Wednesday, March 3, 2010

Sure, Let's Keep Talking About Health Care Reform

As the Democrats in Congress and Pres. Obama renew their efforts to pass health care reform, I thought I'd take the cue and go over the case one more time.  I know it is overkill, but overkill is the true spirit of blogging.

We have an unmistakable health care problem in America.  Most everyone can agree with that (except the wealthy).  There are about 47 million Americans without health insurance, and about 10 million children, most of whom want health insurance but either can't afford it or have been denied coverage based on a pre-existing condition (which can range from big problems like heart disease to something menial like heartburn).

Even if you are lucky enough to have health insurance the picture is not pleasant.  Premiums are rising at four times the rate of inflation and wages, and have doubled over the past ten years (has your earning capacity doubled in the past ten years?).  Insurance companies are also notorious for avoiding paying out for ostensibly covered procedures based on any technicality they can find, or for no reason at all.

You see, health insurance companies are in it primarily and overwhelmingly to make money for their shareholders.  While that may be something acceptable for, say, a toy company or a chain home improvement stores, it is not desirable for our health insurance industry.  It has lead directly to the problems we are experiencing now:  In order to make as much money as possible they do all they can to make health insurance unavailable to the average American.

In the face of this mountainous evidence of a broken system, many will claim that increased regulation, a public option, or a single-payer system would destroy the best health system in the world.  The WHO ranked America's system as 37th internationally.  We are 33rd in infant mortality, 38th by life expectancy, and usually the around lowest among industrial nations in terms of satisfaction and self-appraisal (in other words, Americans hate their system more than almost any other nation hates their own system).

We have hardly the best system in the world.  Maybe the WHO ranking is a bit low, maybe a bit high, but we have nowhere near the best system.  The critics will point to the anecdotal evidence of people coming from Canada and other countries to have procedures done in America.  I would respond in two ways.

First, I have plenty of anecdotal evidence of Americans who go to other countries to get work done faster and cheaper than they could have in America.  Second, and this is the key, if you are rich enough to be able to come to America to have a medical procedure then, yes, we have the greatest health care system in the world.

America has the greatest health care system in the world if you are wealthy.  If you are not wealthy, we have a terrible system.  Like all other facets of our great nation, if you are wealthy our system is the best.  If you are wealthy unfettered capitalism is the best system in the world.  If you are wealthy you have access to the best education system in the world.  If you are wealthy and can buy politicians, we have the best system of government in the world.  If you happen to be like the vast majority of Americans and are not wealthy, well, too bad.  You are not rich and powerful enough to change the system, so you get to be told how great it all is while looking around and seeing nothing but problems.

I don't think the Democratic plan will save health care, but it is a start.  It's something.  What we are doing now has failed, so trying something new that has worked in other countries is not a bad thing.  And if it takes the reconciliation process to overcome Republican filibusters and obstruction, so be it.


Daniel H said...

I agree with you - having my wife spend a year uninsured, only recently covered in part by UPP and my children thankfully insured by ChIP, it's been nerve wracking. Even then, I find myself not giving myself the medical care I think I need for the short term budgetary gain, because otherwise, we can't make ends meet.

So you're right - our system is great, if you're rich. If you're not rich, you dread getting sick and going to the doctor.

Jacob S. said...

My family as been and is in about the same position as you. There is nothing like working a full time job and not being able to afford health insurance. Then add on a minor pre-existing condition precluding you from coverage and it is absolutely nerve-wracking. Every day you wonder if this will be the day someone in your family breaks an arm, gets pneumonia, or something much worse and puts your family on the edge of bankruptcy and ruin.

The emotional strain is the untold side-effect of our broken system.

Elle H-T said...
Jake- read this! It's amazing I think this maybe something we both can agree on. Why is no one talking about this? There was also a frontline done on the same topic, check it out and let me know your opinion.

Jacob S. said...

I'm about half-way through it right now (I won't be able to finish for a while) but I have to say that so far it sums the whole thing up beautifully. My favorite line so far is:

". . . those two failed systems [government and health care] have collided in a spectacular crossroads moment in American history."

I will not debate that the American government, on any level, is a ridiculous hodge-podge of special interests and power-hungry politicians, it is true. But even though the health care reform going through Congress now is flawed and falls way short of what we need to fix the system, I really believe we need to pass something to get the ball rolling towards a real solution. And the real solution, that the author of that article lays out nicely, is a single payer system.

From what I've read so far, an excellent article, thanks Elle.

Jami said...

So none of you know me. I just found your blog through a friend. I have to say I completely disagree. No, that's not true. I agree that healthcare is a major problem in the United States of America. It IS expensive, no one can argue that. But so is going out to eat, going to a movie, buying a car, having life insurance, having car insurance, owning/renting a home, etc... The problem that I have is no one in our generation thinks that we need to buckle down and figure out tough times. Or that we should have to.

No one wants to give up any of the stuff that I wrote because that's just part of how people live and that would be hard to have to take away those luxuries just to put it toward health insurance.

What makes us think that health insurance is a human right? Is having a cell phone a right? cable? Internet? What about a car? A house? You may argue that those are just things, we are talking about people's LIVES!!! I am saying if healthcare means that much to you, which it should, give up everything that isn't necessity and see what you can do...go from there. I just don't think you really can complain until you have done everything you can do.

Insurance companies take advantage. Government has put regulations on insurance so they cannot cross state lines to bring down rates and provide the consumers with good competition between companies. I think when you take capitalism away by shutting down these private companies and give more power to the government, you are going to say good bye to even more of your freedoms.

I am not rich. On the contrary, I am a mother of three and my husband is in school and we live off off school loans and the money he brings in from a part time job. However, taking the road we have has taught me that life is rough and you do what you have to do.

I went to go read the article suggested and could not even get past the first sentence:

"Let's start with the obvious: America has not only the worst but the dumbest health care system in the developed world."

Are you talking about South America? I'm pretty sure that we have the best medical system in the world and that is why people come from all over the world to be trained at our schools and why people fly in from all over the world to be treated by the world's BEST doctors? What country do you live in? This is America!

Quit complaining and get up and WORK HARDER!!! (Millions of people on welfare are depending on you! Sorry, I just love that bumper sticker!) It's the only country left where you can still have a dream and WORK HARD to achieve it. Please don't let it change. Fight to keep our freedom. God helped our founding fathers set this free nation up and no where did it say that healthcare was a right. I say quit taxing America so stinking much and see how generous people will be when they don't feel like so much money is being stolen from them. I think I can guarantee we will always come out more generous that what the government takes from us.

One more perspective before I get off my soapbox. I am SO grateful for health insurance. While it is expensive and most of the time confusing and frustrating to deal with, I have personal experience with it being wonderful. I have a little brother who has had two brain tumors and is now completely hormone dependent and severely mentally behind and physically handicapped, but thanks to the wonderful training of our medical doctors, is still alive. I have a father who had such a rare cancer that he battled with, and thanks to our wonderfully trained medical doctors, is now the 15th documented person to survive the treatment for that cancer after a bone marrow transplant. Without having the medical insurance that he worked his whole life to have, I would no longer have my little brother, nor would I have a father on this earth. I am so grateful for insurance.

Shawn O. said...

Jami, I agree with many of your points; however, there is something fundamental that I want to clarify. I actually don't think that health insurance is a right. BUT, access to medical care IS a right. I agree that many people feel like they have to have a cell phone, go to movies, etc, but the difference is, you won't die if you don't have these things. Health insurance in and of itself is a joke. The real point is that people, in my opinion, have a right to healthcare, and that access shouldn't be limited.

I completely agree that our (assuming we're close in age) and the younger generation have lost most of their work ethic. We do complain too much, and too many people are looking for a free ride. So, yes, everybody should get off their proverbial butt and get to work. But what happens when an individual works to the best of their abilities and still falls short? is denied healthcare because of some "pre-existing condition"? You're brother appears to be a perfect example - is he able to maintain employment that includes healthcare benefits, or is he able to purchase his own insurance? Perhaps he is still listed as a dependent under your parents? Or maybe he qualifies for medical access through medicare or medicaid? My guess is it is one of the latter.

The point is, there are many "luxuries" in life. There are also necessities - health care at the top of the list. Not insurance, but real medical access.

I also agree that the US has an outstanding medical community - the doctors, the technology, the facilities - nobody is disagreeing with you. The problem is that the health care SYSTEM - the ability of every citizen to access said medical community - is what is referred to in the statement "America has not only the worst but the dumbest health care system in the developed world"

Like Jake said, if you are rich, this place is awesome. Don't believe us? Try calling up one of the better surgeons in Utah (or wherever you may be) and ask for an appointment. Tell them that you have no insurance, or even insurance that they "don't accept". If they do let you in the door, ask them how much the surgery is going to cost...

peter said...

You are absolutely right; few people would argue that we don’t need health care reform. However, I have come to realize that health care reform means vastly different things to different people. My idea of health care focuses on cost reduction as a means to make insurance affordable and then continue to cover those at the lowest end just as always. It seems that the focus of most liberals (and correct me if I’m wrong) is to primarily get everyone covered and if we can make it more affordable at the same time, great. I believe that both positions could be argued with validity. Maybe that means that the best bill would truly mesh both of those ideas, but the current one has a very obvious leaning. This is obviously with reason, when the bill was being crafted the democrats had the majority in both the house and senate and saw no need to truly cooperate with the other party. Who can blame them? But I think the bill suffers because of this. Lately there have been overtures and a show of “bipartisan” efforts, but I think that it really has been politics as usual. The democrats are trying to make the republicans look bad for not cooperating (while very few of their ideas are in the bill in any form) and the republicans are hoping that the democrats will hang themselves with their own noose.

As you can probably guess, if I had to side with one or the other group of numbskulls in Washington DC, I’d agree with the republicans and say the bill isn’t great. It’s a hodge-podge of politically driven items that seem to be more focused on winning a popularity vote than in making meaningful reforms that will bring down the cost of health care. Even liberal physicians that I have talked to are wary of the bill and the myriad of unintended consequences that could come from it. No one from the medical community that I have talked to (and I admit I haven’t taken a broad survey of the country) thinks this bill represents meaningful reform. It really does nothing in regards to the drug companies, it doesn’t touch medical malpractice reform (though I don’t expect too much from the group of lawyers on Capitol Hill (yes, that was a bit sarcastic, I apologize)), and it includes several exemptions to different states and special-interest groups in order to win votes. This bill doesn’t do anything to change payment rates to reflect or lead to a primary care based system which is much more efficient than our currently confused, wanna-be-specialist based system. I also don’t like the exclusion of the Stupak amendment. I won’t argue a woman’s ability to choose to kill a fetus as a form of birth control, but I wouldn’t like to be the one paying for it.

“Insurance companies are also notorious for avoiding paying out for ostensibly covered procedures based on any technicality they can find, or for no reason at all.” I loved this line Jake, because it’s true. But if we’re going to be outraged at the insurance companies, let’s not forget that the government is as guilty as all the rest. Medicare and Medicaid act exactly the same way, but because the patient rarely ends up responsible for the bill, people don’t get upset about it. In fact the government takes it one step further, not only will they not reimburse you, they might charge you with fraud.

Sure, there are cases of Medicare and Medicaid fraud perpetrated by physicians and hospitals, but this is the exception and not the rule. However, an accidental miscoding of reimbursement submissions (on constantly changing regulations and rules) can be considered fraud by the government. Therefore, the hospital here has to employ about a dozen people who do nothing but look over medical charts every day and make sure that every little thing is documented correctly, with precise wording, so that they a)get paid and b)don’t get charged with fraud. I find this not a little humorous.

I do hope the president finds and prosecutes people committing true fraud, but I don't think the government is any better qualified to run health care than the insurance companies.

Nick & Liv said...

Jacob, I very much enjoy reading your posts and especially your take on health care reform. I hope you don't mind that I reposted this on my facebook :)

Jacob S. said...

No, not at all. Thanks for reading.

Elle H-T said...

I submitted this comment Jami's blog and thought I'd put it here too! I've thought about her comment for a while and just thought I have to comment back:
I'm a rockin red republican too and I submitted this article to Jake. I think that there needs to be reform because as the article states the health care SYSTEM in america sucks NOT that the health care sucks our care is the best in the world we just let the insurance companies get out of hand! They lie cheat and steal and I'm fed up with all of it and Washington too! It's not fair for a company to say they'll pay a claim and then won't and you get stuck in collections because they didn't pay and then you are liable for the whole amount and all the fees! It's crap and there is nothing you can do about it other than try and switch companies- our laws protect us from any other business from running like this- that what need to be reformed! I'm not the biggest fan of a single payer plan but a single rate rate plan would be refreshing! Furthermore this system has been a great success in other places around the world- Maybe we should get off our high horse once and a while and see how other countries do things- We might just score! So read the whole artical and watch the frontline before you knock it!

peter said...

Elle, I just read the article and it was a good read, I also don't necessarily think that the government should be the administrator of a single-payer system, but a basic healthcare option available across state lines that anyone can access and run as a not-for-profit, I could get behind. I don't know that I would base it on Medicare rates unless the government gets a permanent fix on the "sustainable growth rate" reimbursement formula which they keep trying to patch.

I've been looking at other countries and how they run their healthcare systems. Some are single-payer, but there are several that have a mixture of private/public systems that we could really study since the United States is honestly already a mixture of public/private systems.

One thing, and I've said this before, that I think plays a large role in the quality of healthcare for the cost given is a primary care based system. Most (if not all) of the countries we are citing as examples of good healthcare at a lower cost use a primary care based system, meaning that preventative care and maintenance are handled out of the office of a primary care physician and to see specialists you need a referral. This model has shown to be more cost effective, yet Americans want direct access to their specialists which results in higher cost.

Are these countries so much better at health care distribution based on cost because they have single payer systems, or because they use a more efficient healthcare model?

I guess I'm just disappointed in this whole process and its seeming inability to bring about meaningful reform.