By BRAD WARTHEN
EDITORIAL PAGE EDITOR
EVERYWHERE YOU GO in South Carolina, if there is a presidential candidate nearby (and they do seem to be everywhere), you’ll see people in red T-shirts that say “Divided We Fail.”
That’s the AARP’s way of drawing the candidates’, and everyone else’s, attention to the organization’s belief that “All Americans should have access to affordable health care, including prescription drugs, and these costs should not burden future generations.”
You’ve heard about how one in seven Americans, or some such awful number, has no health insurance. But I’m not here to talk about that. Today, I’m talking about the other six of us who have coverage. If routine — not even catastrophic, but routine — health care is “affordable” for those of us with insurance, then somebody redefined the word while my brain was imploding from trying to figure out which health plan to pick for next year.
As AARP’s Web site notes, “Whether we have good health benefits or not, it seems that insurance premiums, deductibles, and co-payments always seem to rise faster than our paychecks.”
Not that I’m complaining! I love my benefits, and I love the job that provides me with them — love it love it love it. I’ll never, ever leave it, or even threaten to. I will pay no attention to that same AARP article when it moans that “Too many Americans are locked into jobs or stopped from opening their own businesses because of worries about affording or maintaining health insurance.” Hah! “Opening their own businesses?” I’ll let the saps who don’t have families and think they’ll never get sick engage in such crazy entrepreneurial tricks as that.
To complain about our health insurance is to risk offending the Insurance Gods, and their ways are mysterious and terrifying.
Just the other day I went to my allergist’s office to get the results of my first skin tests in 20 years. I’d been getting allergy shots based on the old tests all that time, and my allergist, being a highly trained professional, thought it might be a good idea to see if I was still allergic to the same stuff. Actually, I can’t tell you for sure that the shots ever helped. So why get them? Because my insurance pays for allergy shots, but won’t pay any more for me to take Zyrtec, which I know relieved my symptoms. The Insurance Gods say I don’t need Zyrtec.
Anyway, at the end of my visit I went to pay my $50 copay, and the lady at the counter — one of those ladies who is neither a doctor nor a nurse, but one of the army of priestesses every doctor employs to perform arcane rituals all day aimed at appeasing the Insurance Gods — told me that I had a credit on my account, so today I only had to pay $17.45 cents. Timidly, I asked why I had a credit when I hadn’t paid anything lately. She shrugged and said she and her colleagues never ask, because no one understands why insurance does what it does.
But … come a little closer so I can say this softly… there are times when the Insurance Gods are not so kind. For instance:
Earlier this year, after surgery worked only briefly to relieve head-pounding sinus pain, my surgeon gave me a prescription for Allegra. I started to protest adding yet another drug to the 11 I was already taking, counting the prednisone he was putting me on, but then he said it was the generic version, so I said OK. My copay is only like $10 on generics; the Insurance Gods say generics are good.
Then my pharmacy said my copay for my 30 generic pills would be $81.95. Stunned, I asked why? They shrugged and said no one knew; the Insurance Gods just said so. I shut up and paid it, even though it meant delaying paying on my mortgage or my electricity bill or some other frill. I think the pills helped, but I certainly wasn’t going to get a refill.
I make more money than most people do here in the wealthiest country in the history of the world, and I live paycheck to paycheck, in large part because of the cost of being an extremely allergic asthmatic, and needing to do what it takes to keep enough oxygen pumping to my brain to enable me to work so I can keep paying my premiums and copays. My premiums in the coming year — we’re going to a new plan — will be $274.42 on every biweekly check, not counting dental or vision care. And I’m lucky to have it. I know that, compared to most, I’ve got a sweet deal!
I’m in the top income quintile in the U.S. population, and we can’t afford cable TV, we’ve never taken a European vacation or done anything crazy like that, we haven’t bought a new car since 1986, and aside from the 401(k) I can’t touch until I retire (if I can ever afford to retire), we have no savings.
Yet I will pay my $274.42 gladly, and I will thank the one true God in whom I actually do believe that I have that insurance, and that I am in an upper-income bracket so that I can just barely pay those premiums, and that neither my wife (a cancer survivor) nor I nor either of the two children (out of five) the gods still let me cover is nearly as unhealthy as the people I see whenever I visit a hospital.
Speaking of hospitals, I recently heard Mike Biediger, CEO of Lexington Medical Center, marveling that when he started in the business, health care soaked up 7 percent of the U.S. economy, and no one thought it could go higher. Now, he said, it’s 16 percent, and climbing.
That’s why so many physicians and corporate CEOs who once would have bellowed in rage at the sound of “socialized medicine” now believe we’ve got to do something as a nation to get this mess under control. So we’re going to do something, right? Don’t bet on it. What I’ve seen from presidential candidates thus far seems very timid, and disturbingly deferential toward the Insurance Gods (who once got very angry at one of them), and the Big Pharma Gods as well.
Mr. Biediger pointed me to a recent piece in the New England Journal of Medicine that explained that “no matter how much momentum it seems to have, no matter how many signs point to change, there is nothing inevitable about health care reform in the United States. In U.S. health policy, the status quo is deeply entrenched and, despite all its failings, the system is remarkably resistant to change, in part because many constituencies profit from it.”
And there’s not a lot we can do about it — except maybe get one of those red T-shirts, and show up every time a presidential candidate comes to town. They’ve got boxes full of them at AARP headquarter
s, and they’ll give you one for free.
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Brad, this is probably your best editorial. It hit on all the right points. My family has been hit hard by the medical health care system this year. There is just no understanding it. I don’t mind paying a significant portion of our medical bills. But there should be some limit on what you pay when you HAVE insurance.
As for the uninsured. Those folks have an almost insurmountable challenge whenever they get sick. They will receive care at someone’s expense but it’s unlikely to be the best and much of what they suffer might have been avoided with some preventive care. Yet all we hear from most of the political candidates, especially the Republicans, is that we cannot have socialized medicine. Wake up America. Big Insurance and Big Pharma have pulled off a huge marketing coop. They’ve sold Americans on a failed system that benefits only a few who have a financial stake in these two industries.
The red shirts represent people who want even cheaper healthcare than the already heavily subsidized Medicare program provides (I believe a discount of 50-70% off what those of us with private insurance pay).
It’s fine to complain about the insurance companies, but please offer some solutions.
This article has been cited on the Health Care Reform Now! blog, a companion to the new book by George C. Halvorson. You can view the posting at this URL:
http://healthcarereformnow.blogspot.com/2007/11/health-care-reform-availability-vs.html
Unfortunately, when health insurance reform is attempted, big pharmacy and big insurance team up together and blanket the media with advertisements that claim that the reform in question is worse than projectile plague. In reality both of these big businesses spend a lot of money advertising their wares, often in a misleading way. For all of the “regulation” that these two businesses supposedly have, there is very little that I know of that effectively protects the consumer.
Doug, we need to recognize that we already have a form of socialized medicine; it’s just not very efficient or equitable. Once we accept that as a fact then we cope with the high costs as best we can with some type of European national health insurance plan. Most Europeans pay less for health care than we do and they live longer to boot. Sadly, all the presidential candidates seem to want to continue with some version of the status quo.
Bud,
I can recognize the need for providing more equitable healthcare but I think it is a complex issue. Any solution that involves the government setting rates or establishing who has access to healthcare will be a recipe for disaster. The best surgeons, etc. will not go for it – a good friend who is one of the top ortho guys in the country told me he will quit before he allows the government to tell him what he can charge and who he can treat. He won’t take Medicare patients because he ends up losing money on every surgery after factoring in the hospital costs and his overhead. What’s the government going to do?
It’s all a question of priorities. Was it necessary to spend over $100K on my father’s healthcare in the final two weeks of his life when even the best outcome would have been a “life” spent blind, mute, and being fed through a tube?
The fix to healthcare should start with tort reform to reduce malpractice lawsuits; then look at fixing the drug patents so that generic drugs can be created sooner; then tax the heck out of cigarettes;
And just imagine the healthcare system we could provide to Americans if just 10% of the money spent on the War on Terror was diverted to a more useful cause like medical screening and insurance for all children. Priorities…
There is something inherently wrong when health insurance is tied so closely to capitalism. Why should anyone profit when another person gets sick? Do we really value wealth over health?
I see nothing wrong with offering government-run health insurance and making it available to anyone who wants it. I used to live in Japan and they had national health insurance there. I paid 30% of all medical costs and the government paid the other 70%. I had to pay for my own medicine though. It was so simple to deal with and I didn’t harbor any resentment towards “the government” at all. Heck, I’m sure a lot of us would rather have our taxpayer dollars involuntarily go towards supporting national health insurance that we can ALL use than have it involuntarily go to programs that offer no benefit to most Americans, such as Social Security and Medicare.
Doug, you’re correct, this is a very complicated issue. Medical treatment is difficult and it’s often not even possible to diagnose what’s wrong with you. But why does the financial aspect of it have to be so frustrating and expensive? I don’t mind paying a reasonable amount out of pocket. In fact that is crucial to keep the system from getting abused.
But at some point, after I’ve paid my premiums and met my deductibles, and the doctors are still trying to figure out what’s wrong with me I would just like a little financial relief. That would seem like a good place for the government to step in and help those most in need. The doctors could charge what they want up to a certain number of visits then if they haven’t solved the problem they would have to accept the going government rate. The government would, in effect, serve to finance catastrophic health care. The sky should not be the limit whenever a patient clearly is not going to get better.
Click here for another story (and heated discussion) about a middle-class family’s trouble finding affordable health insurance.
There are two sides to this coin. Yes, insurance companies are monsters, but medical providers charge way too much money. To those doctors who say they will quit before they allow government to regulate them in any way, I say let them quit. They need to work in the real world like the rest of us do. I’m not saying they shouldn’t be allowed to make a lot of money (yeah, yeah, they went to school for a long time and worked really hard — as though the rest of us didn’t) but there needs to be some limits put on unmitigated greed.
While I’m posting, I want to relay my family’s recent insurance company horror story. I know most everybody has their own horror story, but this just happened to my family a few weeks ago. My 38 year old niece was diagnosed with breast cancer and had both breasts removed. This was done on a Thursday morning and the surgery took nearly 8 hours. Friday morning she was dismissed from the hospital because insurance would only pay for one night! She absolutely was in no shape to take care of herself. Because of the muscle involvement of the surgery she couldn’t even open a pill bottle. Cousins, aunts, uncles — we all took turns staying with her for a few days at a time. What if she had had no family? This is just ridiculous.
Martin – the article (and the comments) are a perfect example of the issues related to healthcare costs.
Living in a $535,000 home with a fountain in the front yard and newly installed granite countertops on an income of $70K might be part of the reason they can’t afford health insurance.
As I’ve said before, it’s all about priorities. I work for a company that has excellent health insurance coverage. My rates went up by ONE DOLLAR for next year and I have reasonable deductibles and low co-pays. I could look for another job that might pay 10% more than I currently make, but the insurance (with three kids) is worth it for me to stay.
Perhaps one of the reasons Brad’s insurance coverage is not so great is because he works for a company (McClatchey) which is facing serious financial challenges in an industry (newspapers) that is either going to go the way of the telegraph or else require serious overhauling to survive. Having to cater to Wall Street means that the bean counters will cut costs wherever they can. In that environment, a company has to decide between growing revenue, cutting people, or progressively cutting costs.
Doug, you just made one of my points for me! Why should you stick with your present employer because of health insurance, of all things? Where is the logic in the quality of your health care being tied to where you work? Your pay, sure; your working conditions, why not; but your HEALTH INSURANCE? That keeps thousands, if not millions, of people working in jobs they hate (or at least, in which they’re not doing the most they CAN do) for large corporations or (gasp!) state or federal government, when they could be giving the economy a huge boost taking risks with startup businesses. I personally know people — people close to me — who have good ideas for new businesses, but feel (quite rightly) a powerful obligation to their families not to leave their current jobs — just because of health coverage.
This is insane!
It’s not insane. It’s reality. My family’s health care is important to me, so I trade income for benefits. My company offers a cafeteria plan with a half dozen options ranging from minimal to premium. I can even choose to opt out and get the company’s contribution deposited into my 401K. The choice is mine. As it should be.
There is no way for you to offer a system that gives every person the same access to all healthcare they ever want or need at no cost. The insanity is thinking that it is even possible.
Describe the system you think will be better than the current one. Tell me how much you are willing to pay (as a precentage of your income). Will we all pay the same percentage or will some people pay nothing and others a higher percentage of income (if so, explain why that should be the case)? Tell me how you will control access to services. Will there be co-pays? Will there be deductibles?
Will you force doctors to accept all patients and be paid what the government decides is reasonable? What if they decide not to participate? Will they not be allowed to practice medicine?
How will you compensate my friend the ortho surgeon who INVENTS new devices and techniques to help people get a hip replacement that lasts for decades and only requires a two inch incision thus cutting expensive hospital stays to a single day? By paying him Medicare rates that don’t even cover the cost of Lexington Medical’s operating room costs?
All I am asking is that instead of saying the system is insane, offer your version of how it will work and how it will be paid for.
Much of our healthcare system’s problems are related to government intervention. How exactly do all the government HIPAA paperwork requirements improve healthcare? These are the rules that require my father-in-law to fill out a three page form for every doctor he goes to and separate forms so that my wife and her sister can even talk to the doctor about his healthcare. There’s an example of overhead costs forced onto the system by the government.
Brad, really, the more relevant question would be, “Why doesn’t Brad find a job with better health-care benefits?”
Wouldn’t Brad improving his situation make a lot more sense than retooling the health-care system to suit Brad?
Or does it take a village to raise a patient?
Doug, Brad makes a good point. Why should we be chained to a job that is not suited to our skills simply because it offers the best health care options? Shouldn’t we be able to choose our health insurance plan without consideration of where we work? It would be like working for a company because you can buy the best car models only by virtue of working for that company. And what if you don’t qualify to work at the company that has such a great plan? The you have to make career decisions in college based on health care considerations. It really shouldn’t be that way.
Bud,
I understand the frustration. But I’m asking what would the solution be? Who will pay, how much will they pay, and how will the access to services be controlled?
Rather than implementing a massive government run solution, my suggestion would be to tweak the government regulations that create the environment we have now.
Maybe start with legislation that prevents insurance companies from EVER dropping a customer and not being able to increase total cost of premiums/copays/deductibles by more than X% in any one year.
Or setting price bands that all insurance companies would have to offer to all citizens so individuals cannot be priced out of policies… i.e. for a single person, the range of lowest cost to highest cost insurance would be in a range of +/- 25% based on the person’s health profile.
Adjust drug patent lengths to improve access to generics. Remove the HIPPA regulations that add zero value to the process and, in fact, are negative burdens.
And how about letting hospitals (like Lexington Medical) decide what services they want to offer rather than having that controlled by a government agency?
All of today’s problems with healthcare costs are the result of government meddling:
* Tax breaks to big business medical plans, but not for individuals.
* Medicare, Medicaid and other welfare programs which are 200 times the cost which they were projected to be at this date.
* Mandates for hospitals to treat everyone, crowding our emergency rooms with deadbeats who use if for their primary care.
* 30,000,000 illegal aliens
So why would anyone expect a giving the federal government total managed care control of every patient would suddenly make them capable of fixing the mess they made?
Brad – still waiting to hear how your ideal healthcare system would work.
Who pays? How much? How is access to services managed? How do you handle elective surgery? Are all doctors required to participate by law?
It’s good to see Lee back. Yup, if we kick all the deadbeat sick folks out of the hospital the problem will be solved.
Doug, your point is well taken that funding of our health care system is extremely complicated. I would suggest for starters a four tiered system. These tiers would have nothing to do with age (medicare) or income (medicaid). Instead they would focus on health care urgency and time.
Tier 1 would be for the funding of major 1-time events. These would include serious injuries from accidents and crime victims, heart attacks, strokes and other narrowly defined situations. These could be 100% funded by the federal government. The list of these events would be short and all hospitals would be required to accept the government rate for these services.
Tier 2 would be events that are chronic such as cancer treatments, diabetis and other longer-term illnesses. These events are more complicated to address and hence there is likely to be some guess work to define what ailments are included. Hospitals and doctors could charge whatever they want depending on where they practice. Patients could choose between the largely government-funded hospitals and those that are mostly private (perhaps with a voucher approach). This would allow some market incentives but would still allow everyone access to decent care.
Tier 3 is for the preventive issues. Everyone could visit a state clinic for shots, mammograms, colonoscopies and other screening programs. Individuals would be required to fund a small portion of visits beyond the basics each year. I don’t think a 100% government funded program for tier 3 would work because some people would abuse it. Needy folks might still be unable to afford the basics, even if highly subsidized, but at least most people would could recieve care without an emergency room visit.
Tier 4 would be for elective medical treatment. I see no need for government involvement here. This would include plastic surgery, vasectomies and liposuction.
I suspect there is a large grey area between tiers 2-4. But tier 1 should be pretty straight-forward. Some sort of blue-ribbon committee, established by the government in a cabinet-level agency, could be formed to place medical care into the proper category. The onurous nature of th insurance companies profit motive would be greatly reduced by this system.
From Doug: “Who will pay, how much will they pay, and how will the access to services be controlled? Who pays? How much? How is access to services managed? How do you handle elective surgery? Are all doctors required to participate by law?”
Doug, all of those questions are being answered now; I just don’t like the way some of them are being answered.
How would I like them to be answered? By someone who does NOT make every decision according to how his company’s profit is maximized.
We are, after all, talking about our health here.
Bud,
That’s a well thought out plan. I can’t disagree with the structure at all. My only “enhancement” would be to eliminate some of the regulations that force patients to see doctors directly and set up more flexible environments where highly trained nurses could provide a certain level of triage before passing patients on to doctors.
The next question is: how do you pay for it?
A national health sales tax? Increased taxes on cigarettes and alcohol? Offering the plan as an option to all employers at competitive market rates?
I’d prefer to see us cut useless government spending in other areas to fund this far more important need. For me, I think we can do without NASA if it means every kid in this country gets a free annual checkup and cheap prescription medicine. Or we could abolish the entire Department of Education and use the money instead to pay for mammograms and colonoscopies and other screening tests. (In today’s paper, we find out what we already knew — after years of No Child Left Behind testing, the results of American 4th grade student reading tests show ZERO improvement… should we be surprised?}
Before we spend MORE on government insurance, we should decide where we can spend LESS on lower priority programs.
Brad – at least bud made an effort.
If you’re going to advance the cause of changing the system, you’re going to have to put some more thought into it.
Doug, I very much appreciate bud’s effort (which I had not seen when I was writing my last comment, since I approved them at the same time). I appreciate even more that you’re willing to move in his direction on it.
But … and I suppose I’ll get castigated for this … I made an effort, too. The answer I gave you is my real answer. Honestly, I have no preferences when it comes to details. There are probably a million ways to skin this cat. I’m open to pretty much anything that stresses care over profits, and which removes concern over how to pay for one’s health care from among the things we worry about when we, or (and this is the hot button for me) our kids, go job-hunting.
That said, I’m not sure I understand bud’s system. bud, you describe the tiers, but what is the overall concept behind the tiers? Are these stages in the implementation of the program, or are they different plans people can choose, or what?
I have to tell you, though, I’m suspicious of having plans to choose from. That encourages the healthy (which is for most of us a temporary condition) to pay into the system minimally, which would degrade the economies of scale you get if everyone is covered comprehensively. That way, when today’s healthy person gets cancer next week, there’s not enough money in the system to pay for it, unless the other folks in the system were paying more than their share would have been if everyone had been paying into it. Do you see what I’m saying?
Anyway, what I THINK bud was saying, now that I look at it a third time, is that our share of these things, in terms of copays or deductibles, would increase with each tier. Is that right? If so, it seems to make sense.
As for how to pay for it — Doug, you offered three ways, and I could go for the first one over the two. I really don’t think employers need to be involved in this. That’s the model I want to get away from.
I’ve no objection to cigarette taxes being PART of the solution (just because raising cigarette taxes is a good idea in and of itself, regardless of the revenue), but I think the lion’s share needs to be in something more broad-based than that. Everyone should have a share in paying for it.
The answer to the healthcare problems and how to solve the problems is a lot like the problem with illegal immigration and the 30,000,000 immigrants that are already here. There is a point of no return. When the health care was taken over by the government with Medicare and Medicaid instead of solving the problems in the private sector we started the road to no return. Anything from here on out will only increase the problem if the government is involved.
This is sort of a first shot attempt to try something a bit less confusing than what we’re dealing with. Actually, the tiers apply to everybody. Anyone who is seriously injured in a car crash will be provided care at any qualified trauma center in the U.S. no questions asked other than a basic proof of citizenship or legal status. (I’ll leave the illegal immigrant folks out of this discussion for now). This is basically what happens now except the funding for these types of injuries are so confusing. Tier 1 events would be completely funded by the federal government. There would be no insurance companies to deal with. No forms to fill out. No bills. To fund this we could raise cigarette taxes, an auto insurance tax to cover car crashes, eliminating most of NASA is ok by me. And of course we could reduce the military budget.
Let me think more about the other tiers. Funding and fraud issues are the biggest problems but I think they would be less if we focus on the type of treatment rather than demographics (age, income). As they say, the devil is in the details.
Lee,
Welcome back as well. Responding to your post:
-“Tax breaks”-I agree that we should eliminate the tax break employers receive on premium payments for employees’ health care. However, there is no tax credit scheme that will help a significant number of the uninsured. Family coverage is now over $10,000/year. If you don’t work for a company that provides insurance, that’s inaccessible for most folks. Even if your gross income is $100,000/year, that’s still 10% (Not for something tangible like a car payment, or a mortgage payment or tuition. Most folks don’t have the kind of discretionary income to plow 10 or 20 or 30% into insurance when so many other tangible needs beckon). Any money put into tax credits would be better spent on a single payer plan.
-“Medicare, Medicaid”-these programs both serve their populations well (not perfectly, but well) and operate at about a third of the overhead that private insurers do. I know it’s hard for you to accept, but the government is more efficient in providing health care.
-“Mandates”-are you proposing that hospitals be able to refuse to treat patients that can’t pay? That would represent a fundamental shift in the safety net.
-“30,000,000 illegal aliens”-I think that’s a significantly inflated estimate. The bottom line is that once someone is in the US, it makes sense to provide them medical care. Are you willing to watch an illegal alien die of a preventable asthma attack after you’ve sent him away from the ER?
Medical care is a calling and should be a non-profit enterprise. The current system exists more for the insurance and pharmaceutical industries than for patients. We have the model in Medicare. A Medicare for All system would provide the easiest transition. Over 4-5 years we could reduce the age of eligibility for Medicare by a decade and have everyone covered. If you believe public education makes sense, then it’s hard to argue that public health care doesn’t. Let’s join the rest of the developed world and provide health care for all Americans.
There’s much more that could be said (but much of it was said on this blog 6/05/07 for those who want to revisit the discussion).
For those interested in a single payer health care system, the Health Care Now bus will be in Columbia Monday and Tuesday December 3 and 4. Here’s the schedule:
Dec. 3, 1 PM: Press Conference, In front of State House
Dec. 3, 2 – 4 PM: Benedict University Student Union
Dec. 4, 9–11 AM: Answers to your health care questions: In front of State House
Dec. 4, Noon – 1: University of South Carolina School of Medicine, VA Campus,
M-I classroom. Hosted by the American Medical Student Association
Dec. 4, 2–4 PM: the bus will be in front of the USC Russell House
For more information, call the SC Progressive Network at 803-808-3344.
Paul must be heading up the elect Hillary campaign in SC with all the socialist remarks about the health system and how we should expand it to include EVERYBODY. If you think that the healthcare wagon is broke down now, you haven’t seen anything yet.
“Medicare, Medicaid-these programs both serve their populations well (not perfectly, but well) and operate at about a third of the overhead that private insurers do. I know it’s hard for you to accept, but the government is more efficient in providing health care.”
CMS contracts out membership, claims processing and customer service to private companies. They “operate at a third of the overhead” because they don’t do anything related to health insurance–membership, claim processing, etc. Given that fact, they spend entirely too much to support their bureaucracy.
And the nightmare called HIPAA has resulted in billions of private dollars wasted complying with government mandates that have nothing to do with providing health care, both for providers and insurers.
The government is the problem with healthcare. More government will only make it worse.
Incidentally, I was told by a Canadian a couple of weeks ago that Canada now classifies heart bypass as an elective surgery–a perfect example of government-run health care.
Slugger offers absolutely nothing to this discussion other than to trot out the tired old conservative mantra that we can’t have socialized medicine. Decades ago we decided as a society to have socialized medicine. The only question now is the best way to go about it. I would challenge Slugger and all the rest of the naysayers out there to present some facts that would support their claims. Otherwise just shut up and get out of the way for those of us who choose to engage in actual facts and ideas.
Bud.
History speaks for itself. You think that people cannot afford insurance now just wait until insurance for EVERYBODY is added to the already trillions of dollars of debt. There is nothing free. Somebody has to pay and in this case when we move and more people into a healthcare system that is already broken, where is the money coming from? You are suggesting that the people not only prop up a failing health system with more of the same and subsidize a system that is already broken with more of the same.
Mr. DeMarco,
30,000,000 illegal immigrants is the estimate of a study by Bear Stearns. But our hospitals began to be bankrupted by illegals at about the 6,000,000 mark. Just check out how many hospitals in California and Arizona have gone broke due to treating illegal aliens.
Ending the government forcing ( mandates ) that emergency rooms become primary care for trivial medical problems of those who don’t want to pay $5.00 to $50.00 for colds, cuts, and scrapes, would be a very rational return to using emergency rooms for real medical emergencies. There are free clinics in every city, but a lot of people who don’t want to pay for care, also don’t want to wait at the clinic.
Medical insurance doesn’t cost $10,000 a year for most people. If you don’t have a deductible of at least $3,000 for a family plan, you are abusing insurance and should expect to pay more than the typical $3,000 a year. The vast majority of uninsured young people can afford insurance, but choose to spend their money on cars and vacations, for the same reason they don’t think they should save money, either.
There is no such thing as “single payer”. That is a dishonest euphemism for the productive minority having to give up some medical care in order to pay for the care of the lazy majority, via the single taxer.
Brad,
The very notion of depending upon your employer for your insurance or retirement is an antiquated relic of World War II, when employers offered these benefits to circumvent the wage controls of the socialist New Deal.
True reform would let everyone be responsible for, and own, their own insurance and retirement. Abolishing the Medicare and Social Security would add another 18% to payroll checks, enough to make most workers secure and wealthy.
That is the way Europe is going. They are privatizing while the backward liberals here are still trying to copy the bankrupt programs of 1970s European democratic socialism.
Actually, that would be DOCTOR DeMarco…
I fail to see the significance of Paul DeMarco being a family physician, because socializing the medical industry is not a medical issue, as much as it is an economic issue. It becomes a medical issue when the economic realities of government meddling denies or delays care, as it always does.
Dr. DeMarco, like Mr. Warthen, talk about their feelings, their intuition, and avoid the facts posted by others showing the proven failures of socialist medical programs in this country and abroad.
I urge Mr. Warthen and Dr. DeMarco to look beyond their narrow personal interests in cheap care for themselves and bills being paid for their lower-income patients.
What is best for society at large is a free market system which communicates real demand and the values to the customer in the form of monetary prices. What is broken now are the government programs, mandates and meddling in the market for medical care.
• Health spending already totals more than $2 trillion annually, about 16 percent of national income (gross domestic product). By 2030, it could easily exceed 25 percent, projects the Congressional Budget Office.
• There’s a massive transfer of income from young to old. Americans 65 and older now represent about an eighth of the population and about a third of all health spending. By 2030, their population share will be about a fifth, and they could account for nearly half of health spending, finds a study by the Centers for Medicare & Medicaid Services.
• Neither the government nor the private sector has succeeded in controlling health spending. From 1970 to 2005, average spending per Medicare beneficiary rose 8.9 percent a year. For similar services, spending for Americans with private health insurance rose 9.8 percent annually over the same period.
The above is from an editorial in The Charlotte Observer by Robert Samuelson on Dec. 6, 2007.
Just thought I would add this to the mix so that we might become more informed about why and where this train is going.
The private sector has not had control of medical care since FDR. Every problem in spending is rooted in a failed government program. Those who want someone else to pay for their lifestyles just don’t care about economic reality.
There would be no transfers of tax money from the young to the old, if government had let people save for their own retirement and medical care in the 1940s, 50s, 60s, 70s, 80s and 90s. Most workers would be millionaires, just off the FICA taxes invested in private accounts.
The purpose of most taxes is to make people poor, and dependent on politicians.
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Frequently the reason behind the desire to write this type of paper remains unclear. However, once the events are recounted and recorded, it becomes clear that the writer is striving to find the universal truth.Personal experience essay
I think you really need to understand several realities of our current system.
The first is: WE DO NOT HAVE A “PRIVATE SYSTEM IN THE UNITED STATES OF AMERICA.
Yes, people, you’ve all been duped into having rationed health care. Somebody else, that you never meet, decides what you do or don’t get for your tax/paycheck dollar.
Rationing, whether it’s done by a corporation of the government, is the SAME THING. You don’t decide what you get for your dollar. Somebody else does.
It’s that simple. I see no difference between socialized medicine and what we have now, except that I am allowed to work myself to death (i.e. cram more patients into each day) to make slightly more money than seeing less patients (caveat: all systems are paying me roughly 2-10% less each year, despite inexorably rising overhead).
The private insurers are no better than robber barons of the 19th Century– they call the shots, and with god-like powers manipulate people and government to get whatever they want. The government is arbitrary and threatens me with JAIL and FINES if I fail to follow their bizarre and arbitrary documentation rules.
Meanwhile, the government arbitrarily has decided that I shall get a 10% pay cut, year after year (just Google Medicare Part B pay cuts and you’ll see what I mean).
All of this is done, supposedly, with the input of “experts” to derive what’s “best for you”. Ask any doctor that you know what they think of this concept and you’ll get a uniform reply. Face it, managing disease isn’t easy, nor does it lend itself to textbook/computerized answers. That means that what I/we do as physicians is an art, occasionally kicked in a better direction by science. Worse yet, every year I feel the data that has to be interpreted to make sensible diagnosis and treatment decisions is growing in leaps and bounds– and half of the data is junk science to begin with.
The entire discipline of being an MD is propped up by a personal desire for excellence. In this profession, you can be an entirely crappy physician and get away with it– how can anybody tell if I do a good or bad job removing cancer during a surgery? Hell– my reward for doing a bad job or a good job is exactly the same, so what stops me from doing a bad job? Can YOU tell when I walk out of the OR? Can the nurses? NO. My own conscience drives it all. It’s the same with every one of my colleagues. You can’t legislate or dictate that.
Excellence is being eroded as we get our jobs and rewards defined for us by bean counters who don’t have a clue. They are telling us that we are worthless, and not to be valued. Worse, they blame us for “costing” the system money by our “greedy” behavior–funny, in that my “charges” are a fantasy number I write down on paper, and then get paid a “contracted rate” for my services– dictated by Medicare, Blue Cross, etc. The biggest PR battle, ever, is the illusion that physicians are somehow in control of “charges” when, in fact, remuneration is decided by the payer (caveat #2- they often decide to pay NOTHING AT ALL, and we have NO RECOURSE). The payer, in fact, gets an “insurance claim” from me, not a bill. That means I have no protection from deadbeat insurers, as everything is a claim that THEY adjust!
So here you have it, folks. Millions of young people are choosing NOT to do what I do. Say what you want about how “hard” your job is, but I get beat to death physically, intellectually, and emotionally every day. I haven’t had more than 2 weekends per month off in 8 years (can’t AFFORD another partner) and I am forced to run a small business (HR/management/collections, etc.) to boot.
Here is my prediction, already coming true: I, the independent surgeon, am increasingly being replaced by a the less motivated “Health Care Provider”– essentially a medical technician (still called “MD”)who will maximize their own time off and minimize their own involvement in medicine. You won’t be able to tell the difference… we’re all interchangeable, right?
I hold you all accountable for undervaluing what I do and telling me how to do it.
FIX it. Take responsibility. Take back your own money and spend it the way you want to, not the way somebody else says to do it. Let your own decisions about what you want me to do for your disease be what happens. You decides if it’s “worth it” or “too expensive” or “unnecessary”.
I cost less and less every year. Pretty soon, I’ll be forced to join some big machine like Kaiser and I’ll eventually have my ethics beaten out of me by Mass Medicine Mandates. You can stop that, or you can get what you pay for.
Stay will become old hat to her, boring, and easy as pie. Once you have mastered time and distance, then, put your hand in front of her face while saying stay and walk all the way around her. She may want to try to get up and go with you. If she attempts to get up, say“ no, sit”, and push your hand in front of her again while saying stay. This will teach her that is it okay to be approached from all sides while she is in the stay position.
in my opinion all the doctors should be regulate by government. Being doctor doesn’t allow anybody to start robing people by asking them to get those expensive tests and medicines and then there huge fees.
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yea!!!The very notion of depending upon your employer for your insurance or retirement is an antiquated relic of World War II, when employers offered these benefits to circumvent the wage controls of the socialist New Deal
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A Body Massage to Gain Height
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Thanks a lot blogger for such a wonderful and informative blog about health care reforms .
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Not for profit hopsitals that are exempt from taxes should be in the vanguard of trying to figure out how to improve public health –particuarly in the poorest communities in their regions.
http://healthfreak2.wordpress.com/2009/09/23/helpful-factors-to-keep-good-health/
Insurance have no regulation. Pharmaceuticals have no regulation. Procedural costs are also not regulated, they are as arbitrary as the weather. If the industry as a whole was able to reigned in and work collectively it would correct a good portion of the current health care problem.
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Many health care professionals believe that the industry is wrought with overspending. There have been many discussions about the role of Information and Communication Technologies in health care and ways to cut spending simply by make adjustments to document storage and processing with newer technologies. Programs are being developed to assist in medical equipment maintenance. These are the areas we need to seek remedy for, while we continue reform health care and procure coverage for all Americans.
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