Future of Healthcare
I went to Boskone today and sat in on a panel on the future of healthcare in this country. Seems sort of a boring and banal subject for a science ficiton convention, but then speculative fiction covers a lot of areas. It probably helps that most SF fans that go to these cons are of the baby boomer generation and are all getting a lot older, grayer, and, dare I say it? fatter. So health care is becoming increasingly important to us.
The speaker was a physician who wrote SF and mystery stories, in his copious free time away from his day job as an anesthesiologist in New York. He spent most of the half hour allocated to the talk describing where healthcare was today in this country, as well as devoting a little time to where it is in Canada. He didn't have a lot to say, really, on the topic of where healthcare was going. I think he summed it up by saying he thought we would eventually go to legislated universal coverage where the states would move to force all employers to pay for some health insurance, and where the very poor and unemployed would receive some form of government insurance. I expect he was possibly right on this topic.
The problem is, there are a lot of special interest groups with a lot of money that would have a lot to lose if the situation changed significantly. Certainly doctors would be affected. That's why the AMA is often one of the more vocal special interest groups. The economic situation is that there are a bunch of things doctors do in their work lives that they would cease to be willing to do if compensation were to drop significantly. They would likely leave the profession. If this were to happen, then the market for mid-levels would heat up and nurse practitioners and physicians assistants would be in high demand. After all, they make significantly less money that doctors. Of course, in our practice the mid-levels see fewer patients per hour and don't take any call.
Where would all those mid-levels come from? As it is, one of the reasons it's hard to find RN's these days is that so many of them are becoming nurse practitioners. If we suck even more RN's out of regular nursing, where are we going to find our nurses? Interesting thought. As it stands, I've seen more nursing programs close than open in recent years.
Another special interest group is the nation's major pharma. Here's a group that develops new drugs, then charges a huge premium for them for as many years as they can. They claim that the reason they need to charge so much is because of the costs of research, but if you look at their annual income statements, you can see that as much is spent on marketing as on research. Despite their much ballyhooed costs, they generally manage to piece together double-digit income GROWTH. This is also despite the losses they claim to take in other countries due to price ceilings set by the government. With so much excess profit at stake, they have a lot to lose if the government starts passing legislation to reign them in.
Let me clarify one thing--the people who run these companies aren't in some giant conspiracy to do evil and hurt people. They're no more selfish and venal than anyone else in any other line of work. The current philosopy in business states that the highest duty of a company manager is to maximize shareholder value. That's maximize, not get as much as is reasonable.
So here's a prediction: the government is painting itself in a corner. Within a few years, it will find itself eating away at the special privileges enjoyed by Big Pharma. One of the first to go might be the little loopholes they squeeze extensions of their patents through. That won't seem so bad, will it? The government will suddenly find it's saving money with the loopholes closed. But then the baby boomers will get even older, costs will soar. Eventually, the government will either need to raise taxes or put in price controls. Politicians get money from Pharma, but if the tide turns and the large part of the population demands taxes be kept low by putting in price controls, price controls will be put in place. After all, you won't be given any money at all if you get voted out of office.
More on big Pharma later...
The speaker was a physician who wrote SF and mystery stories, in his copious free time away from his day job as an anesthesiologist in New York. He spent most of the half hour allocated to the talk describing where healthcare was today in this country, as well as devoting a little time to where it is in Canada. He didn't have a lot to say, really, on the topic of where healthcare was going. I think he summed it up by saying he thought we would eventually go to legislated universal coverage where the states would move to force all employers to pay for some health insurance, and where the very poor and unemployed would receive some form of government insurance. I expect he was possibly right on this topic.
The problem is, there are a lot of special interest groups with a lot of money that would have a lot to lose if the situation changed significantly. Certainly doctors would be affected. That's why the AMA is often one of the more vocal special interest groups. The economic situation is that there are a bunch of things doctors do in their work lives that they would cease to be willing to do if compensation were to drop significantly. They would likely leave the profession. If this were to happen, then the market for mid-levels would heat up and nurse practitioners and physicians assistants would be in high demand. After all, they make significantly less money that doctors. Of course, in our practice the mid-levels see fewer patients per hour and don't take any call.
Where would all those mid-levels come from? As it is, one of the reasons it's hard to find RN's these days is that so many of them are becoming nurse practitioners. If we suck even more RN's out of regular nursing, where are we going to find our nurses? Interesting thought. As it stands, I've seen more nursing programs close than open in recent years.
Another special interest group is the nation's major pharma. Here's a group that develops new drugs, then charges a huge premium for them for as many years as they can. They claim that the reason they need to charge so much is because of the costs of research, but if you look at their annual income statements, you can see that as much is spent on marketing as on research. Despite their much ballyhooed costs, they generally manage to piece together double-digit income GROWTH. This is also despite the losses they claim to take in other countries due to price ceilings set by the government. With so much excess profit at stake, they have a lot to lose if the government starts passing legislation to reign them in.
Let me clarify one thing--the people who run these companies aren't in some giant conspiracy to do evil and hurt people. They're no more selfish and venal than anyone else in any other line of work. The current philosopy in business states that the highest duty of a company manager is to maximize shareholder value. That's maximize, not get as much as is reasonable.
So here's a prediction: the government is painting itself in a corner. Within a few years, it will find itself eating away at the special privileges enjoyed by Big Pharma. One of the first to go might be the little loopholes they squeeze extensions of their patents through. That won't seem so bad, will it? The government will suddenly find it's saving money with the loopholes closed. But then the baby boomers will get even older, costs will soar. Eventually, the government will either need to raise taxes or put in price controls. Politicians get money from Pharma, but if the tide turns and the large part of the population demands taxes be kept low by putting in price controls, price controls will be put in place. After all, you won't be given any money at all if you get voted out of office.
More on big Pharma later...
posted by Samuraidoctor | 11:28 PM
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