I know that most are probably rather sick of hearing the debates regarding health care, and maybe that "sickness" is hurting the debate.
It seems that lately all sides of the debate are spitting out all kinds of falsehoods. Some of those who oppose reform in general have gone as far as saying that the proposed plans will allow the government to get rid of old people (which obviously the government has been wanting to do for some time....?). Some who are for reform say that the opposition are just using scare tactics and lies and need to be reported (those stupid, gun totin', religion clinging, change hating fools), then they spout out statistics and numbers which are completely off the wall and false (I'm sure Surgeons would love to make $50,000 on a surgery as Obama indicated they do - too bad the medical board has come out and stated that the most a surgeon makes on a single surgery is well below that, in fact the citation from Obama is that they make up to $50,000 on an amputation when in fact the highest fee is less that $800). There are two things that really bother me about this extreme side of the debate. The first is, do they honestly believe in what they are saying? If so it scares me because that must mean they are extremely ignorant. If not, then what are their real intentions for spouting falsehoods? I know there are many answers to that question, but let's just leave it open.
Second, these extremes are distracting majorly from the real debate of health care. So much so that I recently read on Wikipedia the "definition" of health care reform and where it goes through the U.S. debates it states the extremes and divides those extremes strictly by party line. Meaning, it insenuates that all Republicans believe that reform is the beginning of the decline of our country into hellish communism. All Democrats believe the Republicans are liars and that the only way to "save" the country is to have a public health care insurance option.
I don't know about you but I don't fall into either of those categories and neither do friends of mine who fall on both sides of the aisle. I only hope that everyone researching into the debate will ignore those extremes and, when voicing their opinion to their representatives, will stick to the real facts up for debate.
I have seen some good articles that do just that (avoid ad hominem attacks and outrageous lies) and I wanted to pass them on to anyone reading the blog.
Distractions in the Debate
The Public Option Doesn't Work
Driving the Wedge
Cutting Medicare Costs (Why can't we focus on these ideas? I'm not saying whether this is a good or bad idea, I'm just saying, why not focus on this kind of reform?)
I've read other good articles that debate specifics, but if anyone would comment with something they have read I would appreciate it. You also probably noticed that I only posted articles that I agree with, so it is a biased list, but hey, it's my blog. I am open to opposing articles that stick to the real debate.
3 weeks ago
Posts
5 comments:
I used to be staunchly against healthcare reform, because it seemed that all everyone was talking about was escalating costs. That frustrated me, because as a healthcare professional, I don't see a lot of excess. I don't know many people who would say "yeah, I'm overpaid." Considering the risks I take (exposure to many contagious illnesses, blood-borne pathogens, physical labor, etc) I can definitely say I earn every penny. Doctors have the same risks, and in addition must be available 24/7. They don't get days off, nights off, or much rest. At least not the ones I work with. Also, they have the added expense of malpractice lawsuits. Instead of doing what's really right for the patient, they must also practice defensive medicine. They must order extra tests and procedures to protect themselves from lawsuits. That's another blog entirely, since I think there are way too many lawsuits (frivolous and otherwise).
I have a high school classmate, who is now an ER doctor, and he wrote an excellent blog (in my opinion) on the economics of healthcare reform. Although he had many things to say, the point I loved most was about a government monopoly. Once government achieves this (and with a public plan I think they will), the number of physicians willing to work at their reduced prices will significantly decline. By lowering supply (fewer doctors) and raising demand (covering all Americans) costs will go up. Not monetary costs - those will go down. But quality of life, quality of care, and waiting time for essential treatments are costs that will escalate. The entire post is http://paulamy.blogspot.com/2009/06/what-to-reform.html
Also, on the topic of costs, you get what you pay for. Sure, monetary costs have gone up in the last 50 years, but so have life expectancies. So have cancer survival rates. And mortality rates have gone down. I would much rather pay more and get today's medicine than pay less and get treatments from 50 years ago. Really, who would want to be quarantined for measles, mumps, or scarlet fever? An iron lung after polio? No thanks. These are diseases we now have immunizations for. And let's not forget antibiotics and the wealth of medications we have. Cars and houses were cheaper 50 years ago too - should we go back to the way things were for everything that has risen in price?
But lest you think this is all against reform, I have had a slight change of perspective. Recently I was contemplating the issues and turned my attention to people who are denied insurance because of past medical history. Did you realize that something as simple as elevated cholesterol can make you unisurable? Cancer, diabetes, and a myriad of other common diseases are also grounds for exclusion. For many who have these illnesses the only option for coverage is employer-sponsored healthcare. They must accept jobs, perhaps even those less desirable with lower wages, just the the insurance benefits. I'm not sure I like that aspect of insurance. Perhaps instead of healthcare reform, we should have insurance reform. Keep the healthcare industry private, as it is now, but add stipulations about excluding people (or rather not excluding people).
I don't have the perfect solution, and I don't think Congress does either. But at least for now I have an open mind.
I think that your comment is exactly what the debate needs. We need more people bringing up valid points that can be debated and researched so that conclusions can be drawn. Then those conclusions (because I also don't think there is such a thing as a perfect answer) should be debated. The problem right now is that there is so much "noise" that no one can really research the solutions unless they invest a significant portion of their time.
Since I do get to invest a significant portion of my time in research (I have written one article for our clients and am working on another - which isn't to say that I know all the answers but that I have been able to invest the time into pushing past the noise and have seen the "real" debate - I want to share some of my thoughts on your points.
First, I think a significant portion for your reasons against reform are based on the supply and demand side of the costs. When there is rising demand, which comes not just from expensive new technologies or more insured people but from the volume of baby boomers moving into the age of the highest medical usage, and there is low supply (even though there are significantly more options of treatment and cures available there are fewer doctors and providers of innovative treatments) prices will rise. The problem has been that prices have been rising faster than is considered reasonable for what I believe are three reasons. First, malpractice insurance. That brings up the costs of providing the product which cost must be passed on to the consumer, and as you state defensive medicine brings up costs as it uses up resources. Which brings me to the second reason which is that people are going to the doctor and using up resources needlessly. I know many would argue with me on that but if you look at the research that has been done on how preventative medicine or the going through numerous tests to rule something out, among larger groups will raise costs higher and faster than the benefits. If you screen everyone for a disease that only occurs in 1 in 1,000 people you are paying for a thousand tests and visits before you get to one which, if taken care of, would result in a net cost savings (higher cost to "cure" something in later stages than early). I know that might sound cold because why not check everyone so that you can find the one, but if the original argument is to lower costs then you have to think economically not compassionately (might not be the right word). Finally, and my primary issue, is that the end consumer is separated significantly from the "seller" (doctors and medical companies) by insurance. This separation distorts the free market and will artificially raise demand (think about how much of what you consider an essential but somewhat expensive product you would buy if you didn't have to pay the whole price). This isn't to say that I think insurance evil, it is just that I think insurance morphed into something it doesn't need to be. It used to not be paid for partially by employers and was really only used for rare/extreme circumstances. Think about home insurance, should insurance pay for my landscaping (you could argue that landscaping would help reduce erosion...)? Similarly why have we demanded health insurance cover the little things? Why don't we use HSA accounts to pay for the "little" things that we want which might lengthen and maybe improve our quality of life, but aren't necessary? That's not to say that I am for eliminating insurance. It is just that until consumers "feel" the costs of the things they purchase they will use up more than is likely needful. Of course, there is still the debate of how do you care for those who really can't pay for anything themselevs.
Anyway, I know that is a long response, but I get excited when I see a well thought out and valid argument in the health care debate.
I REALLY liked your last point. I think it would be much better if the patient and doctor communicated directly rather than having a third party in the middle. Besides the benefits you stated, patients could have a better say in their care. Some insurance companies eliminate care that doctors think is necessary. By letting the patient decide if they want to incur the costs, patients have more say in their own health (although they will have to accept the consequences). That way, each person can choose to be tested for that 1/1000 disease that you mentioned if they want. But they will pay for it themselves, either way.
I love your ideas about HSA's. You understand the purpose of insurance exactly - it is for the big things (I used to have my insurance licensing, and would get frustrated when my customers couldn't understand that concept). Our homeowner's deductible is $1,000 for that very reason. Insurance isn't to claim the small stuff. It is for the bigger disasters. I think it would be great to see HSA use for small stuff, and insurance for the life-threatening issues.
As you stated, their is no perfect solution. But I wish the government leaders would focus more on insurance reform rather than creating yet another government program that is sure to burgeon in costs and shrink in efficiency.
Oh, I have one more question for you. I was recently talking about reform with another nurse at the hospital, and she was for reform. She stated that there are many things that can be bought and sold, but healthcare shouldn't be one of those things. Her opinion was that since healthcare is essential to life, it should be above economics and business profits. It should be available to everyone since it can be a life or death matter. How would you respond to her argument?
I would say that as soon as you take the debate away from the economics of health care you get into a give and take. Not everything in life can be called a "right" and therefore be "guaranteed" in a way by the society. For example, the American dream is not a right. Many thought it was and that is what caused the decades of over leveraging and horrible legislation which allowed everyone to get into a home.
If we, as a society, decide that health care is a right we would have to then decide a few other things. With the resources we have can we guarantee that society provide for that right and if so, what other rights would need to be sacrificed due to the draw of resources? We would also have to decide as to what level of health care is a right. Some consider massages part of their health care (in fact some insurance policies cover them). Is that a right we want to guarantee as a society? Could massages for that individual be what is keeping them healthy and happy and if so who are we to decide someone can't have it?
The sad thing is that when I see people debating this topic in comments on articles or in blogs those who feel health care is a right and should be provided for by society never address what exactly should be considered a right and they almost always say that current resources being used for war could be used to guarantee health care. I don't know how you feel about that, but personally I think that is a rather narrow-minded argument.
Post a Comment