Thursday, November 05, 2009

Get real on healthcare reform

In spite of all the things going on I haven’t written much about the huge healthcare dilemma in this country. I suppose in light of news reports which claim we're getting close to voting on a final health care bill in congress, that I should give my take on it all.

Getting a final vote would be good news if serious reform were included in the package, but from what I've seen — and it is difficult to get accurate, digestible information on the proposals — the final bill appears to include little actual reform improvements.

Liberals are demanding a so-called ‘public’, or government ‘option’. That, to them, is already a huge compromise as what they really want is to completely scrap private insurance and create a single-payer healthcare system paid for by tax dollars and managed by the government. I’m glad that is off the table because such a thing would not possibly work in a country as populous, expansive and corrupt as ours.

The bill is reportedly likely to include a ‘public option’ though such a system may only come into being if certain conditions trigger it. It is also likely that there will be an opt-out for states that do not want to participate.

Many are saying that an opt-out for states will keep a ‘public option’ from achieving the cost savings, etc. that it is designed to create. That may be true, but I think it’s a fair compromise to give the states an opt-out and it also follows the constitution much closer by respecting state’s rights.

Personally, I oppose the ‘public option’, in part because it is going to come with individual mandates which will force people to buy healthcare whether they can afford it or not. A boon for insurance companies who would love to have a lot more customers, it will hit middle-income folks the hardest. These are the kind of people who typically don’t have a private insurance option through their employer and, living paycheck to paycheck, cannot begin to afford insurance premiums every month. They also cannot afford the penalties the government will impose for not buying insurance.

Of course, subsidies are supposed to address this issue, and for lower-income folks this may be adequate, but the subsidies proposed will not be adequate for those folks stuck in the middle who make too much for subsidies and too little for high insurance premiums. In the end this means less money for their families and still no health insurance. Incumbents should beware this group of individuals.

I also oppose the public option because it doesn’t actually address the exorbitant costs of health care. While increased competition for insurance companies sounds great — which is why, unlike Democrats who claim to support increased competition, I agree with Republican efforts to eliminate laws preventing insurance companies from offering services out of state — the fact is, much of the high costs in health care isn’t from insurance companies it is from the medical industry (doctors, hospitals, pharmaceutical companies) itself. Insurers having to compete with a government program will not actually do anything about this.

So much for the Democrats pet project. Now for the Republicans. They keep harping on ‘Tort reform’. I’ve been cynical of the idea since I first heard it bandied about because I know that doctors and hospitals will more often than not weigh the costs of lawsuits and bad press vs. the costs of having adequate safety procedures in place and they will choose the least expensive option. That’s common sense that even a Tea Partier should be able to understand.

Quite simply, if you put a cap on malpractice lawsuits then you’ve just given the medical industry at large a free pass to practice much riskier medicine while patients will have little if any recourse to receive compensation and hold those responsible accountable. It is a monstrously bad idea, but Town Hall screamers are too blinded by their laissez faire ideologies and their partisan hatred to notice.

There are other reasons not to support ‘Tort reform’ though — it won’t actually drive down healthcare costs. For those that are wondering, malpractice lawsuits account for about 1% of healthcare costs. And in most states which have legislated tort reform controls, medical costs have not decreased at all. In fact, they’re comparable to states which don’t have tort reform laws. So, next?

I read an interesting article in Time magazine a few weeks back which talked about what Geisinger Health Systems in Pennsylvania is doing. Like some other well-known medical facilities, they are using a great system of paying their doctors by salary, not by services. This keeps patients from being treated like cattle—doctors trying to herd as many patients through their doors as possible to maximize profits.

Incentive for doctors still exist at Geisinger, too, only not based on how many MRI's and unnecessary treatments patients have, rather, they receive bonus pay based on how much healthier their patients are getting due to their care.

This is just one example of the ways that health care in this country could be improved and costs could be lowered by reinventing the way the medical industry does business. And while some in congress, and President Obama, have paid lip service to this in speeches, little attention actually seems to be given to what I believe are the fundamental solutions that could solve many of our problems.

Instead, Republicans and Democrats, liberals and conservatives bicker about bogus remedies like ‘public options’ and ‘tort reform’, or rehash lies about ‘death panels’ and denials about the inevitability of rationing care.

Both sides are so completely dishonest in this debate, it’s difficult to really wrap your head around what is what. An example of this is the 'public option'. Democrats tell us that if we like our current health care we can keep it. Nope, not if our employer switches health care plans we can't. Why not just be upfront and admit that? Conversely, Republicans insist that if a 'public option' is passed we'll all end up getting stuck with it. And, so they claim, it's not fair for us to be denied an option to choose our health care. NEWSFLASH: the overwhelming majority of us have ZERO choice as to who our health insurance provider is. We take what the employer provides for us, or we buy our own for a much higher price.

I, personally, have good health insurance through my employer. Through my previous employer, however, the coverage sucked and the price was more than I pay now, in spite of getting paid more than twice per hour now than I was paid then... And, though it may come as a shock to those upper-middle-class 'tea baggers' who can afford to take a day off from work to wave flags, brandish guns and carry 'Obama as Hitler' signs at the U.S. capital because their taxes might increase to what they were under the Clinton administration, I'm not an isolated case.

I'm covered today. My boyfriend isn't. What is the Republican solution to such a thing? Ending malpractice lawsuits... I don't know which is worse, that elected representatives sell us such a line of deliberate deception or that so many Americans are stupid enough to demand it themselves.

Another fine example of dishonesty displayed by both sides about the same issue can be found in the fact that while each decry the other’s plan as ultimately increasing the cost burden on patients, yet both sides agree that we need to pass legislation that will in all certainty accomplish this very thing. I’m talking about the much needed reform which will keep insurance companies from denying coverage based on pre-existing conditions or from imposing cost caps just when people need the coverage most. Such mandates will increase insurance costs for all of us, but neither side will admit this fact.

Another example of flagrant dishonesty is how conservatives will claim that the Democrat’s bill will give illegal immigrants free health care even though current law doesn’t allow this. Conversely, Democrats claim that their bill won’t do this yet they are in fact building the case as to why we should give illegal immigrants free health care. Liberals, including many in the mainstream media claim that since we’re already paying when illegal immigrants turn up at emergency rooms for expensive treatment for non-emergency ailments, we would save money by  providing them free healthcare.

If either side were honest, they’d propose that we close this loophole perhaps by fining hospitals which bill the government for non-emergency treatment provided at emergency rooms. But then that wouldn’t play well in the Hispanic lobby and besides, they don’t want to actually address this substantial cost loss they just want to bitch at each other and keep droning those talking points for the masses to scream at each other over.

In this whole nonsensical debate about what to do, I find myself constantly frustrated by the total lack of anyone acknowledging the obvious, which is: it is not who picks up the tab that is important, it's how much the bill is.

Many claim that the young and healthy just won’t buy insurance, to which I say BULLSHIT! You make it affordable, most folks will buy it. We don’t need mandates, we need affordability.

I think we could achieve this by improving efficiencies (as has been proposed) and implementing sweeping changes like those found at Geisinger, the Mayo Clinic, the Cleveland Clinic and Kaiser Permanente are absolutely essential.

When it comes to insurance companies, I would like to see increased competition. Let them compete with each other across state lines. There is no reason not to. And create a model for non-profit, customer owned health cooperatives. No, it is not a ‘public option’, yes, it will work.

Prohibit insurance companies from denying people coverage based on pre-existing conditions and imposing cost caps. Also, force them to spend 85 cents of every dollar (as has been proposed) on coverage for their patients. If this doesn’t leave enough profit from some insurance companies, fine, then get out of the insurance business. There are billions of dollars to be made, others can and will make it work.

As for those who cannot afford even a reasonably priced healthcare plan, extend Medicaid to more people. Go to about 4 times the level of poverty. And don’t pay for this by taxing the ‘Cadillac’ insurance plans that some police, firefighters and union workers have, target those ‘Escalade’ and ‘Rolls Royce’ plans of the CEO’s. They can truly afford it. Hard working middle-class folks who took better insurance in place of pay raises, can’t.

So, for what it’s worth, that’s my take on it.

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