A brief rant on health care reform
I plan on discussing this issue in more detail, but until then, here's some of what has been rattling around in my brain the last few months.
Here's my basic take: true reform of health care will never happen until the insurance companies' grip on the system is broken.
It seems that in this country we have determined that "health care" and "health insurance" are the same thing, and that is just bullshit.
I am generally in favor of a public option. I don't even mind spending a ton of money on it--IF it can help reduce actual health care costs. And as I understand the CBO report of the current House bill, that bill does nothing of the sort. Indeed, the ultimate result is that our health care system will still be dominated and controlled by insurance companies--and as long as insurance is the dominating and determinative factor in the delivery of health care, costs will never go down.
And there are some other things that really piss me off about some of the current proposals, but that will have to wait. And I would say something about the Republican's proposal--except those craven cowards have not really made one. And I can tell you why...Anything they can come up with would not really be any different from what the Democrats have put forth.
And I'm so glad I can annoy people first thing on a Friday. :-)
posted by WCharles @ 9/25/2009 03:08:00 AM
5 Comments:
Just a few comments, it's the weekend, I've been doing yard work all day and need to practice my bass trombone - some Teele exercises - so I'll be brief.
For a long time now I've thought health insurance needs to be divorced from employers. I'm not sure how to do it, but being part of an employment package works only for those who are working for an employer who provides it. Everyone else has a problem. I have an excellent plan and an employer who does not pass on the annual increases to their employees.
The second problem I've seen is that the insurance companies often call the shots on medical care. That is not right. A quick personal example, several years ago my wife had routine surgery but due to some minor complications was not recovering as quickly as the insurance company expected her to. The typical hospital stay for her procedure was 2 or 3 days - I forget the exact number. At the end of the alloted time she was not ready to go home, but a nurse tried to push her out anyway only because of insurance. I work in human resources, we are self insured, my boss can direct the insurance administrator to pay the bills. I have the authority personally to instruct the insurance administrator to pay bills that normally would be denied. So, I tell the nurse my wife will not go home until the doctor agrees she is medically able to do so. She vehemently tells me it doesn't work that way. I inform her of authority and she argues back that I do not have that power. I know I do because I was able to do the same for 2 other employees previously. I win the argument. My wife had the medical care she required and insurance paid for it 100%. But, how many other people in that situation would lose the battle and settle for treatment less than the best?
Insurance companies should not have the power to coerce doctors to make decisions that go against their better judgment. But, it happens.
W, you are exactly right when you say heath care and health insurance are perceived as the same thing. They are not. They should not be. But, that is a significant part of the problem. People expect health insurance to pay the bills 100% and if it doesn't then the policy sucks. I hear that often at work. Go outside the network then the administrator pays only 80% instead of 100%. Insurance sucks. Huh? Where is it written you have absolute 100% coverage? We have come to rely on insurance to cover everything though, even for routine care. Maybe that's the problem. You have a little fender bender will you report it to you auto insurer? Most won't because it jacks up their premiums. People rely on car insurance to pay the big bills, the out-of-the ordinary bills. It sure doesn't pay for oil changes - though the last one for my XF cost me $189 and I wish I could file a claim for that. So, change the purpose of insurance.
Public option...... I have to disagree with you there. In theory it sounds good, but Obama has been lying to us so I don't trust him when he talks public option. The option part is the lie. His intent is not to make it an option, but to make it mandatory and to replace all private insurers with a single payer program. The lie is he keeps saying he is not pushing for single payer, but there are too many videos of him saying the exact opposite, that he is pushing for single payer and wants to put the private guys out of business. And fining anyone who does not pay for insurance???? Oh boy.... don't get me started on that one.
You are correct, W, the Repubs have not presented an alternate plan. So with most every other dispute, the truth is somewhere in the middle. The Repubs want to maintain status quo. Not a good option. Some of the Dems (but since so many Dems also oppose obamacare, that in itself speaks volumes) want to completely change how health care is funded. And that is scary and probably blue sky dreaming. The best course of action is somewhere in the middle of those two extremes.
Aren't you glad I was brief in this response?
I have to leave in 10 minutes for a hockey game, so I actually will be brief.
* I'm with you on employers and insurance.
* I am really with you on "insurance companies calling the shots." When I hear people complain that "we don't want the government making treatment decisions," I wonder if they think it's O.K. for the insurers to do that.
* Remember my "IF" on the public option. And I will say that--although I need to review many things--my understanding of the CBO report was that the cost of the public option would increase every year, thus eventually erasing any attraction it would have over private insurers.
* And one of the biggest problems I see is the requirement that everyone have insurance or pay a tax penalty.
More on all of this later...
Have fun with the Teele tones. :-)
Watch those hockey pucks... kind of hard to play trombone missing your front teeth.
Relative to who controls the shots with health care, it needs to get back to the doctors. Now let's take it one step further, why do doctors tend to go overboard with testing? Is it because they fear a six figure lawsuit for a perceived misdiagnosis? This is not as simple as it's been made out to be during the past few months of debate. We need to follow the money.
But, keep one thing in mind as we talk about control, when the government pays for services, they regulate. Sometimes those regulations can be eggregious and lead to further regulation. There is some truth to the so-called wild claims from the opposition, there is a slippery slope. In the February stimulus package there was $1.1 billion allocated for "comparative effectiveness research". Is this just a fancy term for health care rationing? A panel called the Federal Coordinating Council for Comparative Effectiveness Research was created from this allocation working closely with HHS to determine the "relative strengths and weakness of various medical interventions". One panel member is Ezekiel Emanuel, Rham's brother, who has said that the prevailing interpretation of the Hippcratic Oath leads to overuse of medical care and fosters a culture where "reasoning based on cost has been strenuously resisted".
Much of this has been quoted from World Magazine, you must be a subscriber to access their articles.
Having the government take over health care control from insurers still leaving doctors out of the loop is not reform.
Let me boil it down. The big fear is the type of government regulations that will be imposed.
I understand that last point, but let me go back and relate that to another point we each raised. What we have now is a high amount of regulation--only it is not from the government. It is from the insurance industry. The insurance companies determine what doctors we can see, what treatment will or will not be paid for, become the dominant factor in how health care providers must run their facilities and practices, etc. The point is that so much of what I hear people complaining about regarding a government-run program is exactly what we already have thanks to the insurance companies. And that gets back to your point about staying with the status quo not being a good option.
And that brings me to one of the things that is really driving me crazy about the "debate." As I see it, there are plenty of substantive problems with the primary bill being considered. However, opponents have chosen to make bullshit, irrational, emotional attacks. One result of this approach is that the proponents of the bill never really have to address the substantive problems to which I refer (and will try to detail in a subsequent post). Instead, proponents point out that these attacks are bullshit and then make the opponents look like nut jobs. That means that neither side really ever addresses the actual issues.
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