Health Care Reform to Destruction

When Americans and their representatives speak of a better health care system, they mean more coverage for more people. When health economists speak of reform, they mean cutting spiraling costs by allotting care rationally, according to which care will do the most good for whom.

When Barack Obama speaks, he refers to the latter ideal. But nothing currently occurring in Congress in any way reflects this.

For example, outcome research makes clear which treatments are most effective. Reform means channeling Americans into these treatments. Americans will never accept that, and the bills before Congress explicitly forbid paying only for treatments proven to be effective. When Michael Moore wants to get Americans riled up about insurance companies, he describes a case of a person with a fatal disease who is being refused a monumentally expensive experimental treatment by an insurance company -- that always does it!

The idea that to provide unproven care at great cost will deprive many others of effective treatments is foreign to American minds. After all, for us, each life is precious, and we want to do everything we can try in order to save a life, even when we don't know whether what we are doing will succeed. How many movies are premised on distraught mothers finding a way for their child to receive an esoteric treatment for a rare childhood disease that stupid physicians, insurance companies, and HMOs refused to approve -- those craven fools!

Americans will always demand the most treatment, at any cost. For them, good health care means someone else -- insurance companies, employers, the government -- will pay for this. So any reforms that place responsibility for sound health care decision-making back on consumers will be repudiated. Incentives that support rational, cost-effective choices have been removed from all proposed legislation.

Conservatives Republicans most love the status quo. Thus Sean Hannity, Newt Gingrich, and Glenn Beck laud the American health care system as the best in the world, while Gingrich's consulting company advises big players how to cash in on health care reform proposals. And when leading Republican figures chime in about "rationing," they are rallying people against anyone with a good job, money, and health insurance paid for by someone else having to submit to care based on medical evidence.

But, here's the rub -- while liberals (like Moore) are the most vociferous critics of the health care system, they decry only limitations in coverage. Thus, all proposals being put forward are geared towards making sure that more people will receive more expensive care, not on curtailing costs or rationalizing care. And we will all follow this path while our system becomes more bloated and untenable (which is uniquely true for the American system already) until it bankrupts the entire country, as well as the individual states.

This is the worst aspect of the modern American version of untrammeled socialism-capitalism -- grab as much as you can without having to pay for it. And, oh, up until the moment this system irreparably implodes, it won't make us healthy.

Comments

[Peabodies]

I think we should look at how Canada, France, Spain, Australia manage to spend so much less per capita for better health outcomes than ours. Their secret?

Health care is NOT FOR PROFIT. Health care is not tied to employment. The health industry isn't allowed to advertise its products as they do here -- "talk to your doctor about XYZ drug ... or UVW treatment", on TV and radio, ad nauseam, no billboards for this and that hospital.

Health care can be publicly (U.K.) or privately administered, but the profit motive is removed (frivolous denials of care against the advice of physicians). Medicare for All (privately administered, publicly funded) is the easiest way to go here. Everybody included, nobody excluded. Come rally with us on July 30th in Washington, D.C.

http://www.healtcare-now.org/docs/july30.pdf

[wendy82551]

Sounds like you've set up a straw man and spent a lot of energy knocking him down.

In my experience (with a few notable exceptions), Americans do NOT want to be kept alive indefinitely, no matter what. They want reasonable care at a reasonable price and, if they are going to die, they want to do so with dignity and peace and some sort of control. The problem with the American medical system is NOT the patient--it is the profit-driven insurance company which refuses to pay and the liability-driven medical community which refuses to give up.

The government has its faults too, with ridiculous laws that actively prevent people from using options that are more humane AND more cost-effective, like payment for home-care nursing vs. nursing home care.

You picked the woman from "Sicko" who wanted so-called expensive and untried cancer treatment. Well, okay, but two things: what insurance companies call "expensive and experimental" are often not labeled the same by the medical profession. But the bottom line on that is this: what about the example of the man who had to choose which fingers to save? We can argue about "experimental treatments" but it's really hard -- and actually, I believe, immoral -- to argue about that one.

[NMACDC]

Health care reform in this country is long overdue. Read a statement from National Minority AIDS Council Executive Director, Paul Kawata, about the importance of the Women's Health Amendment to ensuring that women have access to preventative health care and services from the provider that best fits their needs. http://bit.ly/rGrlYWe cannot afford stalemate around health care reform. Read a statement from National Minority AIDS Council Executive Director, Paul Kawata, about the importance of the Women's Health Amendment to ensuring that women have access to preventative health care and services from the provider that best fits their needs. http://bit.ly/rGrlY

[dsws]

"After all, for us, each life is precious, and we want to do everything we can try in order to save a life"

No, we don't. When our loved ones are dying, we want them to die in comfort and with dignity -- not with multi-mill­ion-dollar "lifesaving" procedures extending their lives by an extra day.

[jmpurser]

You're implying a conflict between two interpretations of "health care reform" when in fact they compliment each other. Getting health care to more people is a huge cost savings in terms of long term care. And making long term care the focus of a health care system encourages spending on what works.

What we don't have is an access system focused on the benefits of long term care. Why should your employer selected health insurance provider care what health care you need 20 years from now when you're unlikely to be covered by the same insurer in 5 years?

Single Payer is the answer to this situation. First, it pays for itself up front (and is the only reform plan that can make this claim) through eliminating the 30% or so currently spent on overhead by the insurance companies. Second, since from birth to death EVERYONE'S health will be the "business" of one institution that institution can focus on long term gains instead of next quarter's profit statement. Finally, with every case/provi­der/treatm­ent outcome reporting to one body we can quickly establish a database to determining what the most effective treatments, providers, and long term health care plans are.

No other approach to health care reform offers nearly as much.

[Petya6]

Start looking at health care reform by realizing that single payer is not the equivalent of single insurer. In point of fact, there are many good arguments for have an independent single payer.

It would have to contain a national medical network and a medical care management team. The arguments for such a system include:

Most consumers are not capable of managing their own care. The new medical entity would advise patients regarding care as needed.

Care providers tend to over utilize which is the largest of cost drivers. The new entity can control care through provider agreements. All providers in the system would have to agree to follow basic rules for limiting treatment to that justified by clinical findings. Provider performance data can be collected and evaluated for making decisions about care management .

An independent single payer can more effectively manage care as a patient advocate thereby assuring appropriate care.

By receiving all medical bills and reports, medical information is contained and not disseminated to insurers thereby helping to maintain patient privacy.

The insurers, who pay only the fees submitted by the care managing single payer organization, will experience lower claims losses and more stable underwriting.

A single payer system will allow us to rationalize health care by assuring appropriate care for all patients. We really do not have much choice if we want to expand coverage and reduce medical costs.

[greyhound2]

It is true that in any health insurance pool, 20% of the members use 80% of the benefits.

[truthglow]

NO, it's not true!

[tompoe]

Rational allocation of healthcare is not what health care reform does. Universal healthcare means providing equal healthcare services to everyone. It is known as Single payer healthcare, not rational healthcare. Where did you get that misinformation? The Party of Corporate Welfare headquarters?

[noneIn2008]

The interesting part is the AMA who expects this will bring them more income? It will be less income and more patients.

[Tulka2]

Hello. Doctors in civilized countries are very well off. They are certainly more respected and deferred to than they are here. What is the respect of your fellow citizens worth in a life?

Segue, but it's sort of pertinent. When the former Soviet Union fell, the richest man in Moscow was an eye surgeon. He did laser eye corrections. He came in the morning and his patients were lined up for him. He just went down the line doing eye surgeries all day. Apparently, it was cheaper to do eye surgeries than it was to get everyone eyeglasses. (There's a reason the Russians go to the moon too.) That doctor had a country place and raised Arabian horses. Even in the grim Soviet system, doctors did well.

So do not fear for doctors.

[JaxLady]

Single payer or public. I would like to know where we stand on insuring all of the illegals in this country. I know that they are bankrupting us now with the use of emergency rooms. Are we leaning towards including them in this transition? Would they pay? I am not naive enough to believe that we will act on purging the illegals from this country.

[truthglow]

They will NOT be insured in any plan!

[PSTEN]

Well that was an interesting read?! Now if you want a truly enlightened discussion about the health care debate listen to Bill Moyers June 10 discussion. Enjoy.

http://www.pbs.org/moyers/journal/07102009/watch2.html

[Tulka2]

So your argument is Americans are ineducable­....?

No mention of the vicious lies fed to Americans by Big, Fat, for-profit health care. Matter of fact, it's a fact that the counties in America that pay out the most to for-profit clinics, labs, hospitals, are the places where doctors have a financial stake in extra tests, procedures, surgeries. I

It's all about "for-profit" medicine. It's a lot about greedy doctors who have been corrupted by the big money to be made. In such counties the people are no healthier than in places where doctors are paid salaries..­..like the good Mayo Clinic, for instance, where costs are low and every person who walks through the door knows they are getting the best care in the world.

It is really disappointing to see how little Obama has used the bully pulpit to point people to the facts about health care delivery. We do not need to re-invent the wheel. Lots of countries have it right. It takes constant tinkering and re-setting of priorities of course... that's why we pay taxes. Btw...? Yes, the top 10 percent of American taxpayers owe us health care. It is a class war and they started it.

[phasor]

Mr Peele, you need to study and understand the health care system of the other G8 countries, all of which have a public insurance plan.

In those plans, you'll discover that medical decisions are made by doctors NOT insurance administrators.

[cancersurvivor13]

How much is your life worth??? What about providing economies of scale-negotiating prices with health providers for everyone and insuring everyone. Do insurance companies NEED to make billions of dollars by denying treatments to sick people??? I have "good insurance" and had to fight tooth and nail JUST to get them to pay what I had in writing that they said they would pay for. Haggling with an insurance company that is trying to hold on to every nickel and dime is not a pleasant experience for anyone, especially when they are undergoing cancer treatment. I am one of the lucky ones, they paid after much pain and wailing from me and some very determined mediclal billing personnel (bless their determination). Now, however, they won't even pay for my mammograms ( I am a breast cancer survivor). NO ONE DESERVES THIS KIND OF TORTURE. HEALTHCARE DOES NEED TO BE REFORMED. EVERY AMERICAN DESERVES DECENT HEALTHCARE.

[Manx]

Your argument sets up a straw man. Your claim that people who seek medical attention are not patients but budgetary items seems to be at odds with doctors' Hippocratic oath.

[Tulka2]

Bull's eye.

[dsws]

Even a medical degree doesn't enable people to conjure unlimited amounts of goods and services out of thin air. Doctors shouldn't be focused on budget constraints as they practice medicine, but the budget constraints are still there. Every decision to spend money on medical treatment means hours of someone's time will be spent working in a medical lab or manufacturing sterile filters or doing paperwork. Every such hour is an hour that they don't spend camping or reading poetry or writing software or manufacturing wind turbines. We have only so many hours in our lives, only so much mineral wealth in the ground, and so on. That's the real budget constraint. When we pretend we can spend an unlimited amount of labor, resources, and capital on something -- whether that's houses, college, or medical costs -- it always comes back to bite us somewhere.

[RoloTomassi]

Your argument perfectly illustrates why a solely capitalist profit motive is the WRONG way to run a healthcare system. Other nations manage to run theirs without such considerations being the primary issue of concern, and there is no sane reason to do otherwise in the US.