Health Care Reform?

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anarkst's picture
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.  

 

ccpetersmd's picture
ccpetersmd
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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!

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A. M.
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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

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ao
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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.  
 
ao's picture
ao
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Re: Health Care Reform?
ccpetersmd wrote:

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!

Well stated.  I agree wholeheartedly. 

 

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EndGamePlayer
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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

 

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EndGamePlayer
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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

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ccpetersmd
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Re: Health Care Reform?
ao wrote:
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.
 

This was my favorite part, and I wholeheartedly agree!

anarkst's picture
anarkst
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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.    

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RNcarl
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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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green_achers
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Re: Health Care Reform?

RNcarl,

Thanks for that dose of reality.

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becky
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Re: Health Care Reform?

 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

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PlicketyCat
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Re: Health Care Reform?

RNcarl, I agree with a lot of what you're saying. When I worked at the hospital, I saw some pretty hinky cooking fo the books going on depending on who was getting what procedure and who had which insurance company. My own surgery was deemed "not medically necessary" and I had to self-pay... so I ended up having to pay my surgeon, up front, out-of-pocket almost 3 times more than they would have accepted had my insurance authorized it. I was also charged almost double for the other medical expenses... that's double the claimed amount, not double the amount after write-off. Later, it was deemed in court that my surgery was medically necessary and my insurance had to reimburse me... but only for the amount that they would have paid via adjustments and wirte-offs had they originally authorized it. So, I only ended up getting back about 1/4 of what I had to fork over (which was the money I'd saved for my last two years of college - no degree for me!)

How in the world does charging a self-pay patient MORE than an insured patient make any sense?

I don't think it's necessarily the practitioners or the patients at fault here. It's that sneaky co-dependence between insurance companies and the governments, with a healthy dollop of pharmaceutical kick-backs.  The docs have to pay exhorbitant liability insurance premiums and have to jump through all the hoops if they want to be an accepted provider. The patients have to pay exhorbitant health insurance premiums and have to jup through all the hoops if they want their condition treated. Docs get shafted by the HMO-model and the only way they can break even is to stack their patients up every 10-15 minutes... which means we get crappy care. It's not their fault, it's the insurance companies fault for fleecing us on both ends, and the government's fault for getting their grubby little, pharmaceutical lobbyist money-taking, meat hooks all up in the mix.

A true healer wants to heal. He wants to feed his family, too; but his primary interest isn't the money. A doctor out for the money is a capitalist businessman, not a healer... and someone like that won't ever get near my body again! Hospitals used to be places of healing, but now so many of them have become bureacratic and microbial cess pools... despite the best intentions of the docs, nurses and other care givers.

I think many patients would take better care of themselves if they just knew what they were supposed to do... seems there is a new discovery and a new treatment method every week and with every doctor you go to. Fat is bad, sugar is bad, high fiber is good, cholesterol is bad, exercise is good... every single one of these recommendation can be utterly WRONG in certain cases. But the pharmaceutical companies make more money on treatments and supplements than "cures"... which means they can pay the government some more money to not do real research on how many medications we actually DON'T need, and provide some better food guidelines (that pyramid, even the new one, sucks... 9 servings of grain? are you kidding... ooh wait, what's America's most productive crop... GRAIN!). Long gone are the days when you could sit down with your doc for a whole hour and discuss what your specific issues are and what your specific treatment plan should be... nope, nowadays you're lucky if you get 10 minutes, a prescription for whatever the new cocktail is, and the party-line edict to quit smoking/exercise more/reduce stress/eat less-more of XXXX.

So, no, I don't believe that health care should be a business. Free market will only work if you cut out all the insurance, government and pharma meddling... and all the hospitals are run as non-profits again. Just take profit right on out of the equation. If my doc will take a chicken, I'll give him a chicken for his table to feed his family; if I don't have a chicken, I'll go paint his porch when I'm feeling better so that his family can live in a well-maintained home. That's the way it used to work before industrialized-capitalized medicine.

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ccpetersmd
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Re: Health Care Reform?

I realize that it can be hard to understand how a free-market healthcare system would be better than the system we have now. It is particularly difficult given the fact that everyone posting has lived their entire lives within some version of the current system, and it is hard to see beyond those boundaries.

Still, the only option beyond a free-market system is some version of what we currently "enjoy", one with governmental regulation of how business provide healthcare to their employees, regulations on insurance companies, de facto "price setting" in the form of Medicare reimbursements, etc. Time has shown, again and again, that government's attempts to correct problems typically only create more problems.

Healthcare is not a right, it is a personal responsibility. Accordingly, there is no guarantee that healthcare will be equal and fair to all. Life is not fair. Those that are wealthier could afford more healthcare, just as they could afford to have nicer cars. Everyone likes the idea that healthcare should be fair to all, me included. The problem comes when government tries to ensure that fairness. And, even if we went fully down the road to a socialized system of healthcare in the U.S., we would almost certainly see the same two-tiered system of healthcare that has developed in many other countries with taxpayer-subsidized healthcare. One would be the public system, that would be "free", but typically associated with delays in care, rationing, and not infrequently, less than ideal care. The second would be a private system, available only to those that could afford it.

Carl, in a system of free-market healthcare, I do not envision potential patients "price-shopping" their healthcare for urgent medical conditions. But, without the "price-fixing" that currently exists (most private insurers base their reimbursements on Medicare standards, set be the government) and the "middle-man" costs you correctly identified, prices would come down to more sustainable levels. As to elective medical issues, I would fully expect potential patients might "price-shop" their care, and even weigh those potential healthcare costs against other expenditures they face. To borrow your knee replacement analogy, perhaps one more expensive an MRI is not absolutely necessary, and your orthopedic surgeon would be willing to proceed based upon cheaper plain-film x-rays, alone. Or, perhaps the knee replacement could be reasonably delayed in preference for continued, less expensive, conservative management, especially since you need to replace that furnace this year.

Again, we have finite resources, and rising costs. Rationing of healthcare is inevitable, and I would much rather see rationing done by the individual, rather than a government bureaucrat or an insurance company.

Health savings accounts should be thought of as any savings account, except that deposits are from pre-tax income. You direct how much you save, and how much you withdraw for needed or wanted medical care. Any surplus at the end of the year rolls over to the next. I honestly don't know whether HSAs are run by insurance companies, or not, but the contributions to the HSA are yours, not the holding company (excepting any management fees, of course). Catastrophic health insurance is a different matter, and would presumedly be purchased from a conventional insurance company. The HSA would be used for routine care, such as physician visits, routine diagnostics, medications, elective procedures, etc. Catastrophic health insurance would be to cover more serious illness or injuries. This would restore the traditional role of insurance to healthcare.

As to hospitals, the majority of hospitals in the U.S. today are still non-profit, most established originally by various religious organizations. And, while many were originally established in wealthier neighborhoods, many were also established specifically to serve those that are economically less fortunate. Hospitals still provide an enormous amount of free care, and I don't see any reason that that would change. The same applies to physicians.

Like it or not, healthcare is, has always been, and likely always will be, a business. It is just a very poorly run business, currently. There are any number of egregious examples of how our healthcare currently is too expensive, unfair, poorly administered. The question I would ask is whether you think that more government regulation and oversight is actually going to make things better?

ccpetersmd's picture
ccpetersmd
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Re: Health Care Reform?
PlicketyCat wrote:

How in the world does charging a self-pay patient MORE than an insured patient make any sense?

PlicketyCat,

I apologize for not addressing this question above. It absolutely makes no sense that a self-pay patient should pay more than an insured patient, and they wouldn't in a true free-market healthcare economy, but that is exactly how it is engineered in the current system.

Let me illustrate with a fictional procedure, a double brain transplant (I borrowed that from Toy Story 2). I'll be the surgeon who performs said procedure. I work with three insurance plans that pay for that procedure. Insurance company #1 will reimburse me $5000, insurance company #2 will reimburse me $3000, and Medicare will reimburse me $2000. I am required by law to set one price for each service that I provide. I would be foolish to set my price any lower than the maximum I could receive from insurance company #1, so I set my price something close to $5000. If a patient covered by insurance plan #2 comes in, I will charge my $5000, but my contract with that insurance company will require me to accept $3000, and to write-off the $2000 balance. If a self-pay patient comes in, I run the risk of committing insurance or Medicare fraud if I charge that patient less than my customary amount. In actual practice, many providers will make such deals, but they are potentially putting themselves at risk. For example, if I performed the double brain transplant on a self-pay patient, and charged them at my lowest reimbursable rate, Medicare's $2000, I could potentially be sued by insurance companies #1 and #2 for overcharging them.

This example, of course, only looks at the costs from the practitioners point of view. The situation is similar, for hospitals. Their costs are also typically inflated, not only for the reasons above, but also to cover losses incurred by providing "free" care for those without insurance.

I hope this helps you understand the situation in which you found yourself, and to understand the frustration that many of we healthcare providers have with our current system.

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Broadspectrum
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Re: Health Care Reform?

All,

Single Payer Health Care is the only true solution to our Health Care system.

http://carolynbaker.net/site/content/view/1177/1/

Broadspectrum

THE REVOLUTION WILL NOT BE MEDICALIZED, By Kellia Ramares

There should not even be a debate over single payer. All of the objections to it are a bunch of baloney.

 

Waiting times: I remember my dying grandmother stooped over her cane in agony while waiting hours for Montefiore Hospital, a prestigious private hospital in the Bronx, to find a bed for her – in 1964. And insurance wasn't an issue; they just didn't have the space. Surely everyone who has been delayed or denied approval for care from an insurance company knows the waiting time issue is a red herring.

Maybe doctors would have more time for their patients if they didn't spend hours dealing with insurance companies.

 

Freedom of choice: Yeah, you can have any doctor you want, so long as he or she is in your insurance network. If the doctor is out of network, you pay through the nose. Some freedom!

 

The government can't afford it: Well, if we shifted our priorities away from bailing out banksters and waging wars, we could afford it easily.

Why is it that we can throw trillions of dollars at bailouts and bombs but we can't afford health care for all? 

 

ocialized medicine: This argument is the biggest hoot. First of all, so what if single payer were socialized medicine?  If you want to talk about efficiency, as the people against single payer are wont to do, then let's talk about the inefficiency of having the capitalist system, which was designed to provide goods and services, based on profitability, attempting to provide services for everyone, based on need. The process doesn't work well because capitalism was never designed to provide for everyone based on their needs. Trying to shame, cajole, sue or entice it to work that way only results in inefficiency at best and injustice at worst.  

 

 

Several years ago, I saw a newspaper photo of a black women in a Third World country; she was wrapped in a white sheet and sitting in a wheel barrow on the street. She had been put out of the hospital she had been in because she could no longer afford to pay for her care. In the United States, we would rightly consider such treatment barbaric, and then hypocritically hide our own barbarism in myriad bureaucratic maneuvers to deny a patient access to the hospital in the first place.  

Secondly, we shouldn't react as if we don't already have socialized services in America. We have plenty of them: police and fire services, street lights, libraries and public schools to name a few. If they aren't working as well as they should, at least part of the blame can go to the anti-tax attitudes of the last thirty years, which have led to underfunding.  So single-payer health care would not be the first time we had a public service available to all, funded by the taxpayer i.e. socialism.

 

Lastly, single payer wouldn't really be socialized medicine under a Medicare-for-all type of program. Only payment for services would be socialized. The actual rendering of health care would remain private. The practices and facilities that are private now would not become government-owned and run. 

 

 

The Real Reason

 

 

The focus on all of these issues hides the real reason why single payer has been stymied. The real reason is that a “Medicare-for-all” system would put the private health insurers out of business.  Corporatists and their bought politicians cannot allow the insurers to be run out of business because it would set a dangerous (to them) precedent of having a society decide that certain types of industries heretofore wearing the respectable label of  “legitimate business” do not have an automatic right to exist.

 

If that happens, then what comes next? As food activist Michael Pollan, author of The Omnivore's Dilemma and In Defense of Food, points out, many of our health problems in America have their sources in food. For example, a triple-chocolate cake sent to me as a gift last December contained, according to its ingredient list, silicone and propylene glycol, the latter a substance also used as a solvent and as anti-freeze. Ingesting those kinds of substances cannot be healthy if one is not a car. 

Will a society that has the temerity to abolish health insurance companies then  totally revolutionize its food system to run the purveyors of artificial and toxic “edible food-like substances,” to use Pollan's term, out of business? (Monsanto, watch out!) 

 

 

Once we break free of the notion that any particular industry is entitled to existence, will we then finally repeal corporate personhood, stating what should be the obvious: that corporations are things that human beings have created to aid in performing certain functions. They are not our masters who have rights that can trump those of flesh and blood people. Single-payer health care could be the snowball that could start the avalanche that flattens and buries corporatism.

 

Imagine such a  thing because I can assure you that the corporatists have. And the thought makes them sweat. It's is not simply a matter of lost near-term profits. It's a matter of control -- permanent control -- over our lives, money and choices.

 

The “public option” sell-out of single payer is allegedly a form of competition for the private insurance industry. Under capitalist theory, industry works more efficiently, innovation is fostered, and consumers have more choices when competition is promoted. But what do you want to bet that the “public option” will draw the poorest and sickest people, i.e., those who under the current system are deemed uninsurable, or who can't afford what insurance they could get, leaving the prime customers, i.e., the young, healthy and well-off people who will make fewer claims, to the private companies.

The public option will be underfunded in these “hard times”, and the mainstream media will sniff everywhere for stories of how people on public insurance had to wait for their care (to reinforce the “private good – government bad” brainwashing), while stories of private insurance companies delaying or denying care will be buried, sometimes along with the patients.

 

The only true health care reform is universal single-payer health care. Health insurance is a scam! Public option is a sham!

 

 

ccpetersmd's picture
ccpetersmd
Status: Martenson Brigade Member (Offline)
Joined: Oct 12 2008
Posts: 799
Re: Health Care Reform?

I felt a single-payor system made the most sense, until fairly recently. And, one could certainly argue that a single-payor system is a reasonable proposal, if one could reasonably guarantee that such a government-sponsored, single-payor system would be more effective and more economical than other government programs have proven to be. Unfortunately, I do not believe such a guarantee can be made.

PlicketyCat's picture
PlicketyCat
Status: Platinum Member (Offline)
Joined: Feb 26 2009
Posts: 680
Re: Health Care Reform?

Doc Peters - I know the trials practitioners have to go through dealing with the insurance companies and all the price-fixing that the insurance companies and government regulations dictate. I do understand how and why my particular situation occured, and I don't blame it on the doctors or the hospital at all. Blame for this mess rests squarely on the shoulders of the insurance companies, government and pharmaceutical companies.

I think part of the problem is that our current system actually forces practitioners to think in terms of profit because they have to. Using your double brain transplant analogy... the surgeon knows that a double brain transplant will take him most of the day to perform, during which he won't be able to see any other patient or get any other work done. So, he knows that he normally makes about $2k a day doing normal business, so he charges $2k for the surgery... maybe a little more to set aside to cover some "pro bono" surgery for another patient at some future time. Now, simply because Insurance #1 will pay $5k, he sets his price at $5k even though his effort/expense is really only $2k... and the uninsured patient gets nailed by artificial price inflation. If the surgeon simply charged a set rate for the surgery, regardless of whether the "going rate" was higher, then neither he nor the patient would have to be concerned with the whining insurance companies or possibly commiting insurance fraud.  Again, this is the fault of the insurance companies & government... not specifically the practitioner (although there are some money-hungry practitioners out there who do milk the system).

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.

So, no, I don't believe that more government regulations are the answer... unless the regulations are strictly applied to the INSURANCE companies, while leaving the healthcare practitioners to operate less burdened. I fully believe that the healthcare system would function more like a true free-market system if we could remove the blood-sucking leeches (insurance companies) from the mix. But, on the flipside, healthcare practitioners shouldn't be able to jack up their prices simply because they can... and that is the problem with free-market and consummate-demand commodities. Getting rich off the suffering of others just because you can is just plain wrong... black market, war lord stuff! I think community-based "socialized" healthcare (like I described above) is a happy medium. No one should get in the way of a doc who wants to help someone even if that person can't afford to pay... if the doc doesn't care about doing the work pro bono or discounted, then it's nobody's business. Sliding-scale doesn't have to end in price-gouging unless the practitioners get greedy... perhaps more transparency of costs and reasoning would keep people from getting too grumpy about the discrepancy of charges.

keelba's picture
keelba
Status: Bronze Member (Offline)
Joined: Dec 17 2008
Posts: 55
Re: Health Care Reform?

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.

 

ccpetersmd's picture
ccpetersmd
Status: Martenson Brigade Member (Offline)
Joined: Oct 12 2008
Posts: 799
Re: Health Care Reform?
PlicketyCat wrote:

I think part of the problem is that our current system actually forces practitioners to think in terms of profit because they have to. Using your double brain transplant analogy... the surgeon knows that a double brain transplant will take him most of the day to perform, during which he won't be able to see any other patient or get any other work done. So, he knows that he normally makes about $2k a day doing normal business, so he charges $2k for the surgery... maybe a little more to set aside to cover some "pro bono" surgery for another patient at some future time. Now, simply because Insurance #1 will pay $5k, he sets his price at $5k even though his effort/expense is really only $2k... and the uninsured patient gets nailed by artificial price inflation. If the surgeon simply charged a set rate for the surgery, regardless of whether the "going rate" was higher, then neither he nor the patient would have to be concerned with the whining insurance companies or possibly commiting insurance fraud.  Again, this is the fault of the insurance companies & government... not specifically the practitioner (although there are some money-hungry practitioners out there who do milk the system).

Yes, we do have to think about profits, at least those of us in private practice. I will always try to get the best price that is offered, as there are other services I provide that are routine a loss for me financially, and I have four employees.

PlicketyCat wrote:

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.

This is a great model; one that would be a pleasure in which to practice, and one that puts accountability for services in the hands of individuals and the community, in whose hands I believe it belongs. I have written elsewhere on this site about community-based medical services, particularly for primary care services, which would fit well into the experience you describe.

PlicketyCat wrote:

So, no, I don't believe that more government regulations are the answer... unless the regulations are strictly applied to the INSURANCE companies, while leaving the healthcare practitioners to operate less burdened. I fully believe that the healthcare system would function more like a true free-market system if we could remove the blood-sucking leeches (insurance companies) from the mix. But, on the flipside, healthcare practitioners shouldn't be able to jack up their prices simply because they can... and that is the problem with free-market and consummate-demand commodities. Getting rich off the suffering of others just because you can is just plain wrong... black market, war lord stuff! I think community-based "socialized" healthcare (like I described above) is a happy medium. No one should get in the way of a doc who wants to help someone even if that person can't afford to pay... if the doc doesn't care about doing the work pro bono or discounted, then it's nobody's business. Sliding-scale doesn't have to end in price-gouging unless the practitioners get greedy... perhaps more transparency of costs and reasoning would keep people from getting too grumpy about the discrepancy of charges.

Overall, I think you and I are saying quite comparable things, but from slightly different angles. However, I would not describe a community-based healthcare system (at least, not as I would envision it) as "socialist" in any substantial way. This is just local communities coming together to do for one another what they are supposed to do, care and assist one another. And, as to free-market principles in healthcare, I think most practitioners (not all, mind you, and I know some) are very fair and generous people, and would not take advantage of those in need. Most of us provide care for free quite regularly. And, if a given medical service were able to premium prices, that would potentially attract more practitioners to that field, increasing supply, and ultimately decreasing costs.

I have a libertarian perspective on these things, I admit, but I can see much greater benefits to our healthcare system from the adoption of true free-market reforms, than I can see from any other possible system.

ccpetersmd's picture
ccpetersmd
Status: Martenson Brigade Member (Offline)
Joined: Oct 12 2008
Posts: 799
Re: Health Care Reform?
keelba wrote:

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.

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.

jneo's picture
jneo
Status: Platinum Member (Offline)
Joined: Jan 7 2009
Posts: 742
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).  

Brandon's picture
Brandon
Status: Martenson Brigade Member (Offline)
Joined: Oct 6 2008
Posts: 143
Re: Health Care Reform?
PlicketyCat wrote:

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.

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

 

green_achers's picture
green_achers
Status: Silver Member (Offline)
Joined: Jan 3 2009
Posts: 205
Re: Health Care Reform?
becky wrote:

 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

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.

ccpetersmd's picture
ccpetersmd
Status: Martenson Brigade Member (Offline)
Joined: Oct 12 2008
Posts: 799
Re: Health Care Reform?
Brandon wrote:

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

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.

PlicketyCat's picture
PlicketyCat
Status: Platinum Member (Offline)
Joined: Feb 26 2009
Posts: 680
Re: Health Care Reform?
JK121 wrote:

 

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).  

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.

anarkst's picture
anarkst
Status: Silver Member (Offline)
Joined: Jul 1 2009
Posts: 121
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.     

ccpetersmd's picture
ccpetersmd
Status: Martenson Brigade Member (Offline)
Joined: Oct 12 2008
Posts: 799
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.

ccpetersmd's picture
ccpetersmd
Status: Martenson Brigade Member (Offline)
Joined: Oct 12 2008
Posts: 799
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.

http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?_r=1&page...

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.


 

ccpetersmd's picture
ccpetersmd
Status: Martenson Brigade Member (Offline)
Joined: Oct 12 2008
Posts: 799
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/

stephan's picture
stephan
Status: Member (Offline)
Joined: Aug 13 2009
Posts: 1
Re: Health Care Reform?

“Health insurance is fundamentally about peace of mind. If you have good insurance, you don't have to worry about an accident or sudden illness. You know that whatever happens, you and your family will be taken care of.”

http://www.ninjagreens.com

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