The majority of insurance plans being sold on the new health care exchanges in New York, Texas, and California, for example, will not offer patients’ access to Memorial Sloan Kettering in Manhattan or MD Anderson Cancer Center in Houston, two top cancer centers, or Cedars-Sinai in Los Angeles, one of the top research and teaching hospitals in the country. This is being broadcast as a defect in the proposed health plan, perhaps Obama's omission or the ACA's fault when, in fact, there is much more--or maybe less--at work here. The effort to control medical care in this country is an effort at cost control, not the delivery of health care. This has been true in Europe, in the writings of Uwe Reinhardt the early health care theoretician and architect, and in the original plans of Hilary's health care failure.
In the U.S. the decision is simple: Health care costs must come down and no group must suffer disproportionately when it does. The motive here is adherence to some economic model and the protection of certain economic groups at the expense of others.This is a matter of faith as deep--and perhaps as unprovable--as the Trinity. The specifics--you can keep your own doctor, you can continue your current insurance plan, you will have no increase in costs despite more people will be covered--are all meaningless. FOX News spends each day finding inconsistencies in the promise and the delivery, in the picture and the reality, of the ACA. All nonsense. The Western leaders have, gradually, all come to the same position on health care (and many other common notions are not far behind.) Health care costs too much. Period. An experiment based upon this theory will follow. Whatever can be done to cut the cost of health care will be done. Salaries of health care workers will drop. Use of health care technology will drop. Medication costs will drop. And when prices arbitrarily drop, providers of the things that have a lower return start making decisions because the costs do not drop. Doctors will become disenchanted with taking night call, nurses will debate swing shifts in favor of more family-friendly work, medications will be less available, technological research will move to areas other than health.
What is happening here is that lawmakers and think tanks, all well isolated from their decisions, have come to some philosophical positions and are going to act upon them. The citizens and their opinions are quite peripheral. Health care will be the lead dog in this country. Other "Good Ideas" will follow. But this first shot is gigantic. It will pull untold amount of information and influence under the government umbrella, profoundly influence the health of its citizens, dramatically curtail research and technology and most importantly place this power in the hands of naive, arrogant, migrant leaders who specifically exclude themselves from the experiment only to move on later to consultancies, professorships and hedge funds leaving the detritus of the experiment behind.
In the U.S. the decision is simple: Health care costs must come down and no group must suffer disproportionately when it does. The motive here is adherence to some economic model and the protection of certain economic groups at the expense of others.This is a matter of faith as deep--and perhaps as unprovable--as the Trinity. The specifics--you can keep your own doctor, you can continue your current insurance plan, you will have no increase in costs despite more people will be covered--are all meaningless. FOX News spends each day finding inconsistencies in the promise and the delivery, in the picture and the reality, of the ACA. All nonsense. The Western leaders have, gradually, all come to the same position on health care (and many other common notions are not far behind.) Health care costs too much. Period. An experiment based upon this theory will follow. Whatever can be done to cut the cost of health care will be done. Salaries of health care workers will drop. Use of health care technology will drop. Medication costs will drop. And when prices arbitrarily drop, providers of the things that have a lower return start making decisions because the costs do not drop. Doctors will become disenchanted with taking night call, nurses will debate swing shifts in favor of more family-friendly work, medications will be less available, technological research will move to areas other than health.
What is happening here is that lawmakers and think tanks, all well isolated from their decisions, have come to some philosophical positions and are going to act upon them. The citizens and their opinions are quite peripheral. Health care will be the lead dog in this country. Other "Good Ideas" will follow. But this first shot is gigantic. It will pull untold amount of information and influence under the government umbrella, profoundly influence the health of its citizens, dramatically curtail research and technology and most importantly place this power in the hands of naive, arrogant, migrant leaders who specifically exclude themselves from the experiment only to move on later to consultancies, professorships and hedge funds leaving the detritus of the experiment behind.
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