At What Cost Should You Care About Somebody Else's Health?

I don't usually join in the debate about national issues because I have next to no influence in changing the agenda and am not fully aware of the motives of the major players involved. However, this morning I stopped by the general practitioner's office (my family doctor, if you will) to have a physical exam, including all the regular questioning, prodding and probing that goes with determining my level of health. During the exam, the doctor discussed with me the practical aspects of the proposed national health care plan, part of which he knew personally, having attended regional meetings between medical providers and politicians to hone the details of the plan.

The doctor brought up some points that I'll share with you in case you haven't thought about them:

1. He mentioned that the purpose of the national health care plan is to provide medical cost coverage for all citizens, including the 20-100 million people who are currently uninsured -- his concern is that medical providers are already overwhelmed with the number of insured patients they see so who's going to be able to add the newly-insured patients to their rosters? He recommended that the new plan include subsidizing the education of those in general or internal medicine in order to encourage medical students to get degrees in those fields so that they would graduate with nearly no monetary burden (current medical degree graduates have about $100k in loan obligations, according to my GP).
2. When he found out I was teaching at ITT Tech, he jumped on the chance to tell me he looked forward to having a new crop of technically-savvy students who will address the national health care plan's need to digitize all medical records, including where one- or two-doctor offices have resisted moving to computerized medical record keeping. The GP felt that only when a majority of medical providers combine their records into a medical database can economies of scale truly reduce some of the increasing medical costs (malpractice insurance being an exception he didn't have a solution for), showing where pockets of high cost can be brought down to acceptable national averages and still allow medical providers to make a good profit. He predicted a lot of older physicians will resist and retire rather than join the digital revolution, again lowering the number of medical providers that can see the newly insured.
3. My GP's major concern was where we'll find the money to pay for universal health care. If hundreds of millions of people are moving back and forth from one private insurance plan to another as well as getting on and off the government-backed national insurance plan, where will the extra premiums come from to subsidize coverage for the millions who are currently uninsured without increasing the national debt and thus eventually increasing the national income tax (or taking money away from other national budgetary items)?

In my view, we have it backwards. Instead of private companies individually negotiating with medical insurance providers, getting a broad mix of costs and coverages just because of people's sales/negotiating skills, we should have coalitions of private companies using their collective power to dictate to medical insurance providers what they'll pay for medical insurance, along with lobbying for limits to physician medical malpractice insurance costs. If we open the door on what each company pays for medical insurance, eliminating the issue of competitive advantage, we could turn health care into something more like a universal right rather than a commercial interest.

My GP has good points but I'm betting on a different future. If trends continue, we'll have more and more franchised medical clinics run by physician assistants and nurse practitioners, with doctors in corporate offices assigned to groups of franchisees. The IT department of these franchises will treat medical data just as securely as they treat any other data, like credit card info or sales spreadsheets, commoditizing the data and selling it to data mining companies looking for trend analysis opportunities. Pretty soon, you'll have a universal medical scorecard just like you have a credit scorecard today, which will determine what you can and can't do, depending on your level of health. I can't wait to see when hackers will figure out how to use your medical info for black market sales!

If, when, if... somebody wake me up... I must be having utopian health care dreams again. Back to wrapping up my analysis of "The Ego Tunnel" so I can look at other trends in technological development more dear to my heart (or brain, in this case).