Tuesday, July 21, 2009

Alan's Soapbox - Health Care

Like the President, I've been thinking about health care reform lately. I haven't been crunching numbers or lobbying congress. Rather I've been thinking about the one of the major problems with the health care system and trying to find an answer. Everyone (according to the spin doctors and the talking heads on the news) thinks universal coverage is the issue. It is part of the issue, as is escalating cost, but it is not the whole issue. It isn't even the most important part. The issue is that the system doesn't keep people healthy. It doesn't matter if you have insurance or not. The system isn't about keeping you well. It is about fixing you when you get sick. Doctors, hospitals, pharmaceutical companies, etc., don't make money if you are well. They don't really make any effort to insure you don't get sick. Keeping you well is not in their best interest and it is not rewarded.

When I was managing a ranch in Wyoming we had a similar problem. We had about a dozen cowboys on staff and they worked cows and fences all over about 80,000 really rough mountainous acres. Most of the work was done using 4wheel drive trucks and ATVs. Originally the ranch provided these vehicles. The cowboys were required to do all the regular maintenance on the vehicles they used, and the ranch provided everything they needed. Not one vehicle lasted the summer. Every single one of them had a major mechanical problem and ended up in the shop for expensive repairs. The maintenance wasn't being done and that caused major problems and expense.
We solved it by fixing or replacing everything, requiring the cowboys to use their own trucks and ATVs (some of the ATVs were given to staff after they were fixed). The ranch paid each staff person a vehicle allowance that covered gas, maintenance, and depreciated the vehicle so they would have enough to buy a new one at the end of its useful life. The staff paid out of pocket for all maintenance and repairs. All the work got done and only one vehicle ended up out of service and that was an accident, not a maintenance problem.

Maybe if the doctors and hospitals were paid a monthly fee to keep people healthy and had to eat the cost (or most of the cost) of any preventable illness we would have a better system. Insurance would still be needed to cover catastrophic things, but it would be much less expensive. People could by coverage for non health things like plastic surgery. Maybe focusing on caring for health rather than fixing sick people would be a step in the right direction.
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