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Howard Dean Critiques the Health Care Debate

July 29, 2009

Howard Dean Critiques the Health Care Debate

Dr. Dean (yes, he's an MD) did a session at Fortune Magazine's Brainstormtech last week in Pasadena, and one complaint he has about the current state of political discourse on the health care debate is that the Republicans just aren't being serious (in his opinion). Therefore, he says, the so-called Blue Dog Democrats, more moderate than their Pelosi-led House brethren, are at least keeping Congress honest. Dean says he's happy at least someone is raising the right issues, and of course one of the issues that greatly impacts the constituencies of many Blue Dogs is the Pelosi bill's initiative to "soak the rich" to pay for the increased costs of health care. According to Dr. Dean, this is an initiative that would send our own marginal income tax rates on the top brackets into the stratosphere, where we would be surpassed only by countries like Sweden and Denmark. (The top marginal rates proposed by Pelosi are greater than 50%! What are they thinking?)

Dean thinks information technology will actually bring costs down in health care, over the long run, but in the short run any adjustment to a new system or payment technology is likely to be very costly and painful. He had a very interesting formulation for IT installations, which I will repeat here:

Howard Dean's Law of IT Installations: Whatever is promised, it will take twice as long, cost twice as much, and you'll have to do it twice.

One of Dean's key points was that we need to end the "fee for service" model of health care. Paying doctors only for the particular services rendered encourages them to perform services that aren't really necessary. (DP aside: Of course, that is the very definition of the word "professional." Doctors make more the longer you remain ill, just like lawyers make more the longer you remain in court. We call them "professionals" because despite this conflict of interest they are honor-bound to act in their clients' own best interests. But I digress...)

Dean said British doctors, who are salaried in that country by the National Health Service, actually earn more than American doctors today, and I found this fact quite surprising. I never would have suspected it. However, having lived in the UK for a number of years myself, I can state confidently that the NHS is still plagued with its own rampant problems of bureaucratic silliness and delay. Luckily, as an American expatriate, we never had to resort to the NHS for our care.

Despite this drawback (and it's a big drawback!), you still have to admit that if doctors in this country weren't paid for services rendered, but were paid some kind of salary instead, and charged simply with keeping their patients healthy, then we wouldn't have a doctor colluding with a perfectly healthy patient in order to schedule him for very expensive, Medicare-paid MRIs every few weeks, even when they weren't really necessary (see my separate post on the health care breakfast seminar at Brainstormtech that I attended on Friday).

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