Here are my thoughts, for what they’re worth…

1) regarding the bankruptcy thing, this is, to me, the most important message to get out there to Joe Sixpack and Jane Winebox: This issue isn’t about yucky poor people that your kids don’t go to school with the children of, or homeless people that you step over on the sidewalk. This issue is about YOU. Or at least the alternative you that falls through a medical trapdoor and suddenly is in an ENTIRELY different demographic, almost a different universe, than you’re in right now. There, but for one slip of medical fate, go I. Or you. Or any of us. I know this is obvious to any of us who can add two and two and get four, but someone needs to connect the dots for the other 95% of the population.

2) regarding health expenditure. I knew that one, but what I don’t yet get is how we can actually SAVE money doing this, other than to either make up future numbers and show a savings relative to them, or semi-nationalize healthcare, which will have a huge distribution impact. I mean, if we create a private option and offer it up without profit, then how can we be sure that 1) it actually is a better option, what with the gubmint involved and all, and 2) the current healthcare and insurance industry doesn’t entirely collapse as a result. I don’t mind them fading out quietly, going the way of the dodo-bird, what have you, but with the economy on a sort of tenuous ground, sudden moves, sudden changes… could be a domino effect of some sort. Just want to watch out for the unintended consequences.

3) No arguments there. With one exception: I find that, with internal medicine, we (as a people, as a culture) need to get out of the habit of prescribing and taking pills for everything. We get into this endless loop:
“Doctor says I need to eat less and exercise more, and quit smoking”
“So what did you say?”
“I said Hell No!”
“So what did he do?”
“He gave me a pill. With my prescription benefit, it’s only $5/month.”

My point here is that we need to utilize health care less, in general, by focusing on preventive care, wellness, etc. Health care utilization isn’t necessarily a good metric. How do we measure how well we’re successfully AVOIDING the Doctor? And then how do we split that out to “because I can’t afford it” and “because I’m effectively staying healthy on my own”? It’s important to measure and rely on outcomes, but we shouldn’t just measure and rely on the ones that are easiest to measure.

4) Let’s not set the bar too low, then, eh? I mean, how will we guarantee that we’re controlling or decreasing costs, and at the same time improving delivery? I’ve never seen a system so bad that we can’t make it a little, or even a lot, worse. Let’s watch out for that too.

He reminds me of you, Drew.