In much of the debate over health care, the primary fight has been about ideology. I put in my two cents, and I was more motivated by my son's condition and my contacts with the medical system, bith good and bad, than by a need to be right about my politics. In my trying to understand the issue, Dr. Atul Gawande has always provided a clear non ideological perspective I have come to value.
His latest blog post again asks the question of how to keep cost down, and he does disappoint. His analysis of what happened with the Boston Childern's Hospital Community Asthma Initiative. They started a program to help children stay healthy within their condition. It worked and children visits for asthma have gone down dramatically. Insurance only covered a small part of the program, and its success in keeping children out of the hospital hurts the hospital's bottom line. Less children being hospitalized means less beds being filled. Will the hospital continue to do the right thing and keep children from ending in their beds? Will other hospitals implement similar programs. Economic theory says no as it gives no economic incentive for preventive care like this program.
The question is why not create an incentive to keep us healthier, and reward programs like Community Asthma Initiative? Instead of a program of pay for service, one of pay per program. I think that if we continue to view health care simple as what we do when we get sick, rather than how we live, we will continue to have cost for up