Economic Evaluation in Health Care

Healthcare Economics Evaluation

This report is about a proposed healthcare economics investigation. Some early research has been done and will be described based on what was found and how it was found. The report will conclude with a proposed plan for further economic evaluation on that same topic with a great deal the expected and proper form and function of that research to be described in that section. A conclusion will wrap up the report.

Critical Appraisal of the Evidence

Topic Selected

The author of this report has chosen how to make health care affordable and have the most amount of people possible covered in the United States as this is one of the more omnipresent issues and matters in American society in the modern time. Health care being at the forefront of the American news cycle is nothing new as it is has been a huge part of the political and social discussions since the Great Depression and the pitch went up greatly in the 1960's when Medicare was enacted (Berkowitz, 2008). Healthcare as a "right" and getting people covered is important, but the amount of confusion and straight up demagoguery that is occurring is quite vile and really helps no one ("Protecting childen's right," 2012).

Research Found

There seem to be, at least to the author, two major points-of-view that exist in the American political sphere, both with politicians themselves and with the populace. The first opinion is commonly held by the right wing of American politics (mostly Republicans and Libertarians) that feel that government intrusion and over-regulation of health care is the wrong way to go and should not be happening. They feel that either the market can and should regulate itself and/or they feel that the government intruding into the healthcare sphere is wrong on its face.

The common argument for the former is that the market can do better on its own at all times than if the government intercedes and that the greater the intrusion and footprint the government has, the worse off everyone is. The argument commonly made for latter can be presented using an example. The linchpin of the recent Patient Protection and Affordable Care Act (PPACA), often referred to as "ObamaCare," is that American citizens are compelled by matter of law to get insurance or pay a penalty (Souter & Gurevitz, 2012)("The gloves off," 2012).

Many right-wing voices, including Libertarians, view this oft-referred to "individual mandate" as unconstitutional and thus the entire law must be struck down (Klein, 2012). The Supreme Court of the United States has weighed in on this already but has thus far refused to strike down ObamaCare (Souter & Gurevitz, 2012). The left has generally labeled right-wing politicians who wish to limit growth (or repeal) legislation like ObamaCare and the like as heartless and greedy. Many proponents say the individual mandate is too weak because the fine is not high enough and doesn't discourage people from skipping getting health insurance even when they can afford it and should get it (Souter & Gurevitz, 2012).

The left wing American politics postulates that health care is a right that all Americans are entitled to and any/all government resources (including massive amounts of taxpayer income) should be dedicated to getting people insured through setting up of health care exchanges, expansion of Medicaid and other general assistance and stipends for the poor (Daly, 2012)(Dunn, 2012). The left generally favors expansion (or at least a consistent baseline based on inflation and population growth) of existing programs and often push for tax hikes to fund more initiatives or expansions of existing initiatives. This leads many right-wing people to refer to the left wing as "tax and spend liberals" ("Budget problems," 2012)(Hofer, Abraham & Moscovice, 2011).

There are a few factors and thoughts that greatly fuel the invective on this subject and it often leads to some disgusting banter and public relations initiatives on both sides, both from politicians and non-politicians. A few general examples were touched upon above, but there are many, many more. A specific example would be when House Representative Paul Ryan first proposed his budget framework to revamp Medicare due to projections that it would be completely bankrupt within a generation or two. Not long thereafter, an ad surfaced of a person depicting Paul Ryan pushing a wheelchair-bound woman off a cliff (Ephraim, 2012). Similar accusations have been made against Republicans making accusations against President Obama, up to and including racism (Enck-Wanzer, 2012).

However, politicians simply mudslinging rather than trying to work together given the divided states of Congress right now with the GOP in firm control of the House and the Democrats easily having control over the filibuster and what bills are even brought to the floor in the Senate, there are indeed some pertinent and important questions that should be asked (and answered) if there is truly any desire to get a firm resolution to the healthcare cost and spending problems in the United States (Mayer, 2010).

One of those factors is mentioned at the end of the last paragraph, that being spending. One dimension of spending that has to be address is the spending level of the federal government. Many people are sounding the alarm about spending and deficits with the United States and there is indeed some causes for concern. The total amount of United States debt is going up quite sharply. Second, the United States has run trillion dollar deficits every single year for roughly a half a decade now. Third, the projected annual spending arcs for Medicare, Medicaid and Social Security all look extremely dire given the amount of money that will be required to cover the top-heavy (age demographic-wise) nature of the United States population, with retiring Baby Boomers and the benefits they will require far out-stripping the funds that will be coming in when they are need over the next few decades (Samuelson, 2009).

Another factor that also has to be named, and it also relates to spending, is the terrible choices that a lot of patients make, and they take several different forms. One example is people going to the doctor for the most minor thing for no good reason. Sure, there is reason to be concerned if someone that is very young, very old or that has a compromised immune system getting sick and those people should get strict and detailed attention (Warren, 2012)(Wong et al., 2011). However, an average person in average health should not ever be going to the doctor for a common cold or flu bug unless it gets really nasty including such things as a very high fever, the virus not going away timely or something like that. Similarly, many people go the emergency room for mundane and minor reasons and that is deemed by many to be a bad trend as well (Sun et al., 2010).

One major part of any reform package is increased malpractice lawsuit protections for doctors. Many doctors and healthcare professionals prolifically overuse healthcare tests and procedures so as to avoid lawsuits if something is missed. That needs to stop. Even doctors' groups, and their mission is to "do no harm," admit that testing is far over-done when it is simply not called for. Being sure of a diagnosis and prognosis is fine, but wasting money (especially money from government/taxpayer sources) should not be occurring as it is in finite supply. Even therapy methids and types are overused as well. It is not limited to the simple diagnosis phase of the medical process (Bovbjerg & Schoenbaum, 2004).

The aforementioned poor health choices of many Americans is the "elephant in the room" that many people refuse or are unable to talk about. People that do deign to point out the malfeasance and carelessness of many Americans are often condemned as heartless. However, to suggest that many disorders and diseases are not of the person's own doing or at least simply negligence is simply a fallacy and no amount of politically correct speech, whatever that means to any given person, is going to change that.

One great example is the extensive drug use and smoking of many Americans of all ages. It is undeniable fact that extensive smoking often leads to cancer, organ failure and so forth and the amount of money that goes into keeping these people functional or even just alive is jaw-dropping. This is not to suggest that these people should be forsaken and left to die. Instead, it needs to be recognized that a lot of the people contributing to the rising healthcare costs are people that are creating costs out of their own stupidity and these folks are often many of the same people that cannot or will not pay their own way vis-a-vis healthcare, whether it be by getting a job that gets them covered or at least paying their own bills as they come up. The above doesn't even mention illicit drugs (or illicit drug use) such as illegal prescription drug use or hard drug (heroin, etc.) use (CDC, 2011)(SAPRP, 2013).

Another main dimension of healthcare costs being inflated artificially by bad choices and behaviors is mostly through chronic and/or catastrophic events like heart disease, Type II Diabetes (but not Type I) and other maladies that are sometimes engendered through heredity and other genetic factors but are often the result of protracted and wide-spread bad habits such as lack of exercise, bad diet or a combination of the two.

If the body is abused enough over time, it will eventually start buckling from the abuse and the health care costs skyrocket for that person. People that are poorer and less educated often tend to fall into this group and they often do not have the resources to combat their health problem on their own. As such, taxpayer money and government involvement takes on a lot of the burden. Diabetes alone is costs the country (both taxpayers and the government) a total of $132 billion (FOH, 2013).

A last example of a bad actor in the populace that should be mentioned are people that can afford health coverage but simply refuse (for whatever reason) to purchase it. The two main sources of this decision are a general preference to not spend the money at all and people who feel that health insurance is simply not necessary for them due to their overall health being good. These people are taking a major risk because a single major health issue such as a broken bone or a major disease could wipe them out financially even if they fare well from treatment and recovery (PPN, 2013).

Another piece to the puzzle with this subject is the fact that politicians are using the healthcare topic to cater and pander to their donors and political base rather than focusing on bipartisan solutions that can actually accomplish some good. There is no way that ObamaCare itself would have passed had the Democrats not had control of House, filibuster-proof control of the Senate and the Presidency all at the same time running from early 2009 to early 2011. Until the Republicans gained back the House and a few seats in the Senate during the 2010 mid-terms, Democrats were able to push through basically anything they wanted, with a few constraints. Since then, no budget has been passed through both houses of Congress and really any legislation that is the least bit controversial has been stalled from being voted on at all or only gets through the House or the Senate but not both, for whatever reason.

Even with the bad actors in the populace and with politics, there will eventually come a time where someone will stand up and do the right thing because the public will likely demand it. The cacophony of public ire will grow louder and harder to ignore as the years wear on and the situation further deteriorates. When that time eventually comes, the author of this report strives to concoct a solution or at least help lead to an eventual one. The latter is accepted as a preconceived fate because the author is by no means an expert in this field but the science and methodology can be perfected

How Research was Found

The research for this report was found using EbscoHost and the search results were always narrowed to academic journals. Newspapers, editorials and opinion pieces were avoided, although there is some element of that in a lot of academic research that is political in nature. That being said, academic journals (peer-reviewed ones in particular) are the best source of exhaustive and unbiased (or mostly unbiased) data sets. The methodology and results are much more valid and reliable as there is a scientific method to the research more often than not.

Reliability and validity of the current and consulted research is important. Reliability speaks to whether the same results would come from the same overall method if the research is done over and over again. If not, then the research methodology and/or the materials consulted are flawed. Validity technically speaks to whether the research outcomes can be applied to real-world situations or not. Doing research on economics can be fickle and uneven because economic results and research situations cannot be contrived and created in an artificial environment. As such, all results and theories have to be based on actual outcomes that can be pointed to and analyzed.

Further Research Needed

The author of this report has no illusions that the findings and assertions made within this report, either through others or the author in particular, because that is simply not reasonable or possible given the sheer enormity of the problem and the economic system that feeds said problem. It is certainly true that people can and should get health coverage. However, that does not mean that paying for it will be easy nor does it mean that everyone that technically qualifies for assistance should be using it. It is also not true that people always act and behave properly vis-a-vis their health care coverage and overall handling of their health.

The overall question that has to be answered via further research is how much involvement the government should have in healthcare to accomplish the optimal level of insurance participation and general health habits. That level involvement would include how much regulation should occur, how much spending should occur (which translates to how much the taxpayers of this country will be taxed) and how much of the responsibility will be force-fed upon the public, namely those that clearly drains on the system and/or are generally acting irresponsibly.

Lastly, the research should be based on the premise that no single solution is going to be perfect and some people will always slip through the cracks. Similarly, there are people that are going to unfairly exploit the system and the best way to proceed is to find the solution that benefits the most people, spends a measureable and possible amount of money from taxpayer funds and impresses upon people the idea that they can and should empower themselves to be their own healthcare boss if and when they can and that government handouts are only a last resort, not the first step. It is not a matter of compassion. There is simply not enough money for all the hands that exist and many of the hands that are extended do not or should not need it.

Just as a concise summary, here is a review and some more expansion on the prior words. First, the topic of the research should be a single solution that benefits the most people but does not break the bank or enable bad behavior too much. The method of this review should be both quantitative and qualitative with an emphasis on the former more than the latter because the latter is so subject to demagogic language and other silliness that just muddies the proverbial waters.

The overall perspective will be from the government as that is what is most in question here but the perspectives of the populace as well as private industry and the private health insurance companies should all be included because they are all undoubtedly stakeholders and will (and should) be part of any solution since the taxpayer money in question is coming from all of those parties in some manner or form, whether it be based on corporate income taxes or personal income taxes.

Costs will be measured in terms of patient burdens, revenues and profits for the private insurance forms, how much is taken in and used (or wasted) by government agencies and how much capital all of the above parties really have to burn so that all truly know who has what skin in the game and to what extent. Many focus on the consumers alone but to ignore government largesse getting out of control and the razor-thin profit margins that private health insurers enjoy even in good times would be a mistake, plain and simple.