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

[JayMagoo]

In a day when up to 40% of Americans (depending on whose figures you believe) don't have medical coverage, when the average secretary pays a larger percentage of her pay in taxes than a billionaire, and people who get sick once, are forever denied health insurance by the private insurance companies the Republicans put in charge, we need reform.
Democrats believe government should help those citizens who are incapable of taking care of themselves, but Democrats are being met with a blizzard of criticism. From whom? From the rich, the corporations, the insurance companies, media, from the corporate-owned chains of radio stations, and from right-wing radio hosts who rant and rave against the people's interest. , The big money and the corporations who would have to share are squawking loudest.
Roughly 70 percent want a single-payer health plan, roughly 70 percent want a public option for insurance. Roughly 100 percent of the corporate media, the lobbyists, the right-wing talk radio, are against both the public option and the single payer plan.
I believe the rich, who aren't paying their fair share in taxes should pay and I believe we should get the insurance companies out of the mix with a public option and a single payer plan.

I am with the 70 percent of Americans. Where is Congress? With the corporate, right-wing interests? Or with the people? Who will Congress go for? Will it be the people? Or will it be the money?

[freshnotbitter]

Actually, most men don't like going to the doctor at all.

And,in real life, I have found that even people of modest means are willing to pay increases in health insurance premiums (you can check that with employers) because they value health security, not because they like going to the doctor.

Thus, I am skeptical of the dems strategy of fobbing off the financing of reform on "high income individuals who make more than $250,000" so they can tell everybody they got something for nothing.

It is not necessary.

What is necessary is that economists explain to the present government that instead of spending all their tax money on pork projects that nobody will ever use, to jack up housing prices on houses nobody wants, make cars in Detroit that nobody wants, they should use the money instead on something everybody wants: Health security.

Funny how difficult it is to get that across, isn't it?

Maybe somebody doesn't want to hear the good news. Like politicians of all stripes who prefer wasting money on themselves.

[Viola]

I don't accept your premise that Americans automatically demand "the most treatment at any cost". We haven't experienced a system where healthcare, especially preventative, is readily and affordably accessible. We don't know how many expensive, untried, etc. treatments wouldn't be needed if people could get care early on.

I think that "American's" attitudes are greatly dependent on how knowledgeable they are about how healthcare is - isn't provided here, as well as the variety of systems being used successfully eslewhere-systems that provide security and quality care for less, with better outcomes. Here we experience an endless stream of insurance and other companies spending big dollars to confuse and misinform people, including through politicians who receive their dollars and repeat their talking points.

If a real attempt to educate Americans about the facts occurred I think you'd see "attitudes" change. I don't think Americans, in principle, would reject having our "system" evaluate treatments, determine which have value, and focusing on them.

Finally, it's annoying to read things like: "place responsibility for sound health care decision-making back on consumers". While it seems perfectly reasonable for people to bow to the greater wisdom of experts in other areas of their life: their roofer, their accountant, their plumber, their lawyer, somehow they're expected to be "educated consumers" about healthcare - a broad topic area that requires some 8 years of education and a couple of years of interning before physicians are considered acceptably knowledgeable.

[Poboy]

"Am I too much risk? too much outcome uncertainty?"

Yes, to the merchants.

No, to YOUR government, which should be responsible for the public health.

[cktirumalai]

The dilemmas are all there. "Your money or your life." Your money and your life.
I have seen one study which weighs what an expensive drug or treatment would cost society in general tax dollars or an insurance company in revenue against how many months of life it would buy the patient.
Some of these questions are as difficult or as impossible as euthanasia.
I have encountered doctors who justify a procedure by saying that Medicare will pay for it and others who realize that they are called on to be both physicians and honest citizens.

[Dynamohum]

So by your thinking does that mean that say, people with chronic illnesses like HIV/AIDS, CANCER, HEP C should accept whatever limits are placed upon them by rational care? I am still here, living with AIDS for 26 years!! A large portion of why this is my reality is because I took control and established the basics for myself - great nutrition, resistance and cardio training, meditation, plenty of rest, positive attitude, and tenacity. For it takes immense tenacity to weave through the maze of rejections, denials, judgments of pious healthcare professionals and to choose so many paths it would drive most individuals to the grave or the psych ward!! Imagine, if you will, having to manage 250 medical appointments and 2 major hospitalizations in just 2 years time. So, am I to lower my expectations, or forgoe live saving and altering treatments that obviously are frequent to yield to the greater good? I give back to my community through Public and Motivational Speaking to middle and high school youth to try to avert the disaster that I have had to cope with!! Under this new healthcare infrastructure, will or should I just be pushed aside as too much cost or risk? I value my life and defend my contributions to society as justification to continue, what would this new structure change for me? Will large segments of society just be forced to give it up for the "greater good?" Am I too much risk? too much outcome uncertainty?

[blood1]

The most salient part of your post: I took control and established the basics for myself.

How many Americans are willing to do what you did?
The dilema is that a physician can tell a person to take steps, but what if they won't? Does the physician quit treating them? There are ethical and moral arguments that will never be discussed in public.

I could only wish that we could extrapolate your story to the general population, but I am not optimistic. Look at the "epidemic" of Type 2 diabetes and obesity.

The proposed new plan should not affect you, as you are probably following the most quality and cost effective treatment for your disease. What the new proposed plan seems to do is to say that if one test is adequate to diagnose a disease, then why do 10 tests?

We should not confuse curable vs incurable.

Curable: Quality is not always the cheapest treatment in the short term, but if the result is curative vs long term symptomatic treatment, then that is where healthcare should go as it is cheaper end a disease than treat it forever.
Incurable: Then the discussion needs to be directed to exactly where you went - take responsibility to assure that the treatment that you received would be agumented by a lifestyle change that would enhance your ability to survive.

Advanced Directives should also be mandatory for everyone.