Friday, July 17, 2009

Let's Use Our Heads about Health Care

After months of talk, the debate is starting in earnest—if you want to call it “debate.” For the opponents of change, it’s more a process of pulling out the old bag of tricks and finding ways to manipulate the emotions of the public—at least that large percentage of the public that is easily and thoughtlessly swayed by slogans and TV ads.

An angry-looking Canadian woman claims that, in her own country, she was denied timely surgery for a brain tumor and “wouldn’t be alive today” if she hadn’t been able to get treatment in the U.S. Much more would have to be known about the situation to determine, from a rational perspective, whether that claim is true. Was the tumor really terminal? Was it untreatable? Were there better options, in the opinion of her doctors, than surgery? Is the woman wealthy? (That’s relevant, because in America, expensive life-saving procedures are often available only to the rich or well-insured.)

It’s likely true that, for whatever reasons, that one angry Canadian woman is dissatisfied with her country’s subsidized health care system. It’s also true that many, many people in Canada, England, France, Switzerland, and other countries are very satisfied with their health care. As someone who's been concerned about this subject for many years, I've talked with people in each of those countries, as well as with friends from other nations that have public health care systems. I have not personally met anyone who, like the woman in the TV ad, is bitter, dissatisfied, and convinced that the system in her country, as a whole, doesn’t work. (A recent article in the Denver Post, for example, expresses an entirely different view.)

Economists, doctors, small business owners, and almost everyone who’s ever been sick in America (or tried to stay well) knows the current system is untenable. It has to change. If business in Washington continues as it has lately, with some floating ideas and others shooting them down, the result will be much less satisfying than it could be with a spirit of cooperation and mutual support. And if we citizens demand such a spirit from our legislators, we're more likely to get it.

It’s always possible—and not very helpful—to track down a few nay-sayers and put them on television. What would be helpful is for interested citizens—regardless of political affiliations—to become informed about this complex issue and let lawmakers know specifically what they want and don’t want to see in the legislation currently being developed.

For example, there must be a public option to private insurance, in order to relieve the burden on small businesses and the self-employed (or those who would like to be self employed, if only they could get health insurance). There must be some way to control escalating pharmaceutical costs. People must be able to choose their own doctors. Whether you agree or not with these statements, they are the kinds of specific recommendations that could be helpful to legislators. Let's let them know what we want--not just what we don't want.

Change must happen, and the government must have a part in it. For too long, health insurance companies have called the shots—based on their natural desire for the biggest possible profits—when it comes to the health care of individuals. For too long, the divide has been growing between the rich and poor in terms of quality of life and the simple right to live.

It's much more difficult to learn, think, and make constructive recommendations than it is to simply say "no." In this case, "no" is not an option. Let's hope that as many Americans as possible will exercise their civic responsibility with a thoughtful, informed, and helpful kind of "yes."


Sue said...

I agree, Jane, that some changes need to be made in the American healthcare system. First, it is unconscionable in today's world that health care is dependent on employment. That made some sense in the era when people (meaning men) went to work for a company right out of school, spent their entire careers there, and retired a few years before their probable deaths from old age (at between 65 and 72). There was an unwritten contract that employees would be loyal and that employers would take care of their workers. This generally included health coverage for spouses and children. Now, of course, neither employers nor employees expect a lifelong employment relationship. In fact, many former employers now contract for temporary workers and workers may hold several jobs simultaneously. In this environment, employer paid or employer sponsored health coverage just doesn't make sense -- much less work.

Second, premiums range from outrageously expensive to totally unaffordable: both for individuals and for employers (especially the small businesses that make up the bulk of the employers in this country). The small company where I work is being hit with a 26% increase for the coming year, which is typical. Individuals and families will easily pay two or three times as much as individuals as they would as members of even a small group. And yet, if we were a larger company, our premiums would be lower and our coverage better.

Third, medical providers tend to be paid on a "per service" basis, which encourages expensive tests and treatments and to see more patients than they can easily accommodate. Paying medical providers salaries rather than on a service basis could go a long way towards controlling costs.

Fourth, (and this goes right along with point three) we need a good peer review system to assure that the tests and treatments ordered are consistent. This doesn't mean that research facilities would be precluded from developing new approaches or pharmaceutical companies new medications, but it would assure some level of consistency.

Fifth, health care needs to be structured to emphasize preventative care. HMOs have received a bad reputation due in part to the poor business practices of a few, but there are good ones. Kaiser Permanente and Group Health Northwest manage to take good care of their patients/clients while controlling costs and providing a high level of service. They could be excellent models for programs throughout the country.

Finally, health care doesn't need to be a "single" provider to be reasonably cost effective. Choice is a good thing, but the choices should be realistic. We can't afford to have people running from doctor to doctor to find an agreeable diagnosis/treatment. Sure, this means a few people will be unhappy, but the vast majority will find their options more than adequate. Medicare and good HMOs are a good example of this: you can choose your doctor/facility within pretty broad parameters.

The Preamble to the Constitution includes as its raison d'etre "esablish[ing] justice" and "promot[ing] the general welfare -- two things that a reasonably-thought-out health care plan would accomplish.

As to cost: if the money now being invested in employee health care by governments and corporations were pooled into a national program, I think we might find that we could cover all the people in the country for very little more than is now being spent on healthcare. Seems like we should give it a try.

Idna said...

Jane, I take exception to your constant portrayal of Republicans as having no ideas of their own and only saying 'no, no, no' to the Dem's plans.

One reason you say this may be that the Republican ideas are not given a lot of coverage. This is why there can't be a real 'debate'. The Dem's have all the power and numbers in D.C. now and they just will not engage in reasonable debate.

The Republicans did, in fact, come out with their own plan back in May. They have recently updated it. So please don't say that all they do is say 'no'.

As far as socialized medicine working so well in other countries ... I personally know several Canadians who have been coming to the U.S. for medical and even dental care for years because the wait is so long.

As far as the commercials against government run health care ... there are just as many emotional ads that the democrats use to push their agenda. So if you object to a "public that is easily and thoughtlessly swayed by slogans and TV ads" ... they are coming from BOTH sides.

I so agree with Sue that health care should not be based on employment. I have been waiting for this to be addressed in the big HC debate, but so far all I see is MORE suffocating rules and regulations coming down on businesses. The system of employer-based coverage is becoming "a 21st century relic", as one politician said.

As far as I'm concerned, government (fed, state & local) has absolutely no business telling a company owner how much to pay his/her employees (minimum-wage) or what sort of benefits the employees should be given.

I also agree with Sue that there are WAY too many tests being done, way too many office visits are automatically scheduled when there's no health issues and major waste of medical equipment (perfectly good stuff thrown away instead of cleaned.) (I'm speaking from personal observations .. but won't go into details now.) So as a way to curb SOME of this waste of medical personnel time and material waste, we need to reign in the lawyers and crazy lawsuits, make the loser pay for everything in frivolous suits and cap payouts.

And finally, I think we should try to recover from the "hope & change" hysteria that infected the nation recently and come back to reality. When the grownups who will actually have to PAY for the Obamacare fantasy look at facts, it's not a pretty picture. The Congressional Budget Office (Obama's own guys!) issues grave warnings about the trillions that this would cost.

From the New York Time today: "The nation’s governors, Democrats as well as Republicans, voiced deep concern Sunday about the shape of the health care plan emerging from Congress, fearing that Washington was about to hand them expensive new Medicaid obligations without
money to pay for them.

Gov. Phil Bredesen of Tennessee, a Democrat, said he feared Congress was about to bestow “the mother of all unfunded mandates.”

Mr. Bredesen was far from alone in his concern. “As a governor, my concern is that if we try to cost-shift to the states we’re not going to be in a position to pick up the tab,” said (our very own) Gov. Christine Gregoire of Washington, also a Democrat.

So when Obama gets on TV every day to try and get Congress to rush this thing through without people actually considering what will be in the bill ... (as in recent unread bills that were passed), please don't be thoughtlessly swayed, see this RUSH for what it is.

Obama's approval numbers are falling, people are actually seeing and worried about what this plan would mean for the country ... so it's a purely political move to get it passed as fast as possible while people are still in the dark.

Maybe it's time to check out some of those Republican ideas and actually have a real, thorough debate ... what do you say?

Citizen Jane said...

Hi, Idna,

Is there somewhere on the Internet where I can read the plan you mentioned--the one the Republicans came up with in May?

The health care plan that is implemented will be the basis for building a new system for the country. I would hope to see bipartisan work to make it the best plan possible. Since Obama took office, however, there has been precious little bipartisanship. Democrats float ideas and the Republicans try to shoot them down with negative ads, scare tactics, and false rhetoric.

You suggested some points that could be made to help the process along--such as finding ways to limit frivolous law suits. I'd be glad to know of Republicans in Congress working with (not against) the Democrats in trying to include some of those ideas in the legislation being drafted. Please let me know when you see examples of that sort of across-the-aisle cooperation.

Meanwhile, the system must be changed, and historically, delay works against change. Those legislators who have good, constructive ideas had better be putting them on the table, because the country's tired of waiting for the health care system to be fixed.

Idna said...

Dear Jane,

I am happy to steer you to the May 2009 Republican plan called The Patient's Choice Act. It's a 13 page pdf summary -

Your characterization of Republicans being the problem in a bi-partisan debate is ass-backwards. (Pardon my French)

There is example after example of the Dems refusing to entertain any Republican input. To wit:

As one Rep. congressman was trying repeatedly to get an appointment with Pelosi, this is what he said, "I have been told that Speaker Pelosi doesn’t like to meet with Republicans."

Another example: "Monday night Democrats voted to shut down the U.S. House Representatives rather than allow a handful of Republican Congressmen to speak on the floor. The Democrats are the majority – for now. They chose to silence debate on the floor by gagging House Republican Members from using their historical right to speak after the close of the day."

The above quote was from Rep. John Carter - please read his explanation of the tradition that congressmen have ALWAYS had ... until now. Nancy Pelosi and her House Democrats have chosen to ignore the rule on every major issue taken up by the House this year.

Here is Rep. Carter's website - please read it and see what is really going on to stop bipartisan debate -,40&itemid=960

And finally, I don't know if you can bring this article up or if you need to have a login.

Ironically, I had just finished reading the above Wall Street Journal article when I then read your blog. The article lays out just what a very partisan president Obama is and how reluctant he is to actually reach across the aisle that he was so fond of saying in his campaign speeches.

I really hope that you check out these links. If the Wall Street one doesn't open for you, let me know and I can do it another way.

Even if Congress can't have a decent debate, that doesn't mean that WE can't. But we have to be honest about the facts.

Idna said...

Hi Jane, me again,
I was just vacuuming my house, a mindless activity and a question suddenly occured to me.

The Democrats(you)are constantly complaining about the Republicans not embracing their plans of government takeover of one industry after another. My question is WHY? Why all the complaining? They don't NEED the Republicans.

They can pass any damn thing they want. They have all the numbers. They hold all the cards. They own the White House and both houses of Congress.

It's their game and they own the ball & the refs. It's a totally fixed game. They can't lose.

So why complain that the other team at least has shown up to play the game?

Sue said...

Idna raises some good points, particularly the one about the Democrats being able to implement any plan they choose since they have the votes. However, for the good of the country, let's hope that there will be some sort of consensus, some party crossover, in the hope that the plan that finally goes into effect will have some balance and some broad acceptance. I do think the president deserves a lot of credit for finally getting the ball rolling on this. As Idna says, whatever plan is achieved will be the foundation for long-term health reform. We had better all hope and pray that it's a solid one.

By the way, I forgot to mention in my initial post: any plan needs to include dental and vision coverage as a critical component of overall health care.

Citizen Jane said...

Hello, Idna,

I read the “Patients’ Choice Act,” and I fail to see where it deviates from business as usual. A little nip-and-tuck and voila! You have the status quo all over again. States, not the nation, providing what little oversight might be given private insurance companies and the “compassion,” “efficiency,” and competence of—big business.

It’s interesting how, now that the nation is finally ready to move on health care after decades of delay, the Republicans finally concede that it’s broken and come up with this little “plan.” Well, it’s not enough—not by a long shot.

Regarding your question about why Democrats want bipartisan support, here’s my answer: as long as politics in America continues to be a win-lose game, we will all continue to lose. One side wins, implements policies, carries the country down the road a ways, then the other party wins and reverses many of those policies. In terms of many issues, the result is “one step forward, two steps back.” If both sides could work together, perhaps the government could do a better job of forging policies for today, tomorrow, and the next century—when the lives of our grandchildren will be impacted by the decisions being made today.

“Winning” isn’t good enough. We need win-win.

Anonymous said...

"It’s also true that many, many people in Canada, England, France, Switzerland, and other countries are very satisfied with their health care."

Really? Because I live close to the Canadian border and know plenty of Candians... many of whom love to brag about thier system... that is the ones who have not had to actually USE it for anything other than routine medicine. However, every Canadian I have ever known who has had something serious going such as cancer has been very frustrated and has almost nothing pleasant to say about thier system. From my anecdotal experience, what they like living with the perception that they need not worry - however when push comes to shove, they are not so fond of thier system. I am not saying that we don't need change, I prefer (strongly) to not go to a system similar to any of the European (and Canadian) that you mentioned... right now we would be better doing nothing than sinking the ship and following thier worse system. However there have been several more market-based solutions presented but not actively discussed in the political arena because they don't a have a lobbyist group... and don't try to tell me that we have a 'market-based' system right now - far from it!

Anonymous said...

"Much more would have to be known about the situation to determine, from a rational perspective, whether that claim is true. Was the tumor really terminal? Was it untreatable? Were there better options, in the opinion of her doctors, than surgery? Is the woman wealthy?"

I saw an interview with the "angry" Canadian woman and it supplied some of the answers. The tumor was not malignant, but was growing and would have killed her. She mortgaged her house and came to the U.S. for treatment because she would not have made it through the 4-month wait that she would have had in Canada.

That's the problem with waiting to see a specialist. Usually when you need one, it's because you have something seriously wrong. My husband sustained a bump on the head. Six weeks later, his vision went bad and he was losing the ability to walk. We saw our family physician; walked across the street for a CT scan; were told he had blood on the brain. He was scheduled to see a neurosurgeon in 2 days; symptoms worsened rapidly; I called the neurosurgeon who said to bring him right in; the doctor took one look and said, "We're going to surgery." An hour and a half later, they drained 30 cc's of blood out of my husband's head. That's the kind of care I don't want to lose.

Oh, he was 64 at the time. Under the proposed health care rationing system, he might have been given a pill (Obama's suggestion on TV the other night).