Health Care Reform

The current debate over "health care reform" is actually pretty comical. Most pundits and politicians decry the system as "unsustainable" (true) and that is cannot be defended. We have heard ad nauseam that the United States spends more that any other country (true) with worse results (not so true). The comedy is that this is exactly the system politicians and people want.

In the history of health care delivery in the United States we have utilized exactly one model that worked to contain costs while delivering care....the HMO. And because it worked we immediately set about dismantling it. Texas actually serves as a wonderful case study. We have had one of the highest rates of uninsured for the last....well forever really. However, there was a brief period of time when HMOs began to take hold in Texas and the annual increases in medical costs not only slowed to inflation, they actually were negative. While there was a lag period, the lower costs of medical care resulted in fewer uninsured and the rate began to drop.

The problem is that every dollar in health care spending is someone's income (yes, that includes the health plans that I represent). There are basically two ways to contain costs, either you reduce the unit cost or you reduce the rate of utilization. Both of those avenues take money out of the pocket of....medical providers. And that is not a situation which they will tolerate. So as HMOs gained further footing the medical providers in Texas (docs and hospitals) mounted a massive campaign to dismantle HMOs and they were largely successful. Since that time, medical costs have basically been on a steady upward climb.

We had a model that worked. Quality was the same as or better under HMOs as it was under the fee-for-service system. The cost, however, was far less. We voted for a system that was more expensive, less efficient, delivers worse care, and is unsustainable. So where is the comdey you ask? Well, the solution that many in DC are now proposing- the same people, mind you, that railed against HMOs- is to create a giant government run HMO. Somehow the voters will find this far more acceptable because the government will be running it despite that fact that the health plan they currently operate, Medicare, has $35 trillion (yes, trillion) in unfunded liabilities and they have zero idea how to address that problem outside some laughable savings numbers that will supposedly be achieved through adoption of electronic medical records and rooting out "waste." Truly pathetic.

Many would suggest we just adopt the system that works in other countries...say France. I'd content that we don't have to look that far. If the idea is just to find a location where health care is cheap and replicate it, we can just do what South Dakota does. In all seriousness, the solution will be a difficult one but it frustrates me to hear people suggest that the private sector has tried and failed to deliver health care effectively. The truth is that the private sector did it effectively, that interfered with the monopoly rent system enjoyed by providers who petitioned the overnment to intervene on their behalf, the government did so, and now we complain that the private sector has somehow failed. It didn't, it was made to fail.

Back Again

Another extended break. This time due to sheer laziness. Oh, we also had to go into special session in the Legislature, but that was kind of a formality. It went about as smoothly as possible.

Working in and around the Texas Legislature has done crazy things to the way I view the passage of time. The Legislature meets 140 days every two years. My first session was the 76th (1999) which is widely regarded as the best legislative session ever, in any state, any country, anything. That was the year W was running for President and the entire session was just one big party. I still cringe thinking back to how stupid and naive I was. Anyway, I now measure the passage of time by legislative sessions and it is difficult for me to conceive of a work environment that doesn't have the massive swings in intensity.

During the session, I am generally at work by 7AM and I rarely am finished before 9PM and towards the end of session it usually 1 or 2 in the morning before I'm done. It's incredibly intense and the prospect of elected officials, many or most of whom have little knowledge or interest in your area, deciding your fate is nerve wracking. But like I said, it's difficult for me to conceive of work any other way now. At the same time, now that session is over I come and go as I please and have the opportunity to take significant time off to travel.

I'm not sure this really has a point. What got me thinking about was some friends of ours who wanted to have dinner and they wanted to have dinner at....6PM!!! I asked the Tamerwife what kind of crazy people eat at 6PM? We generally eat dinner at 830 or 9PM. She informed me, much to my surprise, that we are the outliers in this case. That got me to thinking about the messed up way I now view the passage of time.