Hillary's Article

[luckyday]

There's a good article on health care today in the NY times by Hillary Clinton. (04/18/04). Go to nytimes.com or buy the paper and read it and post what you think

Title: "Now Can We Talk About Health Care?"

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[Newquagmire]

I like Hillary Clinton as much as the next politically quasi-liberal person, but I thought the entire first half was mundane and should have already been known by anybody willing to begin a seven page article entitled "Now Can We Talk About Health Care?" My problems with the article began somewhere on page four when she began to suggest reforms.

<<Our system rewards clinicians for providing more services but not for keeping patients healthier. The structure of the health care system should shift toward rewarding doctors and health plans that treat patients with their long-term health needs in mind and rewarding patients who make sensible decisions about maintaining their own health.>>

Exactly how would that work? Don't pay doctors for treating patients, but rather pay them five years down the line for having given lifestyle advice? Making insurance premiums lower for suburbanites who are willing to check off the "don't smoke, don't drink" box? Should we also reward women for not having children? Pregnancy, after all, could be construed as a "health risk."

<<Ten years ago, the Internet was used primarily by academics and the military. Now it is possible to imagine all of a person's health files stored securely on a computer file -- test results, lab records, X-rays -- accessible from any doctor's office. It is easy to imagine, yet our medical system is not there.>>

Even in the hands of experienced persons, Internet security leaves something to be wanted. There are people who refuse to send their credit card information online, much less their "test results." Can you imagine the fiasco if the security protocols were compromised?

<<Information technology can also be used to disseminate research. A government study recently documented that it takes 17 years from the time of a new medical discovery to the time clinicians actually incorporate that discovery into their practice at the bedside. Why not 17 seconds?>>

I'm not sure what "medical discovery" means, but if it refers to some sort of basic science research it's entirely unfeasible for this suggestion to work. Would the general public feel more comfortable knowing that FDA drug trial standards had been lowered?

<<In the post 9/11 world, there is one more reason for universal coverage. The anthrax and ricin episodes, and the continuing threat posed by biological, chemical and radiological weapons, should make us painfully aware of the shortcomings of our fragmented system of health care. Can you imagine the aftermath of a bioterrorism attack, with thousands of people flooding emergency rooms and bureaucrats demanding proof of insurance coverage from each and every one? Those without coverage might not see a doctor until after they had infected others.>>

Poor form, Hillary. Although this may be a valid concern, she hardly needs to use scare tactics in the NEW YORK Times (of all newspapers) to convince voters that she is a viable future presedential candidate.

 

[Newquagmire]

bump. it didn't register my post as a new post?!

 

[JohnnyOU]

I like Hillary Clinton as much as the next politically quasi-liberal person, but I thought the entire first half was mundane and should have already been known by anybody willing to begin a seven page article entitled "Now Can We Talk About Health Care?" My problems with the article began somewhere on page four when she began to suggest reforms.

<<Our system rewards clinicians for providing more services but not for keeping patients healthier. The structure of the health care system should shift toward rewarding doctors and health plans that treat patients with their long-term health needs in mind and rewarding patients who make sensible decisions about maintaining their own health.>>

Exactly how would that work? Don't pay doctors for treating patients, but rather pay them five years down the line for having given lifestyle advice? Making insurance premiums lower for suburbanites who are willing to check off the "don't smoke, don't drink" box? Should we also reward women for not having children? Pregnancy, after all, could be construed as a "health risk."

<<Ten years ago, the Internet was used primarily by academics and the military. Now it is possible to imagine all of a person's health files stored securely on a computer file -- test results, lab records, X-rays -- accessible from any doctor's office. It is easy to imagine, yet our medical system is not there.>>

Even in the hands of experienced persons, Internet security leaves something to be wanted. There are people who refuse to send their credit card information online, much less their "test results." Can you imagine the fiasco if the security protocols were compromised?

<<Information technology can also be used to disseminate research. A government study recently documented that it takes 17 years from the time of a new medical discovery to the time clinicians actually incorporate that discovery into their practice at the bedside. Why not 17 seconds?>>

I'm not sure what "medical discovery" means, but if it refers to some sort of basic science research it's entirely unfeasible for this suggestion to work. Would the general public feel more comfortable knowing that FDA drug trial standards had been lowered?

<<In the post 9/11 world, there is one more reason for universal coverage. The anthrax and ricin episodes, and the continuing threat posed by biological, chemical and radiological weapons, should make us painfully aware of the shortcomings of our fragmented system of health care. Can you imagine the aftermath of a bioterrorism attack, with thousands of people flooding emergency rooms and bureaucrats demanding proof of insurance coverage from each and every one? Those without coverage might not see a doctor until after they had infected others.>>

Poor form, Hillary. Although this may be a valid concern, she hardly needs to use scare tactics in the NEW YORK Times (of all newspapers) to convince voters that she is a viable future presedential candidate.

I would have to agree with all your points.
Mrs. Clinton seems to not be listening to her advisors in this article.

"universal coverage" sounds a wee bit like socialism (communism's lil sister) to me.

Johnny

 

[quideam]

I agree with all of your points... also, people presenting to the ER with an emergency - which exposure to bioterrorism certainly qualifies as - will get treated with or without proof of insurance. So her point isn't really as dramatic as she would like.

 

[luckyday]

Quagmire,

Firstly, I think it's interesting that the first thing you mention is the kind of people that would read this article. Of course, it's probably only health care nerds. Unfortunately, I agree with you. That's part of the reason I posted this in the first place, because it is important and more people should pay attention (of course, that's unneccessary because all of the SDN premeds know everything ). I salute Hillary for at the very least using her name recognition to draw a little attention to the issue (her personal interests aside).

As far as the comments equating universal care with socialism, it's true that it is a socialist ideal, but even the most conservative economic classes will teach that socialism is founded on a very humane system of morals. Universal health care doesn't require a Marxist revolution. And if it works better than what is already in place, then so be it. It doesn't matter what it's called.

One thing I have never really understood is why health insurance is provided, more often than not, through an employer. Economically speaking, it doesn't make sense to lock someone into their profession because when they quit, they'll have to change insurance (or go without it). Competition (AKA the foundation of capitalism) relies on people being able to quickly and efficiently reallocate resources (such as labor).

Personally, I'd love to see universal health coverage. As the son of a banker and the stepson of an insurance agent I've learned that banks make their money off of dreams and insurance makes its money off of nightmares. For anyone too lazy to read the article here's one part I hope you'll read:

"The increasing understanding and use of genomics may also undermine the insurance system. Health insurance, like other insurance, exists to protect against unpredictable, costly events. It is based on risk. As genetic information allows us to predict illness with greater certainty, it threatens to turn the most susceptible patients into the most vulnerable. Many of us will become uninsurable, like the two young sisters with a congenital disease I met in Cleveland. Their father went from insurance company to insurance company trying to get coverage, until one insurance agent looked at him and said, 'We don't insure burning houses.' "

Criticisms:
I found Hillary's example of a bioterrorism attack to be a little ridiculous as well. I don't think any health care system in the world would be able to maintain perfect order after a major bioterrorist attack. It's an important concern, but lets be realistic.

Her discussion of technology and lowering costs by harnessing it would be better titled "technology good, paper bad." She really didn't say much. I don't think there is anyone who disputes that computers will ease the information burden on health care workers. What are you suggesting we do about it, Hillary?