Friday, April 17, 2009

FIRESIDE CHAT: Health Care Reform (c)


Besides egalitarian risk-sharing vs. profit-motivated risk-minimizing, a second fundamental issue must be considered in public policy on healthcare financing: the cost of government bureaucracy vs. the cost of private bureaucracy. The preponderance of experience suggests that competition in our capitalist economic system increases efficiency, whereas government administration diminish it. Partly for that reason, the U. S. Postal Service was transformed into a quasi-public corporation (not quite privatized) decades ago, but few would argue that its efficiency has been increased, given the sustained rise in postal prices at rates exceeding inflation.

With the above considerations in mind, I prefer hybrid healthcare delivery and financing systems, drawing upon private and public funds and regulated to conform with reasonable public policy objectives. More important, this seems to be the preference of the Obama Administration. Intrinsic to accepting a continued role for private-pay/private-insurance models in healthcare is the question of how to reconcile the goals of public policy vs. business where they conflict (which is not everywhere).

One example of the need to reconcile conflicting interests is: if health insurers can seek information about potential subscribers as a basis for deciding whether and at what price to insure them, how can patients’ privacy be protected? In our digital age, clearly, obstacles exist. Such obstacles, however, do not diminish the need to formulate policy, just as defining your property rights is important even though robberies constitute inevitable obstacles to assuring your rights. If a physician learns that you are infected with HIV, for example, is he or she obligated to maintain your privacy, even though you might obtain inexpensive medical insurance if the information is suppressed? Is the physician obligated to private insurers, or to the public? Is he/she obligated to report the information to public health authorities to protect other members of the public against transmission of your HIV infection? What is the physician’s obligation to a fetus, or to public coffers, when the HIV-infected individual is a pregnant female, or her husband or her mate?

I don’t pretend to know the answers to these questions. I do seek to impart the complexity of issues relating to healthcare and healthcare reform. As efficiencies increase, as by digitizing medical records and archiving them for future use as needed, these and other complexities will increase.

Copyright © 2009 by The Center for Health Risk Assessment and Management, a Division of RAM TRAC Corporation