Back to Basics
As you may have guessed, Wonks Anonymous is deeply interested in Health Policy. So much of his concern has been focused on the many abuses of the insurance industry that he has not really had a lot of time to think about how health care ought to be produced and delivered. Well, he has recently found some interesting work on this topic right here in the blogsphere. Dr. Garth Kirkwood, who has commented on some of the posts in this blog, has written a valuable and provocative book on the topic, Equal Health Care for All.
Wonks Anonymous has not finished the book but he can already testify that the ideas outlined in chapter one are worth the read and, in Wonks Anonymous experience, a book with at least one good idea is already above average.
While all of us in the health policy community have been discussing adverse selection and consumer driven plans and so on, Dr. Kirkwood focusses on the most serious problem with our health care system, a problem which will no doubt be with us after the health insurance industry is consigned to the dust bin of history: Good health care, really we should say health promotion, is best produced through and ongoing Doctor/Patient relationship. When we evaluate any health policy we should first consider its impact on that relationship.
Dr. Kirkwood has his ideals for such a relationship which Wonks Anonymous may not entirely agree with - no wonk can ever entirely agree with anyone, it's a pledge that we take at our initiation rites. Wonks Anonymous is sure that he is on the right track.
When Wonks Anonymous taught economics he became thoroughly convinced that real learning never took place on web sites or with videos or through multiple choice tests. The only way he could insure that his students understood was to assign lots of written work, grade it himself and then be available so that students could ask him for help and coaching. He is also convinced that a great part of good health is teaching and learning how to live with our imperfect bodies.
The problem, for our society at least, is that this takes a lot of time, patience and attention from the doctor and the patient. It may involve conflicts and other unpleasant stuff and it is almost entirely unbillable. Wonks Anonymous has yet to find a CPT4 code for convincing a somewhat scared and contentious boomer that he needs to take three days off to get over his cough and does not need an antibiotic.
More on this one later.
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