Health care

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(Host) Health care issues seem an unmovable morass to commentator Allen Gilbert. And now there’s a plan to implant radio chips under our skin to try to help out.

(Gilbert) I’m looking at three different articles about health care. Taken together, they make me feel — well, confused and squeamish.

The first article is about Fletcher Allen’s continuing financial problems. Expenditures are ahead of revenues. The hospital is short of cash. It needs to treat more patients and to perform more procedures. Build the Renaissance Project, and the patients will come, the thinking seems to be.

The second article is about Dartmouth Hitchcock. A program there tries to get patients involved in their own health care. Patients use computers to learn about illnesses. They provide data to help the hospital track which treatments work and which don’t. They watch videos about the surgeries that they think will cure, say, their lower back pain. As a result, patients know more when they talk with their doctor. And many of the doctors are paid a salary, rather than earning a fee for service. The end result is fewer expensive procedures — especially procedures of uncertain success.

The third article is about a radio chip that can be implanted in your skin to give doctors access to your medical records. The FDA has just approved its use. A doctor swipes the chip with a scanner. The chip transmits a code. Your complete medical history dances off a computer database.

The first two articles present conflicting views of hospital goals. One hospital aims to sell more services. The other hospital aims to educate the consumer and maybe reduce services. The third article elucidates a remark that George Bush made in one of his debates with John Kerry. Bush said that medical record-keeping is inefficient. Standardized electronic record-keeping is needed to save on health care costs, Bush said. But radio chips embedded in your skin? The loss of privacy is staggering.

What is going on with health care? We’re all complaining about it, but efforts to change it seem to be flying in all sorts of directions.

A good deal of the problem is because health care is tied to employment. It’s a ridiculous notion, when you think about it. Can you imagine your kids’ schooling determined by where you work? Our health care system has a curious history that was shaped by wage controls during World War II. Employers couldn’t raise salaries to attract workers, but they could offer benefits such as health care. So, with little thought about what road we were starting down, health care became tied to employment. Insurance companies moved in to manage the benefit that companies offered. And now we’re in this mess where business can’t afford the benefit that it once was happy to offer, and government is told that things will only get worse if it intervenes.

I know a number of people who think things won’t get better until they get worse. It’s the “crash and burn” theory — a theory that, in the case of health care, could make a lot of us very sick indeed before we do get better.

This is Allen Gilbert.

Allen Gilbert is a former journalist, teacher, and consultant currently serving as executive director of the ACLU of Vermont. He has a longtime interest in public policy issues.

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