Conservative Theology

Fixing Healthcare

JB

First of all, let me say that, while I agree that there are some terrible problems with American healthcare, it is nowhere near as broken as the demagogues claim.  However, I agree with the idea that we, as Americans, should work to increase access to health care.

However, I totally disagree that the way to do this is through insurance, whether single-payer or otherwise.  Insurance may be part of the problem, but it isn't the whole problem.  In fact, I would argue that a large part of the problem is that we are insuring things that simply shouldn't be insured.

For instance, my homeowner insurance doesn't cover the cost of lights that need replacing.  It covers catastrophic damage.  You know that an insurance policy is broken when you expect to use it.  Insurance only works right when you expect not to use it.  So, I would say that any vision of health care which continues the tradition in which routine doctor visits go through insurance (whether government or private), is about as insane as any vision of home ownership in which you present your State Farm policy to a Home Depot salesperson at the store entrance.

The issue that most people miss is right in front of them -- doctors.  I don't begrudge any doctor the amount of money they make.  What I do begrudge them is the monopoly they have on dispensing medical care.

What needs to happen is to legally separate basic medical care from advanced medical care.  There is no reason in the world why someone should see an M.D. for a runny nose.  None whatsoever.  In fact, I would guess that probably 80% of the medical work could be diagnosed and performed by nurses without any supervision.

The problem is that all medical care is lumped into one bucket.  It is true that a misdiagnossis can be problematic.  But what makes it problematic more than anything is that it comes from a doctor - someone who is supposed to know everything about medicine.  If, instead, we split medical care into two tiers - basic and advanced - it would do several things.

First of all, it would remove the expectation that the person giving basic medical care must be right.  This benefits the patient, since, if things aren't going well, they feel better about seeing someone else.  It also benefits the practitioner, since they are no longer legally assumed to be omniscient.

We need to be comfortable with the idea that there is a difference between giving medical care and practicing medicine.  There should be standard training so that nearly anyone can get the qualifications to give medical care to others.

Let's imagine that we allow all nurses with 5+ years of experience are free to give basic medical care without supervision.  In addition, we cap liability at $40,000 for people who are only giving basic medical care, and also don't require them to carry liability insurance.  This immediately provides a source of care that anyone should be able to afford, and expands the options available to everyone.

Shoot - if given the option, I would choose the nurse over the doctor anyway.  Doctor's forget that they are there to serve the patient, and instead feel the need to impose their own priorities on you.  Nurses are true servants, and are usually a pleasure to work with.  There are certainly many things that need an M.D. which a doctor just can't handle.  But imagine a system in which it was only those situations which got referred to the doctor, and everything else was handled by someone appropriately qualified.

We would have a similar problem in any industry where overqualification was required.  What if we required a degree in geology to be a miner?  What if we required a Ph.D. in computer science to be a network administrator?  What if we required a Ph. D. in biochemistry to mix drinks?  It is easy to see that having overqualified people raises the cost of an industry prohibitively, and prevents access to many.  Why is it that so few people see how that applies to medicine?

In Oklahoma, a nurse makes about $35 per hour.  This is the cost of many co-pays, and that pays for an entire hour of their time.  The average office visit costs about $150 and uses only 15 minutes of time.  Imagine the quality of health care that you would be able to receive for less than you are paying now if nurses get to run their own shows, and weren't liable in the same way that doctors are.

Medicine is not a black art.  It doesn't take an M.D. to give basic care.  It doesn't take an M.D. to know when you need to pass someone onto one (as a point of fact, it is always a nurse that runs triage).  If your goal is to provide a greater amount of access to a greater amount of people, and not just be a control freak, then the best way to accomplish that is to relax government regulations regarding who can deliver health care, and completely remove any mindset that says that using insurance to pay for basic care is normal.