Being engaged in the health care debate ever since I first began writing that health care should be a right in the summer of 2008 leaves me to wonder whether there is anything left to be said that all others have not already spoken or written about, either because it is true based on fact and reality, or untrue, based on made-up stuff, like, you know, death panels and killing off grandmas. The other evening my wife, Elena, and I dined with our colleagues and friends, noted Chicago-area cardiologist, Alan Kogan, and his wife, Robin. We were engaged in a variety of topics, but we settled in on, what else, health care reform. I mentioned health care as a right for every single American, and he said that it is either a right, or a commodity, that can be bought, sold, and bartered, like any other service or good. If an American can afford health care, all well and good; if a citizen cannot access or afford health care services with health care insurance, tough luck (this is my description). The more I thought about this, I more I thought this should be not only the beginning of any discussion on health care reform, but also the end point. The doctor friend also equated our need for water to sustain us to health care that keeps us healthy. We pay for water through various governmental and municipal sources, so why not the same for health care? Good questions, indeed.
If we all recall, our system of health care was based for so long on the fee -for-service model -- if you wanted treatment, you pay what the doctor charged. That grew too expensive, so our system morphed into managed care products and services. This new system worked like a charm -- for managed care companies. After all, look at the millions (billions?) of dollars these companies and their executives have made since they were first created close to 20 years ago. The cost of health care services and insurance coverage for those services continue to skyrocket. So, too, this system of care interferes with the doctor-patient relationship every day of the year. Just ask your doctor.
Politicians who oppose President Obama's current plan say that by the government imposing a public plan (or whatever you want to call it that keeps in check insurance company costs, provides for stiff competition and allows another alternative (option) for consumers who seek health care insurance) the insurance industry will be gone as we know it in a blink of an eye. Juxtaposed to this is that leaders of the opposition are now also saying that they stand shoulder to shoulder with the President when he calls out for insurance regulation in the form of, for example, no caps on coverage; limits on out of pocket expenses; and making it illegal to deny coverage based on pre-existing conditions, or rescinding that coverage absent provable fraud after care and treatment has already been rendered. But not for any such public option. But, and this is important for everyone reading this post, all these new regulations will mean increased exposures to the insurance industry; increased exposures mean more expenses and payouts for claims, and less revenues that will go to the bottom line. Without an effective check on insurers with a public plan (again, or whatever you want to call such a mechanism), insurers will be free to raise premium costs to recoup the loss of revenues that these additional exposures will cause. We all will be back at ground zero, so to speak, if regulations without stiff competition come about. If we all think there are catastrophic problems with health care now, heaven help us if we have regulations without real and effective competition with insurers. Mr. President, are you listening?
But if we want the status quo (and it seems that Republicans are for this despite the words their representatives mouth), then we will continue to treat health care as a commodity, as Dr. Kogan mentioned to me at the dinner table.
I prefer to say that health care remains a right for all of us. This is the moral imperative of which Obama spoke when he addressed a joint session of Congress. This is a right that Teddy Kennedy said we all had when he spoke at the 2008 Democratic convention; this is what Obama articulated when he debated McCain on the campaign trail a year ago in Nashville; and even I scribed such words a year ago July. If it is not a right, then why do all industrialized nations besides out country treat health care this way, do not allow their countrypersons to fall into debt and go bankrupt over medical bills, and do not allow them to perish from illness or disease because they cannot afford to pay the charges for necessary care and treatment? Is it that our Republican leaders are intellectually challenged when they oppose President Obama without fact or foundation, or can it be that they just plain don't care whether Americans with serious medical conditions live or die because they can't afford or access our present system? It sure seems like the latter given all their recent rhetoric!
In the end, there must be effective competition together with the insurance regulations such as those being proposed by the President. One other item that should be considered since everything is presently in a state of flux: eliminating the antitrust exemption for the insurance industry. Remember that the opposite of true competition is . . . monopolization (which antitrust laws are intended to protect against). At the moment, insurers don't have a care in the world about this item. It is high time that they should.
With all my talk about health being a right, Dr Kogan, I think you were really onto something the other evening when you planted the notion in me that opponents of reform think health care is only a commodity.
In an idyllic situation, the new policies would provide all citizens with superb coverage. Unfortunately, that is unrealistic because the healthcare system is also a business that must be profitable. I believe a sensible goal would be to construct a healthcare system that is not completely controlled and financed by revenue driven organizations or propelled by the relationship between one’s employment and health benefits.
Americans are required to support the government by paying local, state and federal taxes. With the rising cost of living and unemployment, I question when will the government provide the universal healthcare system that its citizens are in desperate need of.
In an idyllic situation, the new policies would provide all citizens with superb coverage. Unfortunately, that is unrealistic because the healthcare system is also a business that must be profitable. I believe a sensible goal would be to construct a healthcare system that is not completely controlled and financed by revenue driven organizations or propelled by the relationship between one’s employment and health benefits. This nation has become so morally corrupt that some public officials truly believe that the health and well being of a human life is means for bargaining. When did my life become so insignificant?
Americans are required to support the government by paying local, state and federal taxes. With the rising cost of living and unemployment, I question when will the government provide the universal healthcare system that its citizens are in desperate need of. Hopefully, now.
This does not mean that health care should not be paid for by the government, just that such a priviledges is just that, and not a right, similar to how K-12 public education is a priviledge that Americans by concurrent action currently enjoy, but may nonetheless be rescinded at any time.
When then candidate Obama said he believed health care was a right at the debate in Nashville it brought tears to my eyes as I never thought I would hear a candidate for the presidency say it so firmly, clearly and with passion.
I hope he is successful for all our sakes.
"What will be the result of health care reform that provides every American with some basic consumer protections, e.g., prohibit insurance companies from denying coverage due to medical history, not be allowed to drop coverage if insured gets sick, not be able to water down coverage when needed most, no longer able to place arbitrary cap on the amount of coverage in a given year or in a lifetime, placing a limit on how much you can be charged for out-of-pocket expenses, etc. No public option though? What would be the result of that? How are the for-profit private insurance companies going to make up for all the revenue and profits they will lose due to the proposed consumer protection restrictions without a public option? I wonder if premiums would increase at a more rapid pace and higher percentage rate each year for both employer and private plans. I wonder if more people will be rejected for private insurance if they lose or quit their job. I wonder how many ways the health care insurance industry will find to continue to earn the profits they do now with restrictions being proposed without a public option. The credit card companies are the perfect example of having no trouble finding ways to make up the revenue lost due to the "consumer protections" imposed on them. All to the detriment of the middle class."
The top twenty health insurance and drug executives earned $285 million in 2008. Just 20 people!
PER HOUR PAY FOR HEALTH INSURANCE AND DRUG EXECUTIVES:
Miles White - Abbott - $17,395
Fred Hassan - Schering-Plough - $15,677
Bill Weldon - Johnson & Johnson - $13,022
Ron Williams - Aetna - $12,656
H. Edward Hanway - CIGNA - $6,373
Angela Braly - WellPoint - $5,127
For Americans to continue paying billions of dollars a year for obscene salaries, bonuses, perks and profits is unconscionable. I never thought our elected representatives would work so hard to destroy something that would help every single American. But, then again, why wouldn't they? They take millions of dollars from these same companies. We arrest street walkers for taking far less than these clowns do.
Shame on them for putting money before the lives of their fellow human beings.
And the discussion always centers on what the left thinks is "right" versus reality. There are 800,000 doctors in the US with another 25k new per year. 45% say they will consider leaving the profession if Obamacare is passed http://www.ibdeditorials.com/IBDArticles.aspx?id=337909690110379 . Let's add 30-47 million people to the mix with no new doctors or nurses. How many people have every waited in a doctors office for an hour or two? Hmmmm? If, as is done in all national health systems, physician income is limited, you will drive people out of medicine, you will no longer attract the best and brightest, and we will end up importing foreign doctors (as they do in Britain and Canada). Rationing WILL occur and the quality of care WILL decline. We need to deal with reality, not with fantasy. What you want is irrelevant. Let's figure out what will work. Obamacare won't work.
Consider if we were discussing a new Water program because everyone was watering their lawns and the water bills were rising. They aren't adjusting existing free programs, raising the income eligibility for Medicaid or lowering the Medicare age eligibility or the VA service requirement. They want to create a new program.
That's government waste and inefficiency from day 1.
We should analogous to water, ration the health care that currently exists, modify Medicaid so more people qualify but at a rationed amount that provides basics. Water basics to sustain life when there is a drought, don't allow such water or healthcare waste.
If I get free water, how much free water is each household allowed? Can I waste it watering my lawn all day?
If healthcare is a right, does it include plastic surgery? Collagen injections? Chemotherapy for advanced stage 4 cancer? Where do you draw the line as to what is a right and what is a luxury? If we provide free healthcare, let's make hospice mandatory in advanced cancer cases and among those with advanced chronic conditions. Bring back paternalistic models of healthcare, let doctors ration care to limit waste. Those who demand an MRI or CT scan ... what do we do about them? What about those who waste our money laying intubated in the critical care units? We should have the option of mandatory hospice for them.
It is no suprise that the US government gave millions of dollars to expand hospice and palliative medicine programs within the veteran healthcare systems in the past year. They realize the cost savings that exists through these programs, now we need to just make them mandatory in a nationalized healthcare program!
In America, there are some things it's not OK to withhold simply because someone doesn't earn enough to pay for it. This includes, food, water, and yes...health care.
The question is the enrollment threshold for Medicaid.
We are Medicaid, Medicare, VA, DoD, Community Health Clinics. What is being discussed is a new national health care program, not a modification of existing free programs.
Consider if we were discussing a new Water program because everyone was watering their lawns and the water bills were rising. They aren't adjusting existing free programs, raising the income eligibility for Medicaid or lowering the Medicare age eligibility or the VA service requirement. They want to create a new program.
That's government waste and inefficiency from day 1.
Like fire departments, police, and sanitation departments, accessible healthcare is a basic piece of public infrastructure that nations which aspire to first world status should have in place, because it's alternatives are less effective and much more costly, bleeding a significant portion of the GNP out of the economy while providing no enhanced value in return.
"If it is not a right, then why do all industrialized nations besides out country treat health care this way?"
Why are the right to lifers the most adamant that health care is a commodity ?
(I am not saying that life is a right, it may very well be a commodity but that is not a popular opinion).