A radical idea for healthcare

I dumped my subscription to The Atlantic earlier this year, fed up with the magazine’s shift away from ideas, literature and occasional whimsy to politics, politicians and those who affect their decisions, and things that, while not politics, matter mostly to political junkies. If I wanted to read the National Journal, I’d subscribe to it.

Despite my discouragement about the magazine, I’m sorry I missed this piece, How American Health Care Killed My Father, from the September 2009 issue.   The author, David Goldhill, at least tries to radically rethink health care. He’s passionate, smart and articulates the issues simply and clearly. He doesn’t sugar coat anything, but he makes it clear that  the reforms we’re fighting over isn’t really going to help, for reasons beyond the control of the system.
Goldhill starts by noting that despite the data showing that his father was just one of 100,000 Americans a year who die from infections they get at the hospital, many doctors still refuse to wash their hands regularly. That’s outrageous, of course, and he will come back to it in telling fashion.
He also puts the cost of health care in stark context:

already, the federal government spends eight times as much on health care as it does on education, 12 times what it spends on food aid to children and families, 30 times what it spends on law enforcement, 78 times what it spends on land management and conservation, 87 times the spending on water supply, and 830 times the spending on energy conservation. Education, public safety, environment, infrastructure—all other public priorities are being slowly devoured by the health-care beast.

He has sensible discussion like this:

Consider the oft-quoted “statistic” that emergency-room care is the most expensive form of treatment. Has anyone who believes this ever actually been to an emergency room? My sister is an emergency-medicine physician; unlike most other specialists, ER docs usually work on scheduled shifts and are paid fixed salaries that place them in the lower ranks of physician compensation. The doctors and other workers are hardly underemployed: typically, ERs are unbelievably crowded. They have access to the facilities and equipment of the entire hospital, but require very few dedicated resources of their own. They benefit from the group buying power of the entire institution. No expensive art decorates the walls, and the waiting rooms resemble train-station waiting areas. So what exactly makes an ER more expensive than other forms of treatment?

Perhaps it’s the accounting. Since charity care, which is often performed in the ER, is one justification for hospitals’ protected place in law and regulation, it’s in hospitals’ interest to shift costs from overhead and other parts of the hospital to the ER, so that the costs of charity care—the public service that hospitals are providing—will appear to be high. Hospitals certainly lose money on their ERs; after all, many of their customers pay nothing. But to argue that ERs are costly compared with other treatment options, hospitals need to claim expenses well beyond the marginal (or incremental) cost of serving ER patients.

In a recent IRS survey of almost 500 nonprofit hospitals, nearly 60 percent reported providing charity care equal to less than 5 percent of their total revenue, and about 20 percent reported providing less than 2 percent. Analyzing data from the American Hospital Directory, The Wall Street Journal found that the 50 largest nonprofit hospitals or hospital systems made a combined “net income” (that is, profit) of $4.27 billion in 2006, nearly eight times their profits five years earlier.

Maybe I can endure the new Atlantic in small doses. I’m sorry that more of his ideas seem to have faded from discussion already.

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