Healing the Health Care Cost Conundrum

A prescription for making US health care better quality, more accessible, and less expensive for all of us. 

The military health care system is different in many ways from the civilian system, but a primary difference is the income incentive. Simply put, health care providers and other medical professionals are not paid based on the number of patients that they see or the number of procedures that they do. Instead they receive a fixed salary with few if any bonuses for productivity or quality. The budgets for military health care institutions, and many others in the Federal government, are based on Congressional appropriations, not on productivity. This has been changing in the past decade but remains largely true today.

Civilian medicine is not so. They are paid for what they did, patients seen and procedures done, and everyone on staff is usually highly motivated to do more. Some have described such fee-for-service reimbursement arrangements as “you eat what you kill.” In some practices, that can equate to more visits and more procedures, even if some are not medically required.

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“Haves and have nots” or “Do and do nots?”

have nots

Our acrimonious political debates often center on class struggle, those who “have” against those who “have not.” Perhaps the conflict is really between those who “do”, who contribute to wider society, and those who “do not,” who take without giving. 

The 2012 Presidential Election campaign is in its final weeks, and while one candidate seems to relish contrasting the “haves and have nots”, the other candidate recently implied that the real division is between the “do and do nots.” One group seems to boil with resentment against those who they perceive have more than they do. Another group seems to boil with resentment against those who they perceive do less than they do. Is either narrative accurate? Are both narratives accurate but incomplete? The debate is not limited to candidates or even parties; large swaths of the American population seem to feel the same way. The structure of the human body can shed light on these questions.

The human body

The human body is made of billions of cells, the building blocks of life. The cells are fundamentally the same, including parts such as the nucleus, the cytoplasm, the mitochondria, and the cell membrane. There is also diversity amidst the unity, with cells of hundreds of types and functions, including muscle cells, bone cells, hormone secreting cells, nerve cells, skin cells, fat cells, and many others. They are arrayed in a system of incredible complexity, and work together with precision to accomplish the purposes of the body. The human body is a truly magnificent creation.

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