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Thursday, November 11, 2004

For an excellent review of the health care problems we face in this country see Critical Condition: How Health Care Became Big Business--and Bad Medicine by Donald Bartlett and James Steele. Those who blindly speak of what a wonderful system we have should wonder why the life expectancy in this country is going down and is lower than in many other countries where they have some kind of single payer plan like Canada, Japan, Greece, France, Germany, etc.

The authors suggest the problems lie in changes that were made in the 80's under Reagan when an attempt was made to bring costs under control by applying market principles. The problem with that is health care is different than buying and selling widgets. In most businesses you achieve profitability by selling more stuff; a good medical system should not rely on selling more treatments, rather preventing their necessity. Just-in-time inventory principles that work well with car parts are not good at keeping essential surgical supplies on hand when one does not know when they will be needed. When they are it is essential they be in the inventory.

In a market based system doctors are rewarded for the number of procedure's they do, not for keeping patients from needing those procedures or how healthy someone stays. Specialists are rewarded more generously and the family practitioner is becoming a rarity who doesn't make much money in any case. Should it be necessary for parents and friends to have bake sales and fund raisers to finance care for a very sick child. We, as a society, are going to have to decide whether medicine should be a profit center or a Samaritan effort.
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