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Location: Pantego, Texas, United States

Friday, April 11, 2008

I have spent a few weeks in and around hospitals recently. Based on observations I made, there are some problems with the American healthcare system. There is a lot of bureacracy and inefficiency, but in general it does get the job done. I was surprised at the high percentage of personnel who are not native Americans. In the current election healthcare appears to be a major issue. And the rhetoric of the candidates indicates that they want to overhaul the system. The Democrats want socialized medicine, though they may give it some other name. McCain claims to favor market solutions, but like the Democrats he talks about punishing drug companies. All of them talk about reducing costs, with some claims such as Obama's that are ludicrous. All claim to be able to reduce costs without restricting access. In reality that cannot be done. In the socialized systems in Europe and Canada they contain costs by restricting access. I recently had coronary bypass surgery at the time the doctors determined that I had a problem. In England a person my age might be prevented form having the surgery, and certainly would if I were a smoker. In Canada I would have had to wait for a few months.

Restricting access is a common feature of all government run systems. There is some merit in restriction to access, since over 25% of the total expense in the US is spent on people in the last few months of their life. Often, the patient's quality of life as heroic measures are made to keep him alive is poor. The patient himself may not even want the heroic measures to be taken, but usually his family insists on it. How to implement the restriction of access is a challenge that is probably too much for the government bureaucracy. In Hillarycare that was pushed in the early 90's Hillary was going to decide on the rules, which she wanted to be certain were applied to rich and poor alike. (That is fanciful thinking since the rich will always be able to get around the bureaucracy, which I'm sure she knows, but won't admit.) Rules based on age or other clearly identifiable criteria will clearly be arbitrary. Probably there would be constraints on healthcare based on whether or not a person is a smoker or an alcoholic or a drug addict. Age can be problematical since some people are healthy and have a lot of productive life at age 80 so heroic measures may be prudent, while other people are in such poor health generally at age 80 that heroic measures will provide little benefit.

These healthcare issues are difficult, and I have no confidence in politicians effectively solving them. I am certain that the healthcare situation in America is going to get worse, particularly if the government takes over healthcare. The government taking over the development of drugs, as the Presidential candidates seem to advocate, will do nothing for efficiency or safety.

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