Unhealthy system

Another exmaple that shows our current healthcare system doesn't work. Just throw it on the pile with the others.

Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time. So millions of patients are being treated for the wrong disease.

As shocking as that is, the more astonishing fact may be that the rate has not really changed since the 1930's.

This is the richest country in the world — one where one-seventh of the economy is devoted to health care — and yet misdiagnosis is killing thousands of Americans every year.

Under the current medical system, doctors, nurses, lab technicians and hospital executives are not actually paid to come up with the right diagnosis. They are paid to perform tests and to do surgery and to dispense drugs.

There is no bonus for curing someone and no penalty for failing, except when the mistakes rise to the level of malpractice. So even though doctors can have the best intentions, they have little economic incentive to spend time double-checking their instincts, and hospitals have little incentive to give them the tools to do so.

"You get what you pay for," Mark B. McClellan, who runs Medicare and Medicaid, told me. "And we ought to be paying for better quality."

There are some bits of good news here. Dr. McClellan has set up small pay-for-performance programs in Medicare, and a few insurers are also experimenting. But it isn't nearly a big enough push. We just are not using the power of incentives to save lives. For a politician looking to make the often-bloodless debate over health care come alive, this is a huge opportunity.

Now all we need is a leader, someone who cares about the American people and the future of this nation more than his or her own electability. Someone with the guts to take on the monied interests with a stake in protecting a system that just doesn't work.

You know what the solution for this isn't? Pre-tax personal healthcare savings accounts. Because when you're very sick, you're not going to spend time comparison shopping, checking things like cure rates and histories of misdiagnoses. You're going to get yourself in front of a doctor ASAP.

Turning the healthcare industry into a marketplace like that for, say, automobiles, doesn't improve the quality of care. The only point of comparison that would be evident to most people would be price, and, continuing our auto market example, it's certainly possible to go with the more expensive option and still get a dud (right Land Rover?).

Such an environment does nothing to eliminate subpar practitioners. It actually encourages them, because, barring a fuck-up that would cost them their licenses, no matter how poorly they practice, all they'd have to do is lower their prices and business is booming again. Because healthcare spending isn't discretionary. You either need healthcare or you don't. When it comes to healthcare, money is no object -- unless it prevents you from getting the care you need.

For that matter, why even go to a doctor? If you need care and the guy at the questionable-looking clinic in the alley is all you can afford (he insists the only reason he was kicked out of that Caribbean med school was the language barrier), that's probably where you're a-headed.

Making people pay for healthcare costs out of pocket, pretax or not, creates an environment in which the best care is available only to people who can afford it. And isn't that really what this latest idiotic Bush administration proposal is about -- trying to get the poor to buy into a system that benefits the rich and has the opposite effect on them? (I'm always amazed to see a rusty old pickup truck with a "W" sticker on it.) After all, what's the point of being rich if it doesn't separate you from the great unwashed and entitle you to privileges to which "they" have no access? Makes one wonder how news that eight meat packers from Lincoln, Neb., won the Powerball jackpot went over at the Hillcrest Country Club.

Talk about class warfare.