Friday, January 22, 2010

Other Ways to Fix Health Care

After the Massachusetts special election, it seems that many have picked up the narrative that any progressive agenda will have to be scaled back, in particular with the current battle for health care reform. This argument presupposes that the nation's disapproval of the bill is a result of it being too progressive in the first place, rather than being too much of a toothless compromise. (This argument also presupposes that the election results were indicative of the attitude of the nation, whereas it's worth noting that the state already has a form of universal coverage, and Martha Coakley insulted the Red Sox).

Most who are interested in health reform at all agree that the Senate bill would be better for the nation's welfare than no bill, and if that's the only politically viable option, we should pass it. But at the moment there seems to be a news-cycle-zeitgeist of reconsidering options, and thus I'd like to propose a few.

1. Medical education should be fully Federally subsidized.

One reason that health care costs are higher in the United States for similar care in other industrialized nations is merely that we pay our doctors far more. A major justification for this is that doctors in the United States generally have to pay their own way through medical school with loans that are repaid through their careers. When you remove the cost of repaying medical school loans, American doctor salaries fall back to a comparable level. Still higher, but comparable.

The argument that could be made is that this merely shifts a chunk from one budget line to another. Though this is partially true, it is important to note that this would mean that paying the doctor is no longer a reason for health insurance companies to inflate premiums, and it would also mean that education would be paid for on time, rather than with interest.

2. Medical schools should accept more students. A lot more.

The quantity of new doctors entering the labor market in the US is generally fixed. The AAMC accredits 131 medical schools in the nation, and class sizes don't vary that much. In any other labor market, the high salary of the profession would attract more people to pursue that profession. With a fixed barrier to entry, the effect is that the salary stays high – but doctors work exhaustively long hours, with paradoxically limited time to spend with each patient. With more doctors entering the labor force, we will see their hours return to a manageable amount, patients will have more time with them, and their pay will come back down to earth.

3. End agricultural subsidies, tax fossil fuels.

When doctors refer to "preventative care," they tend to refer to early detection and evaluating patient risk for illness. Generally, it refers to things that occur in the doctor's office, with little mention of what the patient does outside. What effect, however, is nutritional counselling with a doctor once a year going to have in comparison to the fact that every day in grocery stores naturally produced foods can cost more than twice as much as their artificially produced equivalents. Somehow in our national discussion of health care, we've completely neglected the incentives that individuals have to eat artificially manufactured foods and avoid exercise.

When the nation subsidizes corn production, it means that foods whose calories come largely from HFCS are cheaper for consumers, and they have incentive to put themselves at risk for conditions such as diabetes. When livestock with a heavy ecological footprint such as cattle are also associated with heart disease risk when consumed heavily, internalizing the cost of the heavy foot print incentivizes both a healthier eater and healthier planet. Likewise, any time one chooses to bike to the store instead of drive, they do the same service to themselves and their environment, which returns the favor with cleaner air and reduced lung cancer risk.

In short, preventative care that works and is actually incentivized.

It should be reiterated that there are very important reforms already included in the health care bill, such as disallowing rescissions and ensuring coverage for pre-existing conditions. These provisions should be made law immediately. I offer these in addition merely as things to consider when it seems like our only options have been dashed by the Coakleys and Liebermans of the world.

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