Health Care Reform?

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  • Thu, Jul 09, 2009 - 07:32pm

    #21
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    Re: Health Care Reform?

[quote=keelba]

One of my favorite stories goes something like this:

One day a tractor-trailer semi truck is driving a small mountain road and goes into a tunnel at full speed, only his trailer is several inches too tall and the whole thing wedges into the tunnel and traffic backs up in both directions for miles. Finally they are able to get some help to the scene and they try everything they can to pull this truck out of the tunnel. They have several bulldozers, chains wrapped all around the truck, even people inside the tunnel pushing just to get it to move but nothing works. After several hours of this a 5 year old girl who has been near the tunnel watching the whole time speaks up and asks one of the engineers, "Why don’t you let the air out of the tires?"

The whole point of telling you this story is that sometimes we try so hard to fix a problem a certain way that we don’t think about alternative solutions. The problem, as I see it, is that we are trying to fix the notion of "Health Care" when we should be trying to get rid of it altogether.

When did this begin? When did we get "health care"? When I was growing up it used to be known as "health insurance" and it was treated as just that – INSURANCE. Insurance is something we buy that we hope we never have to use: car insurance, property insurance, life insurance, etc. I don’t get car insurance and at the end of the year realize that I’ve had no accidents so I go out and cause one so that I can use up my insurance. And yet people do just that when it comes to their health insurance, only now we call it health care as if it is something that is intended to be used. We created this entire system based on the moral hazard of having to use it since we’ve already paid for it.

What’s worse is that people don’t think about the whole sum of their health care expenditures throughout the year. I went without insurance for a couple of years up to about a year ago. It was a bit of a scary time but I still went to the doctor for the same types of things I normally would. When I’d get there I’d explain that I had no insurance and they billed me directly. Then I realized that for a typical doctor’s visit I would pay anywhere from $40-$100. In a years time it would be a lot if I went 3 times. That’s a total of approximately $300 out of pocket for the entire year. But the people with the healthcare plans go to the doctor and only have a $20 copay. They think to themselves that $20 is much better than the $80-100 they may have paid for the same visit without realizing that they are paying several hundred dollars each and every month through their paychecks for the privilege of saving the 80 bucks from their last doctor visit. I can get homeowner’s insurance to cover a $250,000 house for just $750 per year. Why couldn’t I get a similar plan for my medical emergencies.

I understand that different people have different needs and some require much more extensive medical care than I might but the point is that instead of paying $12,000 per year plus what their employers match that could have gone in their paychecks too, they could get an awful lot of medical care for that same amount of money and pay a lot less in just plain old insurance if the system wasn’t as screwed up as it is. There’s nothing wrong with the idea of insurance. If I get a heart attack, get into a car accident, develop cancer, need brain surgery, whatever. Those things can be very expensive and I would want insurance to cover that. But I’m talking about normal, typical daily type medical stuff. Why should we need a healthcare plan for that? 

Employers used to contribute health care to an employee as a benefit or a perk like stock options, vacation time or a company car. It is no longer a benefit but, apparently, a God given right that we all deserve it because we’re Americans. What’s next? You’re going to tell me that I need a "car care" plan to take care of my normal maintenance such as brake jobs, oil changes and car washes? Then I can get a "house care" plan to take care of my lawn, cut my hedges and give me maid service too. Why stop there? Let’s get a "food care" plan so that we can be sure we eat on a regular basis and first our employers can give it to us and eventually the government can step in to fix our "food care" problem. How about an "education plan" for me and my children. This is getting ridiculous.

We can come up with a plan for everything we use in life but normal doctor’s visits are just a part of normal living expenses and should be treated as such. If I get a cold and want antibiotics, then I will go and buy some from a doctor if I have the money, if not I guess I’ll have to spend a few more days in bed. If I break my arm then I guess I’ll have to find a way or come up with some sort of repayment plan much the same way I would if the transmission breaks on my car. Let’s get rid of the idea of "health care" reform and get back to the idea of paying our share for what we use and keep the system simple. Let doctor’s decide what their going rates are and let the free market decide if they are charging too much for their services or not.

Thanks for listening. I’ll step off my soap box now.

[/quote]

Very nicely articulated, keelba! Perhaps obviously, I agree with everything you said, but I especially wanted to applaud you for the commonsense manner with which you expressed our thoughts.

  • Thu, Jul 09, 2009 - 07:59pm

    #22
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    Re: Health Care Reform?

 

Capitalism makes Food a Source of Profit not Nutrition.  Take a look at how many Fast Food places and desert joints are on your way to and from work.  This is why we are sick and HealthCare is getting out of Control.  The Clandestine Eugenics Program in this country is working just fine for the Money Masters.  

We will be forced to accepts Universal HealthCare on a massive scale because we are eating our own sickness.  No program or free market will solve the problem until we change what we eat.  

 Remember DIET AND EXERCISE DON’T FAIL.  That is the best health Care and It’s FREE (somewhat).  

  • Thu, Jul 09, 2009 - 10:58pm

    #24
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    Re: Health Care Reform?

[quote=becky]

 When it comes to healthcare, I would rather not have the government involved, if necessary (same as what most of you’ve said).  But, I can’t get past this thought:  at least in my town, the firefighters answer the call and do their best to save the one bedroom rental with a carport, the same as the mansion on the hill.  Is property protection a right but healthcare is something you get if you can afford it?  Yes, we shop around for car insurance and car repair but we can choose to not own a car.  Can a child choose to not have a body?  Can a child choose to have wealthy parents?  Maybe adults can just say "I’ll take my chances on not being insured" but children, at the very least, should have healthcare.  I have no suggestions for how to fix the system.  I actually feel rather hopeless about it.  And, I know I’m rambling.  Wow.  My ears are ringing — I think this is actually raising my blood pressure.  A bit of dark humor for a forum on healthcare.  I will go think some happy thoughts now…

becky

[/quote]

I think the protection of property vs health care is an interesting way to look at it, but neither of them is a human right.  Rather, societies have made the decision that protecting property from fire and other hazards is a good thing and that the government is the best way to deliver it.  In most advanced nations, the same choice has been made about health care and, despite what you hear in this country about rationing and other supposed perils, the people in those countries are generally happy with the system.  You can not say that about our country.

Does that mean we should shift to a govermnent-run single payer system?  I’m not so sure.  I disagree with those who say that govt will necessarily create a bureaucracy that is in any way worse than the one the insurance companies have given us.  But I suspect that in this country, we would figure out a way to screw up such a system, even though it might be more rational.  I fear that those on the left would demand third-trimester, on-demand abortions for illegal immmigrant minors, while those on the right would do everything they could to sabotage it by withholding funding and figuring a way to get their corporate friends fat at the free gubmint money trough.

So I guess you could call me pessimistic.

  • Thu, Jul 09, 2009 - 10:59pm

    #23
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    Re: Health Care Reform?

[quote=PlicketyCat]

Perhaps I’m lucky in that I lived in a small community where healthcare was not overly monetized. The docs and the tiny hospital charged everyone the same amount, regardless of insurance, and you pretty much had all the time you needed to discuss your issues with the doc. If someone couldn’t afford their treatment, then mutually-equitable deals were worked out. Fund raisers were held 2-3 times a year to make specific improvements to the facility or to pay for specific treatments for specific individuals… i.e. "we need to send Johnny to the city for a kidney transplant, won’t you please buy a cupcake?"  Conversely, the community had fund drives to help pay tuition for the practitioners… i.e. "Peggy just got accepted to med school, won’t you please buy a raffle ticket?".  This community-based system worked quite effectively, everyone got reasonable health care at reasonable cost and the hospital ran in the black without being excessively reliant on government, pharma or insurance programs. To the best of my knowledge, it’s still going strong and still operating pretty much the same.

[/quote]

This makes me think of one of my favorite quotes from these forums (I think from pir8don):  "The big fix is dead. Long live the little fix."  Government, in my opinion, defaults to a big-fix mentality, which never seems to sit well with me, for whatever reasons.

Admittedly, I do not understand the details of all the options described in this thread, but from a layman’s perpective, this situation described by Plickety can only happen when the gov’t stays out of the equation.  It seems to me that such a thing would only become more rare as gov’t involvement becomes greater, if for no other reason than enforcement of standard pricing and level-of-care structures and added system complexity/overhead.

Also, the whole street-lights, police, and fire service argument has always been interesting to me.  (The movie Sicko harps on this as well).  I’d like to know others’ thoughts on:

A) The street-light example isn’t working for me.  People will have medical-related services done, even if they might not have otherwise opted to, because it is inexpensive, or even free (or perceived as free).  I have seen this for myself.  What I have not seen or heard of is someone spending more time sitting at or driving through street lights just because "it doesn’t cost them anything."  i’m not being funny…I’m really looking for what I’m missing here.

B) The police/fire argument seems more compelling.  Why is police/fire service different than health insurance? (in other words, why not just buy police insurance…if something happens and you don’t have it, you’re out of luck.  But if nothing happens, you saved yourself a bunch of money!)

 

Specifics of the issues aside…perhaps I am naive, but I find it mind-blowing sometimes that I can spend 30 mintues reading through a health-care thread on PeakProsperity.com and feel like I’ve learned more than I had from decades of Main-stream media exposer…truly mind-boggling when you think about it.

I really appreciate all the views on this so far, and the level of detail.  Thanks.

-Brandon

 

  • Thu, Jul 09, 2009 - 11:57pm

    #25
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    Re: Health Care Reform?

[quote=Brandon]

This makes me think of one of my favorite quotes from these forums (I think from pir8don):  "The big fix is dead. Long live the little fix."  Government, in my opinion, defaults to a big-fix mentality, which never seems to sit well with me, for whatever reasons.

Admittedly, I do not understand the details of all the options described in this thread, but from a layman’s perpective, this situation described by Plickety can only happen when the gov’t stays out of the equation.  It seems to me that such a thing would only become more rare as gov’t involvement becomes greater, if for no other reason than enforcement of standard pricing and level-of-care structures and added system complexity/overhead.

Also, the whole street-lights, police, and fire service argument has always been interesting to me.  (The movie Sicko harps on this as well).  I’d like to know others’ thoughts on:

A) The street-light example isn’t working for me.  People will have medical-related services done, even if they might not have otherwise opted to, because it is inexpensive, or even free (or perceived as free).  I have seen this for myself.  What I have not seen or heard of is someone spending more time sitting at or driving through street lights just because "it doesn’t cost them anything."  i’m not being funny…I’m really looking for what I’m missing here.

B) The police/fire argument seems more compelling.  Why is police/fire service different than health insurance? (in other words, why not just buy police insurance…if something happens and you don’t have it, you’re out of luck.  But if nothing happens, you saved yourself a bunch of money!)

Specifics of the issues aside…perhaps I am naive, but I find it mind-blowing sometimes that I can spend 30 mintues reading through a health-care thread on PeakProsperity.com and feel like I’ve learned more than I had from decades of Main-stream media exposer…truly mind-boggling when you think about it.

I really appreciate all the views on this so far, and the level of detail.  Thanks.

-Brandon[/quote]

Brandon,

I don’t think you are at all naive; and, in fact, you have a good grasp of some fundamental problems.

I think the police/fire/ambulance discussion is a good one. Essentially, these are services designed, funded, and operated at the local, town or county level. They serve one of the fundamental roles of government, to preserve our natural rights of life, liberty and property. To my mind, these are basic services that would appear to be the proper domain of local governments, if managed responsibly (of course, even with these basic services, we not infrequently hear of excesses and abuses). Without them, each of us would have to be responsible for our own policing, fire fighting, and emergency services. Potentially doable, I suppose, but it is much more effective to enlist the help of others for such issues.

Healthcare, excepting immediately life-threatening issues, is a different matter. Still (and I like this idea, as I have mentioned previously), a community could decide to institute their own local medical care system. Think of it as a healthcare cooperative. Members contribute a regular fee, which would support routine care such as doctor visits, medications, etc., and they might even purchase a community-wide group catastrophic health insurance plan for more serious maladies. This would seem like a very attractive option to the local community members, and might even be a good draw for potential new community arrivals.

Another community might not chose to form such cooperative, opting instead for some other program, or none at all. And, that is a key principle, to my way of thinking; such decisions are best accomplished at the local level, by the individuals themselves, or as members of a larger community, and not by the federal government.

  • Fri, Jul 10, 2009 - 08:01am

    #26
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    Re: Health Care Reform?

[quote=JK121]

 

Capitalism makes Food a Source of Profit not Nutrition.  Take a look at how many Fast Food places and desert joints are on your way to and from work.  This is why we are sick and HealthCare is getting out of Control.  The Clandestine Eugenics Program in this country is working just fine for the Money Masters.  

We will be forced to accepts Universal HealthCare on a massive scale because we are eating our own sickness.  No program or free market will solve the problem until we change what we eat.  

 Remember DIET AND EXERCISE DON’T FAIL.  That is the best health Care and It’s FREE (somewhat).  

[/quote]

At the risk of starting a bit of a CT tangent on this thread… ever notice that most of the pharma companies are owned by the mega-agri-corps? Monsanto… makes franken-food, makes pills, makes poisons 

But, back to main topic… diet, as in daily nutrition, is a big problem in this country. Not only are we eating all the wrong stuff, the "right" stuff changes with the wind, and the "good" stuff is peppered with additives and poisons (unless you’re eating pure organic). I think that we need to really start eating better quality food and getting more sleep, destressing, etc etc instead of just taking another pill. The pushers get us all hooked on the newest drug and the prices just keep going up and up, and even if we improve in one aspect we degrade in others… because, guess what, a lot of medications are toxic!  Bad food + bad medicine = bad ju-ju. So you keep going back to the doc because you still feel bad, and they don’t know what to do about it because the pharmacorps and FDA keep saying that Prozac is perfectly safe, so the person must be a hypochondriac, let’s give them some Cymbalta too so it’ll fix that. And on and on it goes.

People need to take control of their own health… but where do they start and who do they trust? Not everyone understands medical terminology, anatomy and bio-chemistry. Not everyone has the obsessive-compulsive ability to journal every single thing they ingest or are exposed to every day for a year+ noting every symptom and reaction, and then piece it all together and back-track every "coincidence" to self-diagnose.

  • Fri, Jul 10, 2009 - 03:56pm

    #27
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    Re: Health Care Reform?

So many layers of complexity.  Life, death, disease/health, religion/spirituality, morality, ethics, money, individual vs the state, individual vs the family, technology, private vs public, all rolled up into one.  

I believe that the quality of its health care system might portend a very accurate measure of the over all health of the society.     

  • Fri, Jul 17, 2009 - 06:05pm

    #28
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    Re: Health Care Reform?

I thought some may find the following of interest. This is the text of an email message sent out to the members of the American College of Surgeons, announcing ACS support for HR 3200, the House version of a national health insurance plan:

Dear Dr. Peters:

We are writing to inform you that the American College of Surgeons is supporting this first step in health care reform legislation entitled "America’s Affordable Health Choices Act of 2009" (H.R. 3200), which is currently being considered in the US House of Representatives. This is an ongoing process that will require the College to evaluate our support and level of engagement at each step of the process, and does not lock us into a specific position as the legislation goes through additional changes and is finalized.

This decision was made after careful consideration by the ACS Health Policy and Advocacy Group and extensive discussions with the leadership of all the major surgical organizations. Ultimately, the decision to support the bill was made unanimously by the Executive Committee of the ACS Board of Regents.  Our support helps us to ensure that the final bill includes language that we support and does not include language that we oppose.  We would like to take this opportunity to provide you with an explanation of why the ACS leadership felt that it was important for the College to support H.R. 3200. 

This legislation embodies many of the top legislative priorities of the College. The leaders within the College, including the Regents, the Governors and various committees, have had extensive, ongoing discussions related to health care reform and how these issues impact surgeons and surgical patients.  A major part of this discussion included the health care reform statement that the ACS Board of Regents and Governors developed and approved last year. Surgical workforce issues are a significant part of this statement.  One of the most important priorities related to workforce is the need to address the underlying problems of the Sustainable Growth Rate (SGR), which is used to calculate Medicare physician payments.  This legislation (H.R. 3200) would allocate $284 billion to fix the Medicare physician payment system and eliminate the more than 40 percent cuts in payments to physicians that are scheduled to take place over the next four years, giving surgeons stability for the first time in 10 years. 

The bill would stop the pending 21.5 percent cut in Medicare reimbursement that will occur on January 1, 2010, and replace the cut with an increase based on the Medicare Economic Index.  Second, it would reset the budget baseline for the Medicare payment system to 2009.  Resetting the baseline, in addition to action by the Centers for Medicare and Medicaid Services (CMS) to remove physician-administered drugs from the SGR formula that have negatively impacted Medicare physician payments, will finally provide a long-term solution to the difficulties that have plagued Medicare payment reform for the better part of a decade.  Also, rather than implementing untested models of care and reimbursement, H.R. 3200 would implement pilot programs to test various delivery system reforms that would build on models that have been shown to improve quality of care. Collectively, these measures would stop years of scheduled cuts in Medicare payments, better align incentives to improve quality, and ensure that surgeons will be able to care for patients without the annual concern of Medicare payment cuts. 

What is included in the bill is important. However, what is not included in the legislation is also critical, particularly to surgery. While the bill addresses challenges facing primary care, it does not finance increased payments for primary care through reductions in payments for surgical care.  The College appreciates that the legislation recognizes that such payment cuts would exacerbate the trend of declining payments for many surgical services and would threaten patients’ ability to access these important services. 

The legislation does include a public health insurance option.  While the public health insurance option does raise a number of questions, the College insisted that any public health insurance option not mandate that individual physicians participate in the program.  The legislation very clearly allows for physicians to opt-out of the program, with no penalties for doing so.  In order for a public option to be successful for patients and for physicians, physicians need to be able to have the same voluntary participation options that are available to them under any other plan. The College is grateful that this legislation would ensure that physicians will continue to have the freedom to make determinations that are in the best interest of their practice and ultimately their patients. 

Support of H.R. 3200 is advantageous from a strategic standpoint as well. Legislation that will be introduced in the Senate soon is not expected to be as favorable for physicians.  The legislative process will require the House and Senate bills to be reconciled before Congress votes for final passage, and we need to ensure that the College’s top priorities, currently included in the House bill, remain intact. 

The ACS leadership and staff remain very engaged in the health care reform efforts in Washington.  Once again, this is an ongoing process that will require the College to evaluate our support and level of engagement at each step of the process.  We will continue to work with both the House and Senate to ensure that any comprehensive health care reform legislation will contain the College’s priorities and promote Americans’ access to both quality coverage and care.  The College’s Washington office will soon host another webinar to provide Fellows with a detailed overview of the current status of health care reform legislation as it makes its way through Congress.  Additional details about this webinar will be sent to Fellows on Monday, July 20, 2009.

Sincerely,

L.D. Britt, MD, MPH, FACS — Chair of the ACS Board of Regents 
Michael Zinner, MD, FACS — Chair of the ACS Board of Governors 
Andrew Warshaw, MD, FACS — Chair of the ACS Health Policy and Advocacy Group 
Thomas Russell, MD, FACS — ACS Executive Director

While I can appreciate ACS’ interest in the bill, particularly from the standpoint of stopping the steadily declining Medicare reimbursements we surgeons and been experiencing for many years, and the planned-for option of not requiring participation with a future national health insurance program, I personally disagree with this endorsement. It seems to me that the ACS, AMA, and other medical institutions do not recognize the great potential downsides of a national healthcare program, but are willing to endorse such a plan, so long as some of their interests are addressed. Of course, I may be wrong, and such a program could turn out to be of great benefit. However, none of my colleagues with whom I have discussed this matter are optimistic, either.

  • Sat, Jul 18, 2009 - 02:46pm

    #29
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    Re: Health Care Reform?

The following is a long, but very good, article in the New York Times on the need for rationing in healthcare.

An excerpt:

July 19, 2009
 

Why We Must Ration Health Care

You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

In the current U.S. debate over health care reform, “rationing” has become a dirty word. Meeting last month with five governors, President Obama urged them to avoid using the term, apparently for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform. In a Wall Street Journal op-ed published at the end of last year with the headline “Obama Will Ration Your Health Care,” Sally Pipes, C.E.O. of the conservative Pacific Research Institute, described how in Britain the national health service does not pay for drugs that are regarded as not offering good value for money, and added, “Americans will not put up with such limits, nor will our elected representatives.” And the Democratic chair of the Senate Finance Committee, Senator Max Baucus, told CNSNews in April, “There is no rationing of health care at all” in the proposed reform.

Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. “So,” he says, “would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the price.” The man’s response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it’s immoral to apply monetary considerations to saving lives — but is that stance tenable?

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily MedicareMedicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.


 

  • Wed, Aug 12, 2009 - 04:55pm

    #30
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    Fight Against Privatization of Healthcare in Canada

I ran across this today, and found it interesting and amusing:

Privatized, For-Profit Health Care: Pay More and Get LessPrivatized, For-Profit Health Care: Pay More and Get Less

The advocates of privatized, for-profit health services are trying to sell Canadians on a two-tier health system. This time, it’s the so-called “European model” being promoted across the country by Dr. Robert Ouellet, President of the Canadian Medical Association and owner of several private for-profit diagnostic clinics.

The Canadian Health Coalition has launched a major campaign to expose the dangers of (and alternatives to) private, for-profit health care in Canada. We hope you will join us in supporting them.

Sign the Medicare Pledge!

  • As a Canadian, I believe access to quality health care must be based on need, not ability to pay.
  • Our public health care reflects those values of equality and fairness.
  • We must improve our public health care for everyone, instead of expanding private for-profit services that benefit only a few.
  • I pledge my support for the protection and improvement of public health care in Canada.

 Click here to add your name to the Medicare Pledge!

http://www.bchealthcoalition.ca/

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