Ramblemuse Touch Points

The November/December issue of the journal Health Affairs covers the topic of Will Employer Coverage Endure? There’s further discussion that health coverage isn’t the same as the traditional concept of insurance in the Health Affairs Blog. The California Healthcare Foundation has also provided free access links to several of the articles from their page on the journal issue.

Apart from the Health Affairs issue, in an interview for Catallarchy, economist Arnold Kling provides a provocative discussion in which he notes that healthcare “insurance” is more insulation than insurance. Kling also notes the adverse effects gatekeepers can produce in furthering their own interests. Writing for Harvard Business Schools’ newsletter Working Knowledge, Michael Porter advocates that improving the healthcare system requires changing to a finer-grained level of competition for specific services rather than all-inclusive packages. Writing for the New Yorker, Malcolm Gladwell writes about the Moral-Hazard Myth and those not covered. Also for the New Yorker, Atul Gawande writes about funding medical care as Piecework.

Related to healthcare costs and consumer choice, I’ve been blogging about turf wars and professional association ethics on The Massage Politics Sheet. Much of this has been motivated for me by extensive lobbying by the California Chiropractice Association (CCA) to eliminate passive stretching from the massage profession’s scope of practice. Such a move would virtually eliminate Thai Massage and decimate a lot of other massage work. There’s a lot more discussion and background on this in posts just below the one linked above.

In general, it’s going to take public pressure to educate such associations that they don’t own particular sections of healthcare turf—that the turf they keep trying to claim is, instead, publicly owned. Public awareness is needed to create clarity that the various professions have simply been given a nonexclusive right of practice. Both British Columbia and Ontario reorganized their healthcare systems in the 1990’s to make the nonexclusive right of practice principle very explicit. Part of this process was in defining the concept of shared scopes of practice and in moving restricted/controlled acts from individual profession laws into relatively short centrailized lists. Even without a complete reorganization in the U.S., public awareness and pressure can “help” state legislatures to recognize implicit public ownership of scopes of practice and put an end to the restricted choices and increased costs resulting from turf battles.