I LIKE IT WHEN YOU TALK ABOUT HEALTH CURR, HEALTH CURR

Since my last rant didn't cover the majority of what requires ranting, i.e. I was bitching like a chump without proposing solutions, I shall quickly make amends with a more constructive health care rant.

Health Care

I'm not sure that health care is a "right." Do we have a responsibility to look out for our fellow citizens? Fuck yes. But when you think of it as a right, I think you introduce problems. Let's say I invest a billion dollars and discover a treatment that completely cures a specific cancer, does everyone with that cancer now have the right to receive that treatment? Am I obligated to freely provide it? Did you have a right to that medicine/treatment before I invented it? It certainly demotivates me to invest capital in advancing medicine if I'm going to have take further losses in administering the treatments.

I'm not suggesting that we treat medicine simply as any other product or service, because medicine IS different. I am morally obligated to pay taxes to help children with leukemia; I'm not obligated to help buy him a xbox. And it is the duty of the well off to bear the burden of medical costs for those without means. But this gets gray pretty fast, what about adults who are simply too lazy to work? Or should I pay for heart bypasses for slobs who eat McDonalds everyday?

Ideally, we minimize the amount of medical "charity" and help address what I think the greater health care issue is -- insurance doesn't function to actually make medical costs bearable by the middle class. If you make less than 100k a year and you or someone you love gets cancer,there's a high probability you'll currently be bankrupted regardless of your insurance. The insurance company will pay for a while, eventually list the condition as preexisting, and even if that doesn't happen, you're eating potentially hundreds of thousands in copays. Even for non life threatening conditions, insurance currently sucks. Ever break a bone and get an MRI? It's rare insurance will pay for anything beyond the first one. (Which is pretty weak if you want to get a second to confirm you've healed completely -- that'll cost 2 grand)

Why doesn't insurance pay? That's complicated and I don't have a firm grasp but I believe that their inability to pay is by and large the product of various dynamics inherent to the current medical system which I'll quickly itemize:

1) Insurance companies have the ability to dispute the neccesity of procedures (or underpay) and have used this right to put doctors in a position where doctors overcharge for procedures with the expecation that the insurance company will not pay the whole thing.

2) The above leads to inflated costs for all procedures obviously which in turn decreases the likelihood of payment. (Because the insurance companies cannot afford to pay the inflated prices) Repeat step 1!

3) Medicine is not an efficient free market. There's no good mechanism for price or quality discovery. Every board or rating agency lists every fucking doctor as qualified or awesome. Because of the high amount of subjectivity in practice, patients have generally no clue how much treatments will cost, nor are patients really able to shop around. (Compare finding a primary care doctor to buying a television, WTF)

4) Because doctors cannot differentiate themselves based on their talent very well, insurance companies are forced to turn to generally useless metrics to assess quality of care or determine if prices are reasonable.

5) The closed nature of the market also necessitates overpaying for care. If you have a very rudimentary illness, you do not need the BEST doctor who specializes in shit way more complex, with better information, patients would see the "right" doctor more often.

6) Unrelated to all of this is malpractice, but it is equally the culprit in keeping prices stupidly high. Accidents and mistakes happen and they're unfortunate, but this obsession for punishing negligence simply forces doctors to administer tons of expensive and unnecessary tests which really really inflates the cost of care for everyone. Capping malpractice and improving the legal strength of medical waivers would be a game changer in medical costs. (If you want a million extra tests done, pay out of fucking pocket for them)

Lastly, I'm not sure about private health insurance, and I say this as a cynic of most government run shit as I generally think the private sector does it better, but unless customers have MUCH better information and are able to actually shop their insurance providers (i.e. have insurance actually fucking compete in a real market for customers), it seems untenable as the interests of the management of said insurance companies are so out of line with the interests of doctors or patients. The reforms neccessary to make insurance not suck I think are pretty extensive, but one big improvement would be "generic" contracts. By generic, I mean that the contract is completely identical across all companies, offers identical protections, and can be traded/packaged like any other financial instrument. (Yeah, if the plague hits, these medical CDOs could be the next mortgage crisis ^^) The point is that customers will understand their coverage, understand what their payments will be, legal precedent will be simple and customers won't have to battle insurance companies in courts, generally more efficienty and less corruption.

Anyways, time to get drunk.