What Is the Government’s Role in US Health Care? - HBS Working Knowledge - Harvard Business School
 https://hbswk.hbs.edu/item/what-is-the-governments-role-in-u-s-healthcare
--------
The Comment Stream from this 2007 article is 66 comments. Apparently, comments have been closed by the site and/or author ofthis article from a 2019 perspective as relating a 12-year gap between dated article and usage of this important article's content.
I am providing a sampling of relevant 2019 sampling of comments from this article to be provided to @Gruwup readers and listeners of spoken voice text narrative audio presentations.
Name
one thing the government does well, nay efficiently and effectively.
Privatized healthcare encourages competition carriers, acts as a
watchdog over unnecessary or overly inflated claims, and maintains the
quality of care. Entrusting the federal government to administer our nation's healthcare would mean slower claim handling, more bureaucracy, and greater abuses of the system.
- HAKAN HILLERSTROM
- OWNER, ADVISORY BUSINESS
Everywhere in the developed world, the problem of (too) high health care costs is tackled in the wrong way. We have to get people to take more responsibility themselves and over time make them healthier (not just physically) and thereby become less sick.
This will be the solution; and if you think it is too simplistic, just wait for a couple of companies that are now being created that will tackle this huge problem. In about 10 years time we will start to see the first real results of these efforts.
The
cost of healthcare will be a problem that will increase in multiples
unless something is done that is radically different from what we are
doing now. The cost of healthcare is rising faster than inflation,
new costly procedures are being discovered daily, and the present system
of the health care practitioners investing in the equipment to give
these tests are all pushing costs higher.
Increased taxes
would solve the problem but could put a damper on the economy. Business
is having an increasingly tougher time competing with countries that
have subsidized healthcare (automotive companies), so business is not
the answer. The individual cannot afford much more healthcare cost
without a cut in their standard of living. Multiply this with the
demographic increase caused by the 'baby-boomers' and we have a crisis
that standard methods will not solve.
For our industries, government, and individuals to survive this healthcare crisis, a radically new approach has to be looked at.
This will most likely be a combination of all the above participants
with the 'suffering' (excuse the pun) spread to all. Certain high-cost
infirmities may have to be subsidized, for want of a better term, with
government and industry helping the people with these high-cost medical
problems.
This is, without doubt, a problem that only gets worse as the population ages.
The tough part will be determining what to do and then doing it.
Considering politics, lobbies, interest groups, and our increasing life
spans, I do not know if we have the will to take on this enormous task.
- PAUL T. JACKSON
- INFORMATION CONSULTANT, TRESCOTT RESEARCH
First
I would like to say that government involvement in health care is the
problem. When the major company that helps the drug companies is also
contracted by the government to run the Medicare drug program, there is a
conflict of interest and should not be allowed. Any subsidies add to
the cost of everything.
Why do drug companies
do so much advertising to the public, who are not doctors? Why do drug
companies draft legislation? Why do drug companies and doctors fight
natural remedies and want to make natural herbs into regulated drugs?
Why do some insurance companies still not allow payment for chiropractic
or naturopathic services? Why does Medicare cover eye surgeries but not
hearing? It appears we have an industry that does not want us to be well at any cost.
Our buy more, eat more, eat bigger sandwiches culture may be driving people to be sick, but the medical institutions are making us worried to sickness.
Education is not necessary to the extent that people who don't have
insurance to pay for things tend to do better health wise ... but the corporations, the government, and the health profession don't do studies on those healthy people. They keep telling us all our poor uninsured people are desperately sick and need insurance when perhaps they don't.
One honest doctor told
me that, of the male population that gets prostate cancer, only 3% die
from it, and with all the testing that we've been conned into taking, it
hasn't improved (decreased) that figure in over 10 years. So what is
going on? We are being conned into testing and other procedures that don't change the problem or are unnecessary, or just give the medical and drug companies something to do that they don't need to do, but get tax money to do.
Several books now cover the problem of worrying about health that can actually make us sick, and
I believe that's what the medical industry (drug companies, insurance
companies, and the medical profession) wants us to be ... a sick nation ... asking the government for help in their endeavors, not the people's.
The
only thing the government should be involved with is controlling the
drug, insurance, and medical industry advertising spending, which would
bring down the costs of healthcare considerably.
Many
of the commenters here have touched on different facets of the problems
facing the healthcare industry, all of which are valid points; but they
have so far ignored a central fact. The healthcare industry is fundamentally unlike other industries. Its stock in trade is in alleviating the sickness and suffering of human beings. It, therefore, comes freighted with a host of fundamental moral, ethical and emotional issues that simply don't exist for other industries.
One
commenter says that virtually no one is denied emergent care, without
following that up by stating that this is because hospitals are legally
required to provide that care, and that cost, therefore, becomes a
secondary consideration in that case.
Another commenter suggests
that the economic burden of caring for the aging members of our
population is becoming too large for the system to handle. True enough,
but following that sort of logic, the most economically efficient solution would be to euthanize people once they reach retirement age. Or perhaps simply store them somewhere handy until we can bring our new Soylent Green manufacturing facilities online.
Another
commenter brought up the issue of the many illnesses that are the
result of poor lifestyle choices to which the US population is
increasingly prone--things like diabetes, high blood pressure, heart
disease, lung cancer. Yes, people with these illnesses should have taken better care of themselves. And if that 70-year old diabetic is our mother?
What do we suggest then? That she diet and exercise, but not receive
any other treatment, because it's costing us too much? That it's OK for
her to lose a foot to gangrene because she should have known better?
What do we do when our own child is diagnosed with leukemia? Say,
"Sorry, kid, worse luck, but you're destroying the efficiencies of the
system?" rather than do everything in our power, insisting on any
treatment, if it would keep the child with you for one more year, one
more month, one more day?
Purely economic models will never supply a complete solution to the problems addressing the US healthcare industry because they do not and cannot address these issues.
- CHARLES CARROLL
- CONSULTANT, INDEPENDENT
You
can't legislate reality. There are only so many people who are both
talented enough and willing to spend their youths becoming proficient in
the more complex health treatment disciplines. If not expressed in
dollars, access to them will be expressed in time or access.
Amazingly,
I had a Canadian acquaintance who lost both parents while they waited
for treatments my own parents and parents-in-law (middle class, all)
received in days and weeks. I am not nor am I related to any doctors or
surgeons.
The U.K.'s National Health Service nears
receivership and so the powers-that-be determine that some conditions
will NOT be treated or some people placed outside eligibility for
treatment. Also, not having health insurance is NOT the same as not having access to healthcare.
What is the proper role for national government?
1. To protect against outright fraud through organizations like the FDA and prosecutors.
2.
To encourage mechanisms for prudent (read "catastrophic" and
"continuous, significant") health care situations. I realize it is not
the same but I believe it is analogous to automobile warranties which do
NOT cover air filters, wiper blades, brake shoes, etc. endemic.
3. To foster research into prevention and cures/treatments.
4. To provide education (in public primary and early-secondary schools) concerning health maintenance (wellness) and nutrition.
5. To provide tax relief to healthcare providers/institutions for providing life-saving (immediate) services to indigents at the same time as auditing against fraud.
6.
For providing a legal basis for voluntary healthcare savings accounts
without unrestricted, mandated coverage subsequent to the onset of major
life-threatening conditions.
HOWARD DOKUA-SMITH- PATIENTS HEALTH SYSTEMS
The Ultimate Socialized Medicine For America:
1.
Everyone (citizens, legal aliens, illegal aliens, visitors, employees
of U.S. multinational companies) will get FREE healthcare coverage.
2.
The healthcare providers (physicians, dentists, hospitals,
chiropractors, acupuncturists, faith healers, training schools for these
professionals) get their money from the government.
3. The cost
is deducted from everyone (billionaires, millionaires, employers, the
middle class, the working poor, and a percentage of our foreign aid.
4. It opens the door for more healthcare providers.
5. These providers get paid standard salaries (they won't like that) from the government.
6. No incentives for them; therefore the quality of practice is mediocre.
7. They cannot be sued so they are happy.
8. If you want private care, you pay the difference and you see a private doctor.
9.
Item 3 will be a percentage increase on taxes and also a percentage on
everything that we buy. Since everything that we buy (food, clothes, drinks, smokes--cigar, cigarette, marijuana--[
black market transactions of other "drug use" that actually, against
popular opinion and misinformation campaigns do not cause "addiction" ]
cars, personal care, house cleaning chemicals can make us sick.
10. We will be a happier nation.
- This is where this disenfranchised citizen MUST MAKE A POINT OF
- OBJECTION... being the pansy of a system of hate and victimized by the
- HIV/AIDS hate dysfunctional paradigm interface of social
- services region to region. This is not just indirect involvements, but direct
- and relevant involvements of the directors and upper tier leadership of these
- non-profit government-funded agencies.
- [ see: http://ryan-white-care-act.fuckeduphuman.net ]
- A real blow account backed by documented real-time event happenstance
- evidence of blow on point deliverance of truth about the hate of received
- retaliation for thinking out of the box" of solutions and discussions.
- That has now once again been once again detached from doctor care
- provider care access to healthcare [ Detached: Doctor Nancy Madigner,
- The University Of Colorado Denver, Detached: Colorado Health Network aka
- Denver Colorado Aids Project, Detached: Rocky Mountain Cares Denver
- Colorado, Detached: Doctore Zane, County Of San Bernardino Public
- Health Department Primary HIV Care, Detached: Doctor Christopher Eric
- Berger ( Through of Dr. Zane's Office ), Detached: Doctor Mirza,
- County of San Bernardino, Department Of Behavior Health,
- Detached: Foothill Aids Project San Bernardino, Detached: Doctor
- Shigeno Borrego Health San Bernardino because of special interest,
- conflict of interest, bias against change, hidden agendas of both lower
- level staff, as well as upper tier leadership that overrule rational common
- sense behaviors of these involve persons of this dysfunctional interface.
- These interfaced persons of staff and leadership act as untouchables to their
- insane actions and thinking processes rather than allowing common sense
- values and business operations standards to rule.
Referenced Reading:
----
A Wild View Of Substance Drug Addictions,
After
the disastrous misconceptions of the 20th century, we're returning to
the idea that drugs are an ordinary part of life experience and no more
cause addiction than do other behaviors. This is rational and welcome. -------
What is on planet earth as a model to follow?
. -------
02 MAR 2007WHAT DO YOU THINK?What Is the Government’s Role in US Health Care?by Jim HeskettHealthcare
will grab ever more headlines in the U.S. in the coming months, says
Jim Heskett. Any service that is on track to consume 40 percent of the
gross national product of the world's largest economy by the year 2050
will be hard to ignore. But are we addressing healthcare cost issues
with the creativity they deserve? What do you think? Summing UpThis
month's exchange of ideas regarding U.S. healthcare reform ranged far
and wide. Some of us were interested primarily in the issue of cost
escalation and how to contain it. Others addressed issues of quality.
For still others, it was a matter of inequality of treatment. If this is
a microcosm of current concerns and suggested solutions, does it bode
well for the formation of a consensus, political or otherwise, leading
to progress? But a number of respondents raised the question of whether
the most feasible solution may lie primarily in the free market, with
perhaps some help from government. Suggestions
of causes of the current challenge of rapidly rising costs in relation
to quality of outcomes, at least by the imperfect measure of life
expectancy, included waste in the system (Julie Maire, Edward Hare, and
Jack Flanagan) as well as fraud (Kate McClelland), risk avoidance on the
part of physicians, a litigious society, and inadequate protection from
it for physicians (Rowland Freeman), "defensive" medicine leading to
unnecessary tests and treatments, an insurance system that is costly and
inadequate for those who really need it (Amar Sahay and David Albert
Newman), the high cost of new technology, artificial restrictions on the
supply of drugs (Sergey Mirkiin) and healthcare providers (David Stahl
and Michael Robbins), the size and complexity of the problem itself
(James Sullivan), government involvement (Paul Jackson), and uninformed
or unnecessarily needy consumers (Hakan Hillerstrom). In
addition to these issues, Elizabeth Benbrooks reminds us that
(healthcare) "comes freighted with a host of fundamental moral, ethical,
and emotional issues that simply don't exist for other industries."
Perhaps this is why Hakeem Yesufu asserted, "I am an ardent free-market
capitalist who realizes capitalism has no place in healthcare
provision." But Tery Tennant asks what is perhaps the ultimate
philosophical question: "… when did an individual's medical needs become
an inalienable right that the government has to insure?" A
number of responses suggested various free market mechanisms for
addressing these issues. Where to start? Paul Jackson suggests that "The
only thing the government should be involved with is controlling the
drug, insurance, and medical industry advertising spending which would
bring down costs." On the other hand, Wayne Baldwin argued that
"Containing costs will come at the expense of something … technological
advances, profit, access to certain services, and patient choice are
likely candidates …." One line of thinking would make both talent and
drugs more competitive. Sergey Merkin asks, "Why not open the country to
foreign medications?" In citing the need for more doctors and nurses,
David Stahl comments that "it could be a way to help open immigration in
this country." Michael Robbins adds, "Healthcare has been a closed
guild." David Othmer cited "the maze of regulations that keep, for
example, nurses from using all their skills" in providing basic
healthcare. And Hakan Hillerstrom implied that consumer education and
choice may be an important response to many of these challenges. In
spite of the issues' complexity, Richard Fallis offered the observation
that "Reform is coming … because Wal-Mart and GM want it." He thinks it
could come in the form of a "Two Percent Solution" in which everyone
would pay 2 percent of their income to be held by the Government for
their healthcare, with "competition … maintained through private
providers" and the bills of those unable to contribute paid by the
Government. Keith Butler believes that it could come in the form of a
two-tiered system of private treatment at personal expense layered on a
service free to all with protections for healthcare givers and the
elimination of third party insurance. Are these the free market answers
we've been waiting for? What do you think? Original ArticleHealthcare
will grab more and more headlines in the U.S. in the coming months. Any
service that is on track to consume 40 percent of the gross national
product of the world's largest economy by the year 2050 will be hard to
ignore. Business management already feels the effects of healthcare
costs more acutely than most consumers. Several recent studies and
proposals shed light on the problem and possible solutions. They leave
us with questions, too. To
put things in perspective, U.S. healthcare currently costs about $2
trillion per year. Of this, more than $600 billion (31 percent) is never
seen by recipients. It goes for administration. On a per capita basis,
it is roughly $280 billion more than is spent for administration in the
other twenty-one countries whose life expectancies exceed those in the
U.S., all of whom have some form of taxpayer-financed, single-payer
system, the kind that used to be referred to by detractors as
"socialized medicine." Worse yet, the current system leaves more than 40
million Americans without health insurance. Because many are not
employed or have very low incomes, programs that provide incentives
through employers and tax relief don't help them. With this much room
for possible improvement, the incentives should be sufficient to foster
changes in behavior. A
recent McKinsey study estimates that more than half of the $98 billion
of excess administrative costs it identified goes for insurance company
marketing and underwriting. Its estimate does not include the costs of
sorting out acceptable applicants or denying payments under existing
policies, another substantial amount. And it does not include the costs
that doctors and hospitals incur in denying applications for payment,
often in the form of payments to consultants who specialize in this kind
of responsibility-shifting activity. By contrast, McKinsey estimates
that it would cost "only" $77 billion per year (or about $1,900 per
person) to provide healthcare to all of America's uninsured. If made
available along with consumer education, others have suggested that all
of this amount could be recouped eventually through the elimination of
healthcare expenses incurred by those unable to pay now. Now
comes Robert Frank, a Cornell economist, who has proposed ways of
overcoming opposition to some kind of government- (and therefore
taxpayer-) funded solution to the problem. He has put his finger on the
two main obstacles to major change in the current system, insurance
company opposition and higher taxes. He suggests that insurance
companies, who have acted in good faith to respond to incentives
provided by the market, could be subsidized for their losses while their
managements shift their health insurance strategies, perhaps to provide
only supplemental private coverage. A portion of the $280 billion in
annual savings suggested above could be used for this purpose. He
proposes that the other obstacle, higher taxes, could be overcome
through an effort to educate the public about the long-term economic
benefits of such a move. How his proposal would fare in the face of
previous failures is a real question. Given
their magnitude, failure to solve these problems in the U.S. could have
global economic impact. But are we addressing them with the creativity
they deserve? For example, to combat opposition to a tax increase, could
tax credits for later use (when savings kick in) be issued to
individuals and businesses in the amounts by which their taxes are
increased? To provide universal insurance, could the government provide
vouchers (along with consumer-oriented education) to all uninsured to be
used at their discretion for their own care? In other words, could a
consumer-driven solution be combined with a single-payer system? What
can the U.S. learn from other countries in the delivery of high-quality
healthcare? What is the government's role in U.S. healthcare? What do
you think? To Read More:Robert H. Frank, "A Health Care Plan So Simple, Even Stephen Colbert Couldn't Simplify It," The New York Times, February 18, 2007, p. C3. He is the author of a book, The Economic Naturalist, to be published this spring. McKinsey & Co., "Accounting for the Cost of Health Care in the United States," January 2007. |
|
