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Health Care Reform?

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  • Wed, Jul 08, 2009 - 11:21pm

    #1

    anarkst

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    Health Care Reform?

I believe no other institution so clearly reveals the broad dys-function endemic in the American socio-economic system as does health care.  The current round of  “reform” seems to be another pathetic exercise in ‘moving around the deck chairs on the Titanic.’

In my mind (I have been a practicing physician for 30 years), real health care reform can not be attained until there are fundamental changes in the following five areas: 

– Is this a ‘health care system’ or a ‘disease care system?’

– Technology

– Control – Human or Corporate?

– Personal responsibility

– Life, Quality or Duration?

 I could literally write a book on this subject but would be interested in your comments.  

 

  • Thu, Jul 09, 2009 - 01:00am

    #2
    Peak Prosperity Admin

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    Re: Health Care Reform?

Anarkst,

I agree that our industry is a mess, and see little hope that the current discussions regarding "reform" will be of any value.

From my libertarian viewpoint, I think the best solution would be the following:

  1. Eliminate government involvement in the healthcare marketplace (getting rid of Medicaid and Medicare, which serve as the constructs upon which most private insurers base their reimbursements). This would serve to reestablish free market economics in healthcare, which would tend to reduce the costs of many services (especially hospitalizations and invasive procedures), and likely also improve reimbursement for primary care providers.
  2. Encourage a shift from the current model of medical insurance (which, to some degree or another, ignoring co-pays and deductibles, cover most physician visits, hospitalizations, procedures, diagnostic testing, medications, etc.) and toward a combination of catastrophic medical insurance (for truly unexpected illness and injuries) and health savings accounts to which contributions and withdrawals are directed by the patient. This would encourage individuals to use their healthcare dollars wisely, and to be more accountable for their own health, such as by adopting a healthier lifestyle. To use automobile insurance in comparison, we purchase said insurance to cover auto accidents and the like, but not to cover routine maintenance such as fuel, oil changes, tune-ups, etc.

Such changes would foster personal responsibility for one’s health, encourage competition, and therefore reduced costs, among healthcare providers, and promote greater awareness of the costs of healthcare among both patients and providers. In a fully socialized system, rationing of healthcare is inevitable, as resources finite and costs are seemingly infinite. In a patient-directed, free market system, such decisions would be made by the involved patients and their healthcare providers, not by bureaucrats at the state and/or federal level.

By the way, this is essentially how medical care was financed until early in the last century. For those unable to pay for care to treat a life-threatening condition, hospitals and doctors provided care for free, or at drastically reduced costs, and/or families and communities helped support those of their members who were less fortunate. Government then intervened, in the form of "safety nets" like Medicare and Medicaid, and of regulations imposed on small business to provide medical insurance for their employers, and we eventually ended up with the system we have now. Along with a sense of entitlement to healthcare, loss of personal responsibility, an undermined sense of valuation of our families and communities, and skyrocketing costs. We need to turn this clock way back!

  • Thu, Jul 09, 2009 - 01:08am

    #3
    Peak Prosperity Admin

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    Re: Health Care Reform?

Doc Peters:
HUZZAH!

Amazing how things worked just fine before Government involvement.
Then things get worse, and the solution is… oddly enough… more government involvement.

To quote one of the most misunderstood and most abused political figures in history:
"More government is not the solution, and more often than not, it’s the problem."
-Sarah Palin

The government is going to break all our backs under the burden of the welfare state.

Aaron

  • Thu, Jul 09, 2009 - 01:22am

    #4
    Peak Prosperity Admin

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    Re: Health Care Reform?

Hi anarkst,
 
 
With regards to this topic, here’s an excerpt from a blurb I wrote to a forum where the issue of healthcare reform was being discussed.  I’m not going to take the time to edit it but you get the gyst.  The bold text is an edition for this forum.  Sorry this is a run-on paragraph.  I couldn’t break this text into the paragraphs that were in the original (I’m a self admitted computer idiot).
 
 
"With regards to your statements about writing members of Congress, it’d be nice if that worked.  However, if you look at this present economic crisis and the bailout situation, the mail against the bailout ran 100:1 against.  Congress ignored their constituents and capitulated to the powers that be.  If we had any real leadership in Congress, they would vote themselves a 10% pay cut as a symbolic gesture to show their solidarity and support of the hard times most of their constituents are experiencing.  They haven’t.  They would downgrade their healthcare benefits to the level of those experienced by the average Medicare recipient.  They haven’t.  They would vote for a graduated pension system whereby they would not receive a full pension until having put in far more than just one term, just like the retirement plans most of their constituents have.  They haven’t.  They are in it for the money and power, pure and simple.  And except for a few exceptions like Ron Paul, they are corrupt and serving their own interests over their constituent’s interests.
 
 
As for our executive branch, I’m not very optimistic about the outcomes there either.  We are no longer a democratic republic.  We have become an executive socialist plutocracy.  And quite frankly, it doesn’t matter which party is in power.  An one individual so accurately put it, "There isn’t a Republican Party, there isn’t a Democratic party, there’s just one one party … the party of Money".  The two party system where you appear to have a choice and where there is constant friction and conflict between the two parties is part of  "a divide and conquer" strategy that’s been in place for a long, long time (read about the Banker’s Manifesto of 1892 for just one example).
 
 
As for healthcare being a right, I have a hard time with that proposition.  Is that because it is essential for our well being.  Well, to survive economically in the modern world, a telephone is pretty essential.  Should that be a right?  So is an automobile.  So is good nutrition.  Does that mean we have government programs paying for phones, automobiles, food and nutritional supplements, etc?  Healthcare is certainly something we want to have for all but as for it being a right, I think that contention is mistaken.
 
 
Furthermore, health care reform without legal reform is non-sensical.  The average American family pays $10,000 per year in added costs to their goods and services to cover legal liability.  Many of the costs that have encumbered our system, from healthcare to manufacturing, have come about due to legal excesses.  Some of the health care systems that we look at with lower costs also have very different legal systems.  In my career, I’ve talked with health professionals from Canada, Great Britain, Australia, New Zealand, Australia, South Africa, Switzerland, Holland, Germany, France, Italy, Japan, the Scandinavian countries, Iceland, Caribbean nations, Argentina, Chile, etc.  Those who come from countries with more efficient healthcare systems than ours literally laugh at us due to the restrictions of our legal system.
 
 
There’s much talk of the rise in cost of health care.  How many providers, however, have seen these increased costs converted into increased incomes.  Very few I’d wager.  The ones who benefit are the middlemen, the insurance companies.  You have individuals like the former CEO of United Healthcare who received about ONE BILLION dollars in total compensation during his time with the company (before being forced to resign due to questionable activities such as backdating stock option) and received a lump sum of 100 million dollars in stock options.  It’s these individuals who are driving up the cost of health care, far more than any providers, even the scammers.
 
 
The insurance industry and the pharmaceutical industry are two of the most powerful lobbies in the country and they are vested in disease.  If you want to lower health care costs, you start with children in kindergarten, grade school, and high school.  You educate them in nutrition, posture, body mechanics, exercise, and other preventative strategies.  You encourage wholesome foods and make soft drinks, candy, cookies, cake, chips, ice cream, white bread, bologna, and other overly refined and highly processed foods difficulty to access.  You use government propaganda campaigns and spinmeisters to make it uncool to eat this garbage.  You reinstitute physical education classes in schools but make them into something worthwhile rather than opportunities to play basketball, football, and baseball.  You teach posture and movement.  You teach somatic stress management principles so children learn to manage stress rather than having it destroy their health (especially considering that it is conservatively estimated that at least 80% of disease has adverse stress as a significant component).
 
 
Etc., etc.  
 

  • Thu, Jul 09, 2009 - 01:38am

    #5
    Peak Prosperity Admin

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    Re: Health Care Reform?

[quote=ccpetersmd]

Anarkst,

I agree that our industry is a mess, and see little hope that the current discussions regarding "reform" will be of any value.

From my libertarian viewpoint, I think the best solution would be the following:

  1. Eliminate government involvement in the healthcare marketplace (getting rid of Medicaid and Medicare, which serve as the constructs upon which most private insurers base their reimbursements). This would serve to reestablish free market economics in healthcare, which would tend to reduce the costs of many services (especially hospitalizations and invasive procedures), and likely also improve reimbursement for primary care providers.
  2. Encourage a shift from the current model of medical insurance (which, to some degree or another, ignoring co-pays and deductibles, cover most physician visits, hospitalizations, procedures, diagnostic testing, medications, etc.) and toward a combination of catastrophic medical insurance (for truly unexpected illness and injuries) and health savings accounts to which contributions and withdrawals are directed by the patient. This would encourage individuals to use their healthcare dollars wisely, and to be more accountable for their own health, such as by adopting a healthier lifestyle. To use automobile insurance in comparison, we purchase said insurance to cover auto accidents and the like, but not to cover routine maintenance such as fuel, oil changes, tune-ups, etc.

Such changes would foster personal responsibility for one’s health, encourage competition, and therefore reduced costs, among healthcare providers, and promote greater awareness of the costs of healthcare among both patients and providers. In a fully socialized system, rationing of healthcare is inevitable, as resources finite and costs are seemingly infinite. In a patient-directed, free market system, such decisions would be made by the involved patients and their healthcare providers, not by bureaucrats at the state and/or federal level.

By the way, this is essentially how medical care was financed until early in the last century. For those unable to pay for care to treat a life-threatening condition, hospitals and doctors provided care for free, or at drastically reduced costs, and/or families and communities helped support those of their members who were less fortunate. Government then intervened, in the form of "safety nets" like Medicare and Medicaid, and of regulations imposed on small business to provide medical insurance for their employers, and we eventually ended up with the system we have now. Along with a sense of entitlement to healthcare, loss of personal responsibility, an undermined sense of valuation of our families and communities, and skyrocketing costs. We need to turn this clock way back!

[/quote]

Well stated.  I agree wholeheartedly. 

 

  • Thu, Jul 09, 2009 - 01:48am

    #6
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    Re: Health Care Reform?

Hi ao-

That was really hard to read. None the less – here’s my take on present health care:

My experience comes from having a child with a disability living in my home, my 17 yr old niece has been with us for 12 years and all I can say – they are constantly over doctoring her to the point of near insanity. At age 12 they told us if she didn’t have a intensive surgery by breaking her hips (both) and alligning them, moving muscles around her knees to straighten her legs and ro re-constructive surgery on both feet (they opened the heel, spread it out and inplanted bone marrow) – all to help her walk better. Well she could take a few steps before the surgery and walk up and down stairs hanging on the railings. AFTER the surgery – forget it as she can barely stand straight.

Her regular doctors have been good, kind, informative and active in helping make choices regarding regular life issues but some specialty doctors see people in need and go way-over-board.

I wouldn’t be so upset if I though her case was isolated but I have even heard of them telling kids if they don’t get a paricular surgery done – they will never drive . . these kids aren’t going to ever drive anyway.

I think if Obama wants to help out the health care system he’s got a good start by finding out what works – and what doesn’t. . .because my guess is 30% (or more) is wasted time, money and is invasive as all H-;;.

And I could go on for hours about what I think of the health care system in general but who has time these days?

EGP

 

  • Thu, Jul 09, 2009 - 01:52am

    #7
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    Re: Health Care Reform?

oh and one of the things doctors have going for them when dealing with kids with disabilities – usually the parents have some guilt about thier child being disabled, so they can usually talk them into alot of treatments. . . we don’t have that problem since we’re aunt & uncle. EGP

  • Thu, Jul 09, 2009 - 02:29am

    #8
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    Re: Health Care Reform?

[quote=ao]

As for healthcare being a right, I have a hard time with that proposition.  Is that because it is essential for our well being.  Well, to survive economically in the modern world, a telephone is pretty essential.  Should that be a right?  So is an automobile.  So is good nutrition.  Does that mean we have government programs paying for phones, automobiles, food and nutritional supplements, etc?  Healthcare is certainly something we want to have for all but as for it being a right, I think that contention is mistaken.
 

[/quote]

This was my favorite part, and I wholeheartedly agree!

  • Thu, Jul 09, 2009 - 04:11am

    #9
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    Re: Health Care Reform?

ccpetermd:

Your original post was really well taken.  Who can argue with any of that?

ao:

You also raise many interesting points.

If I can address technology, as I believe it to be at the heart of the paradox that confronts all of our institutions.  In general, technology, if we can define it as the forward movement of applied science, is completely relative.  In other words, it will always improve.  If this is the case, then we can never be satisfied, nothing is ever good enough.  We live only for the future, when things will be better, by definition.  Of course, that time will never arrive.  This is problem number one.

Problem number two is that, economically, technology is the method by which economies of scale increase their productivity, and therefore must be employed to that end in order for the system to perpetuate.  Number two implies that number one must be "sold" (or enforced) to people as, essentially, the prevailing philosophy of life.  And it certainly has.

The problem with this scenario is that if you sell technology as "the answer," issues such as responsibility and dependency arise.  And I believe that a great number of people live in denial of their lifestyle choices because they believe technology will bail them out.  Why exercise or eat appropriately when a pill or knife will take care of the problem sometime in the future.  People become intellectually lazy and depend on science (and its controllers) to take care of them.  And you have essentially what you have today, a society of misfits.

Add to this the corruption of our institutions, whereas the balance is horrible skewed, power is used to manipulate and dis-empower, outright fraud and corrupt science is pervasive, and now what do you have?  Well, we have a tremendous mess with layer upon layer of complex dilemmas reaching well beneath the surface of where the public debates are held.

We, as a society, have yet to ask the right questions, yet come up with any answers.  This is an amazing mess.    

  • Thu, Jul 09, 2009 - 05:19am

    #10
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    Re: Health Care Reform?

Wow!

Chris, I think this is the first time I have disagreed with your opinion.

I do not see healthcare as an open "free" market. Healthcare "savings accounts" are just another way insurance companies can give catastrophic coverage at full coverage prices.

There is no such things as patients "shopping around" for the best deal. I will use the following example: If I am having an MI and have crushing chest pain, am I going to look in the phone book to see who is giving the best discount on angioplasty today? No. I am calling the ambulance, then tell them to take me to the best damn heart center they can find and fast! I realize this falls under "catastrophic" and not routine. OK, lets move back a bit form the "panic" scale.

I need knee replacement. It isn’t too pressing, but my practitioner and I agree that I can no longer put it off and knee replacement is the best remedy. So, again, do I go to the phone book and call around to see who is having a "blue light special" on titanium joints? Perhaps I can get by with the nylon ones. Maybe just a steel one will do….. So many choices. What about the OR? What is the hospital’s infection rate? What about post surgical care? A cheaper hospital that has high patient to nurse ratios may just undo all that fine work you just did for me Dr. Peters. The nurse was stretched too thin, a PCA cared for me and didn’t really have the proper training to notice that I was showing signs and symptoms of infection. Wait, was that infection caused from the OR or post-op care?

Remember, that I have special knowledge and can make an informed decision about my care. I know what questions to ask.  What if I were a simple laborer who’s knees were bad from years of kneeling when installing carpet? My formal education ended in seventh grade. I can only read at the fifth grade level. How do I know who to trust? How do I know if the cheaper nylon knee is better for me than the titanium one? St. Elsewhere has a shiny brochure and they say their rates are 50% lower than Hometown General. I hear their food is better too.

I disagree that healthcare should be a consumer driven free market commodity when the patient is the "consumer".

I do agree with what has been said about "shadow science" and the last half of the prior century small fortunes were made by layers of corrupt persons in the healthcare field.

At the risk of sounding too Utopian, I would remove all of the insane monetary incentives from the system. I would remove the layers of bureaucracy and unnecessary middlemen who’s only purpose is to turn a profit for their shareholders. I would also remove those who seek to make money by selling the "lottery" mentality of litigation. Alas, this will never happen.

The system that you spoke about prior to the second half of the last century was not a system of access, or rights or even fairness. If you look at where the hospitals were built in the "old" cities, they generally surrounded the homes of the richest in the respective city. Medical care has never been a "right". Many, many of the poor died from otherwise treatable illnesses at the turn of the 20th century. "Doctors" only treated the rich who could afford to pay. Most industrialists realized that the poor state of health of their workers from injury required better access to medical treatment. I would like to think that we have progressed past that point as a civilization.

There are many psycho-social reasons persons choose to ignore their lifestyles. One reason may be that they feel technology will bail them out. I go back to "follow the dollar". I can’t nearly make as much money by teaching folks how to live better and healthier lives as I can by treating their illnesses. In some ways the entire "medical model" is broken. We reward our practitioners when they "fix" a problem not when they prevent it from happening.

Yes my friends, we have a mess on our hands. I am afraid, the system may have to collapse before it can be made better. It does not have to come to that, however, there is too much greed for it to happen any other way.

FWIW – C.

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