Yet another health care blog post

Let's not be stupid.
Writing good public policy is hard. Practicing medicine is hard. Developing, testing, and delivering medical treatments - medications, surgery, rehabilitative services, and myriad other therapies - is is hard. Paying for medical services is hard. (How much is my health worth? To me? To someone else?)
As with most hard things at the macro level, whatever solution we implement will work very well for a few, pretty well for me, and horribly for another few. It's not a bell curve, where a decreasingly small percentage of people who do very well or very poorly become insignificant. For those on the very-poorly end of the scale, for example, while their numbers are few, the impact can be devastating. Thalidomide, for example, was and remains a useful treatment for leprosy and certain cancers, even as the horrors of birth defects that it caused remain a permanent part of our memory.
As individuals, in consultation with our doctors, we all have to wrestle with notions of acceptable risk, probable outcomes, and watchful-waiting. I recently discontinued a medication that worked pretty well but that the long-term side effects could be deadly. (Recent court filings indicated that the pharmaceutical company lied about the medication's side effects.)
We've been members of the Fallon Community Health Plan and receiving care through the Fallon Clinic for nearly 30 years. We've received superb care from professionals who know their stuff and from an insurance plan that lets the professionals do their stuff. The Fallon plan was one of the earliest and certainly one of the best examples of what health maintenance organizations (HMOs) are supposed to be.
I can also guarantee that anyone reading this will have first- or second-hand stories about how Fallon has failed to deliver adequate care.  Expand that a bit and the number of horror stories about HMOs increases exponentially. Having a bad insurance plan, in some ways, is worse than having none. With a bad plan, as in any other bad relationship, you keep hoping that you'll get something good and that expectation drags you through misery that you would never otherwise tolerate.
So, the policy implications of all this are what? Well, it goes back to one of the basics of engineering: Fast, cheap, good - pick two.
While we're making our choices, here are some links to thoughts of some others on the broad topic of health care:

• From the Congressional Budget Office Director's blog -
  

  Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.
  

• Inventor Dean Kamen observes:
  
  

  Each side of this debate has created the boogieman and monsters, like "We don't want let this program to come into existence because that will mean rationing." Well, I hate to tell you the news but as soon as medicine started being able to do incredible things that are very expensive, we started rationing. The reason 100 years ago everyone could afford their healthcare is because healthcare was a doctor giving you some elixir and telling you you'll be fine. And if it was a cold you would be fine. And if it turns out it was consumption; it was tuberculosis; it was lung cancer—you could still sit there. He'd give you some sympathy, and you'd die. Either way, it's pretty cheap. We now live in a world where technology has triumphed, in many ways, over death. The problem with that is that it's enormously expensive. And big pharmaceutical giants and big medical products companies have stopped working on stuff that could be extraordinary because they know they won't be reimbursed, according to the common standards. We're not only rationing today; we're rationing our future.

• Psychologist Gene M. Heyman reports, in his book, “Addiction: a Disorder of Choice”, that most drug addicts stop “using” without the help of treatment.
  
• Lee at Pink Granite invites us to imagine what we want our health care to be like.