoiding medical penury, we can begin to design a reform process that can sequentially address other priorities.
No comments:
Post a Comment