Friday, October 25, 2013

The Journey...

There is an old saying, supposedly of Chinese origin that goes:

"The journey of a thousand miles begins with a single step"

There is a lot of wisdom contained in this and also a couple of unspoken assumptions. First the wisdom: The goal may take a lot of time and effort but it will never happen unless you start. The parts that are not mentioned all fall under the category: Just setting out does not guarantee you will succeed. First, you have to go in the right direction. If I set out for Spokane Washington from my home in the Boston area, I had better head West. If I go North or South, each step gets me a little further from my destination. If my destination is London, I had better build a boat. Walking will not get me there.

I got to thinking of all this in conjunction with the complaints we hear from the left that us mean Republicans are undermining the healthcare law and dooming it to failure. That is not the way we see it. Rather we see it as already doomed. We would just like to avoid walking 500 miles in the wrong direction before having to make the inevitable course correction.

I will stipulate that in the broadest sense, our goals are the same: We would all like for the health and well-being of our people to improve and to do so in an efficient manner. We do have quite different ideas about what an "ideal" system would look like though. In general, I think those on the right would like to see more market based systems which have the natural tendency to improve quality and reduce cost but have the drawback of inequality between the quality of care wealthy people and poor people can obtain. The other side, I think does not acknowledge any trade-off between equality of access and efficiency, but if they had to choose one--they would choose equality of access.

Just a final thought: The new healthcare law is intrusive in many ways and certainly will be expensive too. If we could "spend" the intrusiveness in some other way, could we achieve more positive results in some other hypothetical law? What if instead, we had a law which required everyone who is physically able, to walk 30 minutes/day? It could be nice-n-complex with waivers for people who do more vigorous exercise and documentation requirements, plus of course a tax/penalty if you refuse to participate. Does anyone really doubt that this program wouldn't improve overall health and well-being more than the new law*.

*My view is that the ACA will actually harm overall heath since it will make an already inefficient delivery system even more convoluted and inefficient, with the end result that more will be spent on administrative costs and less on actual healthcare delivery.

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