Blogging the Right Thing: Quit Treating Snakebites

This is Huckabee’s chapter in Do the Right Thing is on Health Care which he’d hoped to make a major focus of the campaign, but found his efforts were stymied by game show hosts debate moderators who kept questions on health care out in favor of what interested them.

Huckabee writes, “Frankly, it never occurred to me that any American family was sitting around their dinner table having a discussion about whether the next President might consider a pardon for Scooter Libby. But I was dead certain that most families were talking about the runaway costs of their health care expenses.”

Huckabee took flak from some libertarians for a statement that Congress would solve the problem if they were told either to give th American people the Health Care Congress has or to accept the type of health insurance many Americans had. Huckabee was not calling for government control of health care, only point to the fact that Washington was insulated from dealing with the health care system.

The Huckabees were not. When leaving the Governor’s Mansion, Huckabee had to purchase more expensive insurance policy that increased when his wife took a leave of absence from her job with the Red Cross and had to be added. His daughter faced $12,000 in medical bills over a relatively minor procedure.

Huckabee gets to a point that many Libertarians will nod their head at. Access isn’t the problem. First of all, the 47 million uninsured cited by Democrats, only 15 million are truly unable to afford health insurance or the bills that will follow.

Huckabee argues the problem is systemic and finds the Democrats’ solution of adding more people problematic in light of what he sees as the underlying problem. Huckabee writes, “simply giving an unhealthy population access to our current health care system and not addressing the underlying crisis only makes problems worse. Our current system is upside down, built entirely on the notion that we should interven when catastrophic illness hits, rather than aim to prevent illnesses in the first place.”

 Huckabee is vitally concerned with chronic disease which is rattling our healthcare system. Chronic disease is generally caused by activities such as overeating, smoking, or lack of excercise.  Huckabee finds prevention to be key.

He’s clear that he doesn’t think government’s role is to lay down harsh rules, to the “sugar sheriff” or the “grease police.”  But that there needs to be fundamental culture changes beginning with the way doctors are trained (for example lack of training in treating diabetes as well as a focus on prevention.

Huckabee throws innovative ideas out. Huckabee’s own efforts to offer incentives to health and provide greater opportunities for state employees to excercise (by offering mid-day excercise breaks) and creating a points system that allowed employees to earn points for losing weight, taking walks, and not smoking in order to earn personal leave time.

Huckabee had the policies evaluated by outside company that found the polices led to $3400 per  year in extra productivity from the employees who took part in them.

Huckabee explains why real solutions to health care don’t really happen politically. Most politicians want to focus on things they can get fixed within their term of office, and health care isn’t one of them. Democrats promise health care plans that create programs as if a program is going to fix the problem. Real solutions require more innovation and more than just government.

Huckabee has often mused as to why health insurance companies don’t cover preventive measures. In Doing the Right Thing, he explains the reason as told him by Insurance Company Presidents. With people changing jobs so often and changing insurance companies every time they switch jobs, it doesn’t make sense for insurance companies to cover prevention because the benefits of prevention will be reaped by another insurance company. Huckabee says that it’s time to move away from the employer based policy to a consumer-driven one.

Huckabee writes, ” Think about it: we don’t expect our employer to ensure our cars or homes, so why should employers insure our bodies. If we bought the insurance and were likely to keep the same carrier as we transitioned to other employers, the carriers would then have a clear incentive to take extraordinary measures to keep us healthy.”

Chapter 11 is incredibly outside the box and it brings a very interesting perspective to the health care debate.

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Huck's Wrong answer on SCHIP vs real outside-the-box thinking

I realized when he gave that answer in favor of tripling S-CHIP funding, the same answer as the Democrats in Congress, that he would be a big govt Republican. That plan would give subsidies to people who make up to $80,000 a year.

The fact is that preventative medicine is one of those oft-touted things that alas doesnt actually pay for itself in many cases. Like Obama's 'inflate your tires' tout, its one of those common-sense things that is already done to a large extent to the degree that it makes sense, and an public policy push to do more wont yield great return-on-investment.

That said, there are certainly things we should do to refactor health care that go beyond the simplistic spend-more/spend-less dichotomy.

The REAL thing that is missing are two agenda points: 1) CHOICE  and 2) LOWER-COST HEALTH CARE.

They are related. Put more choice and more direct consumer information, including price information, into the health care system. Give people choice and focus less on trying to insure everyone and more on getting BASIC COSTS DOWN and we would have a 'rising tide of improvement' in health care. As noted, the attempt to insure everyone is a chasing-butterflies activity, it doesnt go after the real issue. The real issue is affordability and the cost tradeoff that gets people off, combined with our unhealthy connection of health insurance and employment, which hurts the unemployed and self-employed alike in this area. We need to get to the point of enabling cost-effective self-direct health insurance. That includes health savings accounts but is more than that.

Cost improvement can be done with: More online health records; require posting of all prices publicly; allow for more bare-bones health insurance and end insurance mandates; allow imported drugs; relax, in ways that dont undermine safety, medical practitioner rules, eg, can we get qualified nurses to prescribe limited set of drugs so you dont need a doctors visit for your kids ear infection? A nurse can figure that out well enough, turning a $150/visit into a $40 one. And put our $40 billion NHI budget and focus more on technology for cost reduction, eg consider what we could do in microsurgery so that hospital stays are briefer, etc.

I think such thinking is quite a bit more outside the box.

OTOH, I do give credit to Huck for focussing on an issue that is a concern for many Americans. The GOP needs a good agenda on this.



"Choice" is a false choice

This  "choice" thing in healthcare is mostly bogus. For example, if you get sick with something that requires repeat outpatient treatement, and if you are blue collar or middle class and you get cancer, you need to have the health center that is nearest to you to be able and willing to treat you - a "choice" to go so some other center on the other side of town/county/state is, for 99% of working people, just not useful/helpful/interesting becasue of the logistics.

Read about what is going on in the UK. Tony Blair for years tried to cover up for failures to make real improvements in the NHS by waffling on about "improved patient choice". Finally everyone got sick of it and said "we don't won't choice. we want a decent hospital and outpatient clinic in our area, and that is the end of the story".

It is like fire departments. do you want a "choice" of fire departments? or do you want your local fire department to respond when called. ditto police.