Healthcare Revisited–Again!

We at Common Sense Medicine know that any healthcare system must pay attention to significant facts in order to work. We also have suggestions to make it work.

Fact 1. Healthcare is both complex and adaptive–it evolves.

Fact 2. Regulating such systems doesn’t work; learned from the fall of communism.

Fact 3. The best way to manage them is with a transparent marketplace, which empowers the consumers.

Fact 4. Consumers have been replaced in our marketplace by 3rd party payers, which destroys the market.

Rebuilding a market based system means empowering consumers, i.e. patients, to make their informed healthcare decisions. This is best done by supporting HSAs; funded, like social security, from employer and employee contributions, with help from government when needed. We like the Unified fund of Singapore where the fund is owned by the individual and can be used for several socially beneficial purposes–healthcare, education, housing, and retirement for starters–and it can be shared within the family. Broadening it in this way broadens the appeal–there is something in it for everybody.

Empowering consumers with this type of funding answers the management part of Antonovsky’s sense of coherence that he saw in healthy people. Another part was understanding, and it is integral to making the informed decisions that work as the invisible hand to guide the marketplace. The lack of transparency in our profit driven market has largely destroyed Adam Smith’s invisible hand that guides the market to continual improvement. If transparency is not there we are at the mercy of profit seeking advertisers and the invisible hand has no effect. The best way to establish transparency and guide informed decisions is through an expanded Public Health Service, challenged to establish communities of people sharing problems where they can listen to and help each other. Such communities would also be an ideal forum for testing interventions such as modifying immunizations to see the effect on autism.

We also recommend a mandatory period of public service following high school with military, service, and work options. This would allow those involved and their families to be eligible for VA benefits, which would be in competition with private hospitals. It would also allow us the opportunity to address the radicalization that so many of our young people are exposed to.

The third leg of Antonovsky’s sense of coherence is meaningfulness. In her book on the subject Emily Esfahani Smith shows its relation to listening to and supporting others, a clear function of the PHS communities.

In our current system the focus is on profiting from our illnesses; no one is looking at how to be healthy. That is a function of the Public Health Service and it needs our support. Long ago a group of private physicians petitioned the mayor of New York to stop a handwashing program, begun by Dr. Sara ‘Jo’ Baker of New York’s Public Health Service in order to cope with cholera and typhoid, because the lack of sick children was hurting their practices. That mentality persists today in the profession and it needs countering.

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*Insurance is designed to pay for the unexpected crisis. Health insurance started that way in the U.S. but gradually, because the companies we work for were paying for it and getting a better tax break, it morphed into paying for it all. That means we have less interest in getting the ounce of prevention than if we were paying for some of those costs. Children we talk to about the dangers of drugs just say they’ll get a brain transplant if they burn theirs out. That’s why we think that Health Savings Accounts should be promoted by the government more; they put the individual back in a position of responsibility in making more choices in their health care. With Health Savings Accounts an ounce of prevention is worth a pound of cure.

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