Medical care as a commodity, patients as 'episodes of care' ... Part 1
You can't create good health care policy unless you are talking about people.
Medicine, seen as a business proposition, is reduced to the treatment of specific complaints at an isolated time in a person's life.
Need a bypass operation?
If I'm in the business of selling bypass operations I don't care why you need one and I don't care what happens five years down the road. Hospitals work that way. They call it 'episode of care' because that's how they bill for it. Insurance companies pay for 'episodes of care': a hospital stay, a visit to the doctor.
This is the business model of health care: see a problem, sell a treatment. You are dealing with a problem, not a person.
HMOs have helped this situation a tiny bit by looking at health care as caring for members, but a member is not a person because a person's medical history is evaluated in terms of potential liability (see 'pre-existing conditions') and once a person is no longer a member, they are quickly forgotten.
Looking at Health Care as a business is short-sided because the billing cycle is necessarily short.
Looking at Health Care as a business will inevitably result in policy that is designed to serve business.
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Effective health care policy must be based on something called a person and a person lives for a lifetime, not a benefit period.
But Health Care is not just about a bunch of individuals, it is also about populations. without a view of a population, there is no means of discerning epidemics or patterns of risk for chronic illness.
The business model blinds policy makers to both persons and populations.
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The 'health care' debate we are having is misnamed. It is really about the business of co-pays and coverage limits. It is a debate about fine-tuning a deeply flawed approach to medicine: one episode of care at a time, one benefit period to another.
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Is it surprising that Republicans fight tooth and nail for a business approach to medicine? No. The primary goal is the preservation of business model and the profit motive. Fragmented care and limited data resources for studies about efficacy of care and long-term outcomes are the result and if lives are lost, profits are preserved.
