<== Site of the Week for 2009-08-10 ==>

American Academy of Home Care Physicians

I learned about today's site of the week in a response to a blog post about health care options.

This review starts with a political rant that expands on my blog post. It then introduces the site of the week (skip rant).

The political rant is my personal opinions and is not reflective of the ideas of the site, or of the good work done by the people in the AAHCP.

The Health Care Issue

As politicians wrangle over who should own our health insurance pools (The left believes that the pools should be owned by government and financed with deficit spending. The Right believes that the pools should be owned by big insurance firms headed by greedy billionaires), people seem to have missed the point.

Pretty much all of our disenchantment with the current medical system lie with the fact that we are paying for health care through pools rather than people buying direct from the doctor.

While writing programs for the actuarial analysis of computer claims, I realized that the very model of insurance is wrong. Insurance is based on an analysis of a population. A better system would be one built around the life cycle of the individual ... such as a medical savings and loan.

The insurance industry positions the insurance pool as the buyer of health care. The medical savings and loan simply assures that individuals have the resources to buy health care throughout the natural life cycle of a human life.

The politics of health care really yanks my chain. If you jumped back in time a half century; you would find that this system of big insurance companies that the left claims to despise was a creation of the left. The government of the day created large tax breaks to subsidize the insurance companies in order to give pooled insurance a competitive edge over direct payment of health care costs.

When President Obama rails against the inefficiencies of the insurance industry he is railing against a creation of progressives past. The current debate is not about the free market v. socialized medicine. It is a debate about which progressive alternative is less evil: big insurance companies or big government.

How the Issue Affects Us

One of the primary example of the way that pooled insurance affects was the discontinuation of the practice of house calls.

It used to be standard practice for doctors to visit sick patients in the patients' home. This is especially true of the elderly who have a harder time getting about. A big advantage of the practice is that it does not subject the patient to vectors in the home. It also lets the doctor see the patient's living conditions. Often one can improve the lot of a patient by seeing and improving their living conditions.

The house call disappared with the rise of employer based health care.

Pooled insurance takes the individual out of the health care equation. Marketers in the insurance industry and big medicine will define healthcare as a product (a commodity) that will be administered to the population.

A primary goal of the pooled health care paradigm is that health care must be regulated. Regulation means that there is a standardized program that is delivered to all patients.

To created regulated care, one needs to create a standardized environment for delivering care. That means the elimination of irregularities like the house call.

The system of house calls is rife with irregularities. The distance people live from the ddoctor is irregular. Even worse, house calls make for strange interactions between physician and patient.

Imagine a person who likes to combine his annual check up with a game of golf. This patient might schedule a house call at the golf course. They might even play a round while talking up health.

If the patient is paying for this care; then it is fine and wonderful. Who knows a doctor might rationalize that it is better to see patients while the patient is engaged in physical activity and try to sell products involving a golf outing, a hike in the woods or a workout at the gym.

This type of irregularity might be fun and wonderful in a free market.

Pooled insurance needs standardization and regulation. House calls are an inherently irregular activity that is difficult for the group decision aperatus to control. Hence the pooled insurance mechanism eliminated it.

American Academy of Home Care Physicians

The American Academy of Home Care Physicians (AAHCP) is a group of physicians sees value in the home visit (especially for the elderly). The site 1-800 Call Doc is a home health care physician service in San Diego.

I do not know the political affiliation of the group or its members. A robust professional society would accommodate people of different ideological bents. I imagine that many of the members of group find loud mouth Libertarians like me quite annoying.

AAHCP has a team of lobbyist in Washington working to write home care into the reform bill. The lobbyists argue that, if propperly administered, home care could help reduce costs.

Having worked on the claims adjusting side of insurance, I think the idea is really untenable. Care needs to be regulated and homogenized to fit in a group pool package.

The way the free market works is that people build their resources and spend those resources as they see fit. Pooled systems of health care operated within a group think framework. In such groups lobbies form to influence the deciders in the halls of power about which activities should be allowed by the group.

I believe that house calls could be a valuable part of a system. I wish the group well in their lobbying efforts.