Wednesday, July 29, 2009

Comments are the Best

One of the reasons I write this blog is because I know how many smart people read it. Kenny K is a way to bring a ton of smart people together to share informed opinions and because I know who reads it, I know they are trustworthy as well. I've shared classrooms at Kellogg and CAL with some, worked in tight quarters under a lot of pressure with others, met some on social networks that I participate in and still more have shared their opinions over dinner or happy hour (less trustworthy :)) over many years. This is what makes the blog special for me and I hope you get the same out of it.

You can imagine my delight when I read Colby's comment on my Healthcare Myth's post, which was originally referred to be my Taylor Meyer. I'll post Colby's thoughts below and she references some great resources. I took many classes with Colby at Kellogg and was always impressed with both her intellectual horse power and her ability to compassionately see the other side of an argument, especially in Healthcare, her passion.

Not to be overlooked in the discussion is my friend Shalon's comments from a few days before. I met Shalon on, a social network that I help run with Ben Munoz. Shalon is an incredibly positive force on AVM Survivors and she is a healthcare services consumer, undergoing precisely the experimental treatment for AVM that might not be available if the healthcare system socializes. Shalon is an inspiration to me and many others, and her comments deserve a lot of thought.

Her are Colby's thoughts:

He has a few accurate points - most notably, as you point out, I definitely agree with him that the US is subsidizing medical innovation for the globe. We'd better be careful about how we mess with the incentives to innovate, because all these smart people will go do something else if no one wants to pay for their research.

However, I do have a problem with people who say that a) our healthcare is expensive because we get more from it, or b) our healthcare system is expensive because of the tort system. We'd like to believe both, but neither are true. We consume more healthcare, but our outcomes are NOT better in the country, and who really wants more drugs, tests or procedures if those things don't create better outcomes? (Not me. Nothing in medicine is riskless.) Also, even combined costs of malpractice litigation and defensive medicine have been shown to be relatively paltry.

You can read McKinsey on exactly where we spend the extra dollars - - but far more interesting is Atul Gawande's diagnosis of WHY we spend those extra dollars, recently published in the New Yorker, which analyzes the most expensive (to Medicare) town in the US, McAllen, Texas, and compares it to El Paso as well as national averages. It's worth reading the whole thing, but here's a summary: fee-for-service payment structure creates some funky incentives for physicians. The bad news is that this is an incredibly de-centralized problem, and current reform plans haven't figured out how to address it, which is why Obama is wandering around the Cleveland Clinic looking for clues.

All of this is totally separate from how to meet the challenge of providing coverage for all Americans, which I personally feel is an imperative for an industrialized nation, although I'm not going to weigh in right now on the touchy subjects of how we should achieve that or how to pay for it. Let's just say I'm obviously still a capitalist, but we can have a capitalist approach to getting everyone health insurance and preventative care.