Alright, I'll bite...kind of. Here are some of my general thoughts on the topic...
All the politicians are off base and none of the proposed solutions will have any impact on the core problem of health care (stick with me for a min.). Obamacare was half-baked and we don't need another half-baked solution.
First, we need to be clear on the difference between health care and health coverage/insurance; they aren't the same thing and the terms should not be used interchangeably. Health care refers to the actual services provided to a person. Health coverage /insurance refers to the medical insurance used to pay for a portion or, in some cases, all of the services provided.
What are our politicians really trying to solve for - health care or health coverage? So, far it appears to be health coverage. To me, that's not the issue.
The primary issue is whether people receive the care they need, when they need it. Secondarily, is the issue of managing the continued increases to the cost of care. Every proposal so far, including Obamacare, suggests the solution to is to provide everyone with health coverage. I disagree completely and it certainly does nothing to solve the rising costs of care. And, despite not having coverage, millions of Americans still receive health care services when they seek it out (uncompensated care).
This is an incredibly complex issue, so there is not a short, simple answer. That said, to be truly effective, any solution needs to address and result in changes to behaviors and expectations of consumers, providers, payers, and the government. So, consider the following when viewing proposals:
1. Consumers: Americans are insulated from the direct costs of care. We don't ask, as we do with other goods and services, if the extra benefit of service justifies the cost. This leads to increased cost and utilization.
In addition, rather than take responsibility for maintaining their physical condition, people generally assume the medial system will cure any health problems that arise. Expectations are often unrealistic regarding the medical system’s ability to repair damage that has occurred over time and/or as a result of abuse (lifestyle choices). Bottom line: Americans typically expect no expense will be spared to remedy their problem.
2. Providers: Physicians play a key role in deciding what medical resources are used. Because of the threat of malpractice suits and the desire to use new technology, doctors can often be pushed in the direction of doing more than providing only the necessary and effective care.
In addition, despite an increase in the supply of doctors, the distribution of doctors from one part of the country to another remains uneven. Although the supply of many specialties is far greater than needed, particularly in urban areas, the supply remains inadequate to meet needs in other areas. Little has been done to address this.
3. Payers: By simply paying the bills, payers (usually insurance companies…but not always) encourage consumers to use the system in an inefficient way, with little regard or understanding of costs. Consumers have little incentive to examine cost-effectiveness or quality of care. Traditional insurance has also directed its payment system to the treatment of disease rather than prevention or early intervention. While there has been some movement on this issue by plans over the past several years, the tendency to emphasize care for illness over prevention results in both increased costs and reliance on health care.
4. Government: Government action contributes to, rather than helps, the cost problem. The legal environment in this country has led to the practice of defensive medicine. The threat of a lawsuit encourages doctors to provide more services than they would if they did not fear being sued for malpractice. This results in higher provider fees and premium costs.
Where the federal government could take a leadership role is in defining common data collection formats. Failure to do so has led to inconsistency, as individual states establish state-specific requirements that are often not comparable to those of other states. This leads to data deficiencies that often limit the analysis of the cost-effectiveness of accepted, new, and emerging technologies and standards of practice.
A couple more considerations to the cost equation:
New technologies: Generally speaking, medical devices today do not provide dramatic potential for curing or preventing a major category of disease. Instead, as shiny and sophisticated as they may be, they tend to only marginally improve the ability to treat disease. Obviously, a number of technologies are beneficial in improving patient welfare by reducing pain and risk but more often these are diagnostic technologies that enhance the ability to identify medical problems but don't add greatly to the ability to improve a patient’s health.
And the elephant in the room:
Demographics: The population of the U.S. is aging rapidly. The age group growing most rapidly is senior citizens 85 years and older. This group makes greater use of the health care system than any other age groups. In addition, because of chronic or debilitating diseases related to aging, their care often includes more high-cost services, rehabilitation, and/or care and medication use over a long period of time. These demographic increases in chronic care groups have placed a greater demand on the health care system. The demand, of course, is followed by an increase in the supply of services that, in turn, leads to increased costs. This topic is not popular to discuss, especially for politicians. However, it's an important part of the equation that needs to be discussed as part of any proposed solution.
As mentioned, none of the proposals I've seen discussed address the issues above nor will they help reduce health care costs. Rather they will serve to exacerbate them.
One of the more interesting concepts I read proposed providing tax incentive back to consumers for the purchase of private policies and eliminating employer offered plans altogether. I'll see if I can track down a link or two.