Often at the turn of the year, I’m professionally accountable, looking back at last year’s columns and assessing what I did wrong. But in the January edition of this year, we’ll take another kind of backward gaze and try to answer one of the most frequently asked questions when writing about the experience of chronic illness last fall. Have you changed my view on health policy?
That’s a good question. Like the health policy itself, the answer is complex.
As an example of my pre-illness view, consider the column I wrote in 2013. This article, entitled “No Health Insurance,” examines evidence from an Oregon study that tracks the effects of lottery-induced Medicaid expansion and is truly random to the population who had the opportunity to enroll. Brought about.
Results years later showed that access to Medicaid helped people avoid “catastrophic spending” and reduce depression rates. However, this program does not seem to have a significant impact on the physical health of the recipient. This was an counter-intuitive discovery, but it wasn’t necessarily a surprising discovery. From the famous RAND experiments of the 1970s and early 1980s to the recent National Institute of Economic Research papers examining the effects of Indian insurance, the relationship between health insurance spending and physical health is relatively weak.
With these findings in mind, my 2013 self-warning is because trying to provide comprehensive compensation to everyone would encourage excessive spending on unnecessary care. , Warned against health insurance proficiency. Instead, an ideal insurance system covers truly catastrophic costs and helps people avoid bankruptcy and the worst types of psychological stress, but with a large amount of public funding only for health and health. Avoid overtreatment and cost inflation that can occur if you assign.
I was healthy at that time. Two years later, I started a strange descent. And some of the experience took those pre-illness views — I call them centre-rights and have a libertarian taste — and pushed them to the left.
This was part of my experience of being ill and having no idea what was wrong. That is, I went from doctor to doctor, from expert to expert, and submitted to a test that succeeded in excluding various plausible diagnoses. In fact find out the cause of all my fiery pain.
Over the last few months, I have taken object lessons on the ambiguities contained in terms such as “overtreatment” and “unnecessary care.” Given my final diagnosis, all of these visits were a form of overtreatment.IveryWhat I had, I didn’t know, was a tick-borne disease. But here I took a tilting table test, had a CT scan and endoscopy, and ran a big tab on the New York Times insurance policy tests and procedures, but what directly or immediately to my health? I didn’t.
But from my point of view as a patient, my illness was serious and needed treatment, and there was no way to know which specialists helped and which tests or scans helped. So it was all reasonable and necessary. It revealed what was really happening. Also, I act as a discerning consumer and a good capitalist, and I’m not in a position to make price comparisons among various neurologists and cardiologists while my legs are burned and my chest is burning. did. Instead, as a patient, I was so vulnerable and desperate that I could do nothing but devote myself to the mercy of the medical system.
So my desperate self reaffirms the limitations of the patient’s libertarian vision as a cost-sensitive consumer and what makes healthcare unique in the burden that the welfare state is trying to reduce. I got it. Also, an Oregon study found that Medicaid spending clearly seemed to be achieved, not only that, but also stable mental health in worried situations, and the importance of insurance for greater peace of mind. I also got a deeper understanding of. Your body may be devastated, but so is your finances.
But then there are complex factors. It was part of my experience and turned me into a more right wing. After getting a rough idea of what’s wrong with me in the second stage of the illness and how the problem treats it, I immediately have little formal medical consensus to offer to me. I entered the world. I found real help and real hope only outside of that consensus among Lyme disease doctors who lacked CDC or FDA permission to approach treatment.
And this experience has made me more liberal in many ways and skeptical of not only our own medical bureaucracy, but also our centralized approach to health policy and care.
This was true even though the aid I found was often expensive and it was generally not covered by insurance. Like many patients with chronic Lyme disease, I had to pay in cash. But if you couldn’t trust the CDC to recognize the effectiveness of these treatments, why would I trust a more socialized system to cover them? After all, in a socialized system, cost control follows system-wide rules and guidelines, including the National Institute for Health and Care Technology and the controversial Stillbirth Independent Payment Advisory Board envisioned by Obamacare. Often it depends on the central authority to set. And if you’re looking for a treatment that isn’t approved by official expertise, I don’t expect such authorities to be particularly flexible and open-minded about paying for it.
In fact, the opposite is true given the trade-offs that often appear in health policy. More free market systems not only increase inequality, but more experimentation, but more socialist systems tend to sacrifice some innovation and realize their equal benefits. Therefore, many European countries have cheaper prescription drugs than we do, but drug development is quite costly. Americans spend obscene and seemingly unnecessary amounts on our system. The United States is also producing most of the medical innovation.
And if mysteriously illness makes it possible to better understand the value of equal coverage of health insurance, the incredible discoveries and discoveries of those breakthroughs. We recognized the importance of value and even the incentives to guide researchers on unexpected paths. The value of a rare personality type who becomes a doctor in the first place. (Are American doctors paying more than their peers in developed countries? Maybe. American drugs are enough to attract weird Type A egomania who prefer to go against consensus. Are you happy to have a reward?)
Whatever the daily health insurance coverage for a sick person, treatments for incurable illnesses have been more valuable. Cancer patients need to get more from a single drug that remits the disease than a single payer’s plan to cover 100 other drugs. Or, taking the example from the area of chronic disease, last week researchers provided strong evidence that Epstein-Barr virus causes multiple sclerosis, a disease that was once generally dismissed as a “hysteria” species. I reported. If that discovery someday provides a real cure for MS, it is more valuable to people suffering from the disease than the insurance currently offered by the government.
Therefore, if the weaknesses of libertarian views on health insurance tend to minimize the strange characteristics of the disease, treat patients like consumers, and treat medical insurance too much like other benefits. Libertarians’ weak focus on equalization of costs and compensation is outside the realm of medical care already available The implicit feeling that it is a fixed pie that needs to be carefully divided, not a zone where huge profits await.
Unfortunately, I don’t have the perfect policy system to integrate these insights. The value of solid coverage, the value of decentralization and innovation and experimentation, which does not require much individual patient. What makes health policy so difficult is the very challenge of integrating them.
But if I was skeptical of Obamacare before I got sick, today I’m relatively happy with the anxiety and unfinished location of the 2010 medical care reform.
Ten years ago, if I told me that the clearest legacy of the law was the expansion of its Medicaid, and attempts to build a thriving personal insurance market and curb unnecessary spending were not very successful, I would say its architecture. You may have seen the house’a grand ambition and its consequences called failure.
But today, I am more thankful for the reassuring simplicity of the basic Medicaid Guarantee, and more skepticism about the patient’s desire as a consumer to support the replacement of Obamacare. And I’m a little more thankful for all the American-style bloat and unnecessary spending that Obama’s technocrats wanted to get rid of from the system, but rarely did.
Don’t get me wrong. If there is an easy way to bring a scalpel to a hospital monopoly and its benefits, I will still do it. We would accept if you could provide us with a blueprint to extend the Means test at Medicare and fund our new research program with the savings. Congratulations if you have provided me with a plan to reduce the cost of prescription drugs by reducing the regulatory burden of new therapies.
But once you become part of the American pattern of trying something, absolutely anything to make you feel better, and find the spirit that is essential to your own recovery, the idea of managing health care as a key policy goal is inevitable. It loses some of its appeal, and the American way of spending money seems a bit more defensive.just try it The cost can never be exceeded without counting. However, what looks wasteful in a technocratic ledger can be a lifeline needed by a desperate patient.
Ross Douzat writes a column for The New York Times.
