Tuesday, February 17, 2009

Staggering towards health care access ...

There's just a hint these days that Americans are, for the first time in about sixteen years, starting to think about health care semi-seriously ...

Managed Care Matters - Comparative effectiveness - what's left after the sausage-making process

... As the Gooz said;

"Based on the experience of the past few weeks, it's clear the U.S. is still many years away from having a rational discussion about limiting access to technologies that have been priced far beyond a societally-agreed upon benchmark for what constitutes affordable care." ...

The mere fact that anyone mentioned "affordable", even in the context of saying we're year away from a serious discussion, is progress.


I'm so glad you asked. Excuse me while I pull out the soapbox.

There are an infinite number of ways to deliver health care services, but since the dawn of time they have mostly fallen into two large bins

  • Deluxe (luxury)
  • Adequate (spartan)

The word "quality" doesn't come in here. The appearance of luxury might mask lousy quality (think the bad years of American cars). Spartan things can be very high quality (Honda Civic, 1990).

In health care, as with everything else, a new medication, procedure, lab test, or imaging study can be very expensive. There's not that much competition, and there's a lot of development costs that need to be recovered. Five years later the prices are often a lot lower (though modern IP absurdities can keep price high). Development costs have been recovered, the technology may be "obsolete", there's more competition driving prices down, cheaper ways have been found to deliver the service, etc.

Part of what makes care "Deluxe" is the availability of new stuff. A lot of what makes care affordable is avoiding the expensive new stuff. Sometimes the new stuff is really good, so affordable care is inferior care. Sometimes the new stuff is overrated or even harmful, so affordable care is (usually in retrospect), superior care.

Real healthcare access is about making "good enough care" available to every US citizen and taxpayer. Good enough, as in at least 88% of the benefit for 50% of the cost.

Good enough care is not not Deluxe care, it's adequate care. Waiting rooms with peeling plaster instead of plush carpet. Formularies with good-enough drugs. Lacerations repaired by relatively inexpensive family docs rather than plastic surgeons. Care that follows the best affordable standard practices, rather than the preferred practices of a cutting edge surgeon featured in USA Today. (Ironically the "standard" practices usually turn out to be better in every way than the unscientific whims of a single star performer).

So that's what to watch for in discussions of Health Care reform. Any "reform" discussion that doesn't involve delivering "inferior", but good enough care, doesn't really move the ball.

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