Health care, or wealth care? (Part two)

Let us say that the unthinkable happens, and the United States adopts nationalized health insurance.  What will this mean?  For one thing, everyone will have to see a doctor at least once a year, and probably more often.  Regular check ups are the single best way of reducing health care costs, by catching problems early.  If a person is injured in an accident, at work, at home, commuting, or out partying, all of their expenses will be covered, including physical therapy.  Bankruptcies as a result of medical costs will cease, and case loads in Emergency Rooms will likely decline significantly.

Who needs the most health care?  The elderly.  As the emphasis in medicine shifts to preventative care from catastrophe care, the elderly will receive more care in terms of check-ups, tests, and evaluations.  Exercise and diet, along with social activities, will become medically directed, instead of individually initiated.  Health care will be about health instead of care.  The elderly are likely to gain in importance to the rest of us, because so many activities will be oriented around the them, because it is much easier to keep an elderly person healthy than it is to get them to recover after being seriously ill.

Extreme procedures, which can prolong life for a short time in an elderly person, or for many years in a younger person, will become rare, because few young people need extreme procedures, and we simply cannot afford to provide them to large numbers of people.  Quality of life will become more important than simply keeping a person alive a little longer, when they are unlikely to ever leave the hospital.  The elderly will be less likely to suffer from cross drug reactions, when a doctor monitors all of their care, instead of people being seen only be specialists.  Tests will become less common, as doctors opinions are not contradicted because of costs to an insurance company which threaten its profits.

Because the emphasis will be on preventing catastrophic illness, specialists will be in less demand.  Instead of expending huge amounts of resources to repair damage caused by lifestyle, huge amounts of resources will be spent changing lifestyles.  Most people have accepted that it is cheaper to wear a bicycle helmet than it is to hire a brain surgeon to repair the effects of a head injury.  Regular exercise is much cheaper than open heart surgery.  Preventing diabetes is much cheaper than treating it.

That isn’t the way things are right now because it is more profitable to deal with catastrophe than it is to prevent one.  Great strides are being made in the treatment of various disorders, but little progress has been made in learning how to get people to change their behavior to prevent the disorders in the first place.  If diabetes is becoming a national epidemic, shouldn’t we be focused on changing behaviors rather than accepting  higher disease rates?

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