Healthcare rationing: Real scary

I am very sceptical of this proposed healthcare legislation. Do we need better healthcare? yes. Does everyone deserve healthcare? yes.

The problem is we are going to entrust the federal government with our well-being.

The very same government that thought giving trillions to AIG and Goldman Sachs was a good idea.

The same government that brought aid so quickly to the victims of hurricane katrina.

The folks who said invading Iraq would only cost $60 billion and the people would greeet us as liberators.

The people who at every turn, will legislate to the aid of corporations while endangering the health of the populace.

Sure, I trust the Federal government - to do the bidding of lobbyists EVERY time.

I don't have the answers but I seriously doubt the government does either.
I'm with Electric Universe on this one. And No, I'm not a republican.

We have a friend in her middle 70's who has a very modest income. She has gotten some help with drug costs through Medicare but her medicines are very expensive and she has now reached her "doughnut hole" in coverage and must pay full price. She has additional "medigap" insurance, for which she pays dearly, but it does not cover drug costs. One of her medicines alone costs $600 per prescription. That's $20 per pill. There is no reason on this green earth why a pill should cost so much, other than exorbitant profits for the drug company. What does she do? She goes without a lot of her medication. Good medical care without the necessary drugs can only help so much.

Medical care and pharmaceuticals in this country are already rationed. It's often based on ability to pay, but sometimes on just the best judgment of health care professionals. Many mistakes are made.

It's true that even in the best of public options the government cannot possibly insure every single medical expense of every single person in the U.S. without limits. Some medical expenses under even the best of national health insurance coverage will have to be paid out of pocket. Decisions will have to be made at some level (I wouldn't assume they would be made by bureaucrats, health care professionals would most likely be consulted here as well) and there will be some poor ones even in ideal circumstances.

But the decisions can't be worse than what is already happening in the totally privatized health care system we have now.

The negotiations Obama has been doing with the pharmaceutical companies has to do with lowering drug prices by billions a year.

As a side note: The article cited in the OP is an opinion piece, not a news article. People's opinions are always interesting, but they don't always have a lot of evidence to back them up. It's important that opinion pieces be identified as just that.

Ahem.

Pardon me while I attempt to inject some logical thinking into this thread.

One thing I have learned in life is that if you find yourself in a problem, the proper course of action always includes figuring out how you got there so you don't get there again... or make it worse. So the question about healthcare becomes, should one agree that we need a better system, what exactly went wrong?

Not so long ago, healthcare was abysmal, but affordable. Back in those days, doctors would drive to a patient's home to make a house call. They would bring their little black bag and make diagnoses right there in your home, while you laid in your own bed. They usually brought the most common medicines with them, so you would have a supply until you could get to town to buy more. They would take into account your ability to pay, and many times would adjust their regular prices down a bit for those who were unable to pay the full amount. Many doctors actually became more wealthy doing this than by patients paying in cash, because the items they accepted in lieu of cash (up to and including land) became worth more in later times.

Back then, the family doctor was a trusted familiar face. they knew you by name, knew your children by name, and actually cared whether or not you were comfortable during your convalescence. They worked long hard days to offer a desperately needed service and were paid very well for that. It was rare to hear someone begrudge a doctor their high income level.

There were hospitals, and if the condition warranted it, the doctor would often transport you in their car. But hospitals were for the most severe cases, and you never heard of someone going to one for anything that was not chronically life-threatening.

Somewhere along the line, the house calls stopped. Now the patient had the responsibility to get themselves to the doctor. Since not everyone has someone right there at hand to drive them, and they were usually too sick to drive themselves. At the same time, the cost of medical care began going up. In no small part this was due to the advent of more expensive and more complex medical equipment... equipment that could save lives, but equipment that also had to be paid for and was not given to mobility.

Enter the insurance companies. Insurance was not new by any means, but it now became an almost necessity for anyone who was faced with the rising cost of medical care, especially long-term. As more and more people saw the coming of heinously high expenses just for basic care, more and more people began to purchase insurance against this potential financial disaster. that in itself sparked more problems: since the insurance rates were not directly tied to the cost of any single patient's expenses, human selfishness caused many people to demand the best treatment in return for their monthly payments. This translated to higher prices for the premium care that soon became the norm, and this caused more people to buy into insurance. It also led to higher insurance rates to cover the higher expected costs.

Widespread insurance also led to another phenomenon: people began using more expensive healthcare options for simple convenience. No longer were hospitals only for those with serious medical emergencies, but rather they became the most convenient, albeit the most expensive, option for those who didn't feel well. Suddenly, hospital emergency rooms found themselves treating mild fevers and colds instead of the critical patients they were used to. The cost for their treatment didn't go down, since they still had to be prepared for the more serious cases, but their workload went up, requiring new construction of larger facilities and more of that notoriously expensive equipment to comply with the higher demand for services.

Insurance companies also began offering riders that included ambulance services. Soon it was commonplace to call for an ambulance any time one didn't feel well enough to drive themselves. After all, it's covered under my policy, so why not use that benefit? Higher costs to the insurance companies = higher rates.

With all this money flowing so quickly, doctors as well began raising their prices to astronomical levels, in that age-old human custom called 'keeping up with the Joneses'. As the wages for doctors increased, more and more college students, trying to choose a career path, chose this lucrative occupation regardless of aptitude and for the sole reason of income. This of course led to an influx of doctors who were never cut out to become doctors, and subsequently to errors that cost patients their health, their limbs, and even at times, their lives. In a typical knee-jerk response, the court system began to award higher and higher awards to the victims of there errors, causing doctors to pay higher and higher malpractice insurance premiums to protect their financial life.

As with any industry, higher operating costs get passed on to the customer. So it was (and is) with the medical profession. Higher malpractice costs were passed on as salaries increased tremendously, raising the prices to record levels. Insurance became a necessity for anyone who could afford it at all. Those who could not afford it quickly realized they could take advantage of the system and have treatment performed and worry about the bill later. Since they had no real intention of paying due to a (usually factual) belief that they simply couldn't, people again chose convenience over economy. To a family living on $20,000 a year, what's the difference between a $10,000 bill and a $1,000,000 bill? Nothing; you can't pay either.

Now we get the inevitable government involvement. Medicare and Medicaid are established, the former to assist the elderly and the latter to assit the indigent. Both had the result of again driving up prices since now not only were the newly insured not worried how much their bill was, but they didn't even have to worry about the premiums. Also, in the case of Medicaid, the newly insured were those self-same people who were used to abusing the system due to their inability to pay. Old habits die hard.

To try to combat the expense encountered by government programs due to this unforeseen situation, programs were enacted to combat rising costs. Politically it would be suicide to remove benefits; public opinion, however, had turned against the now super-wealthy doctors and they made an easy target. In return for authorization as an official healthcare provider for a huge potential customer base, the government limited payments to doctors. Of course, since no one wants a cut in pay, the doctors simply raised their costs across the board to everyone else to make up the difference. No one complained, because it really wasn't their money that was being spent; it was the insurance company's money.

Hospitals also took their own initiatives to make sure they got paid. They began requiring proof of insurance for admittance whenever possible. This was a major boon for the insurance companies because it meant insurance was now a key to opening the door to healthcare. Of course, they took advantage of this fact to make sure they profited well, partly to make up for the problems they were experiencing as middleman between rising costs and apathetic customers, and partly to take financial advantage of a windfall.

Government stepped in with regulations to require hospitals to treeat patients regardless of their income or ability to pay. But these regulations could not legally be enforced on private hospitals. Since most people do not really care whether a hospital is a private operation or is publicly assisted when they try to gain admittance, this led to quite some confusion and stories of people being turned away from healthcare for inability to pay. In reality, no one in America today can be turned away from a publicly-assisted hospital in an emergency for inability to pay.

One more way doctors made up for this reduction in income was to accept kickbacks form pharmaceutical companies. These companies are like any others: they exist to make as much profit as possible. So seeing the opening and realizing that the only way to really sell their product was via physician prescription, pharmaceuticals began increasing the stakes when dealing with doctors. This provided some relief to the doctors, but also caused them to prescribe more frequent and more expensive medications, increasing the total cost to patients. of course, sensing another opportunity, insurance companies began to offer riders to cover medication, which, as with medical care, led to patient apathy and increased prices in another vicious spiral.

Hospitals began something similar, seizing on the practice of charging for every minute detail of care, and charging exorbitant prices to boot. Thus we hear of the $20.00 over-the-counter aspirin or the $5.00 Kleenex napkin. Again, higher payout leads to higher premiums.

And finally, as insurance rates spiraled completely out of control, employers in general recognized the need for prospective employees and began offering insurance as part of their benefits package to attract employees. Over time, this became less of an incentive and more of an expectation. As they fell into their own trap, employers began making up the difference by decreasing raises in both frequency and amount, leading to the static wages we have lived with for so long.

So what we have here is the perfect storm, a unique mixture of human greed, increased costs, apathy on the part of patients, corporate greed, lack of understanding, and governmental interference with poorly-considered programs. The question now is, how do we fix it?

--to be continued--

--continued from previous post--

Some time ago, I authored a thread about this very subject. It received very little response. I will not repeat it here; however if someone can locate this old thread, please feel free to post it. That said, I do know what will not work based on past performance: governmental involvement at anything beyond a purely judicial role or attempts to deny income to those involved.

We tried governmental involvement. It resulted in higher costs to everyone else, since the government had to restrict costs. Should there be no one else to make up this decrease in costs, the result will be a decrease in quality of care or actual rationing of health care based on bureaucratic regulations. It cannot be anything else.

We tried limiting income. That resulted in no change in prices, but it did result in an increase in other costs.

Obama's version of a heathcare dream is a nightmare in disguise. Calling for a change to better the care and accessibility is a noble thing; accepting any change that comes down the pike simply because we are dissatisfied with the present conditions is both foolhardy and naive. Change is not always good; it can also be bad.

TheRedneck

reply to post by crimvelvet


I agree this not the right time for a venture as the one the government is trying to take upon, no after the billions and trillions of dollars wasted trying to fix the economy.

We are in a Depression and this not the right time for government experimenting with business ventures at the expenses of tax payers.

reply to post by Kaytagg


That is do to manipulation of the interest rates by the fed, guess what we are no better today that when the economic crisis started all the Fed has done is slow down the crashing process, right now they are losing their grip on what they believe they control.

The economy is falling apart one piece at a time.

All the stimulus around the globe is going to cause inflation eventually.

reply to post by TheRedneck

Good Evening Redneck.
Thank you for your usual well-thought out, and wise analysis. There is very little that I can add, but there are few things I would like to say about the "solution" possibilities.
First of all, as you stated, malpractice lawsuits are certainly a part of the problem. Any solution requires a complete overhaul of the entire torte system. One of the ways that auto insurance attempted to control costs due to lawsuits, was the limited torte waiver option for those buying insurance. Perhaps this could be tried with health care insurance.
Generic drugs are another issue that deserves serious consideration. Any reform should require the use of generic drugs, if available, unless there is absolute proof that the name brand is superior in the treatment.
Focus should be on prevention. Everyone agrees that the cost of preventative messures such as PAP smear, mammograms, colonoscopies, annual blood tests, in the long run will save money and lives.
As you stated, this problem did not just pop up overnight.
The RUSH on the part of Congress to jam something through is unconscionable. Most members of congress don't even know what is in the bill. How, in heaven's name, can they put together a "solution" without much more deliberation, and public and expert input.
I doubt that many people do not recognize the need for a complete overhaul of the health care system in this country. That is even more reason to take our time and do it right.
After all, the current legislation, if passed, won't even take effect until 2013.
What's the rush?

reply to post by TheRedneck


Good analysis of the problem as usual. Redneck

I would like to add one thing I learned from a Doctor's blog. Doctors are willing to treat some patients for free but they hate wasting valuable time with government (and insurance) paperwork. Also it is now ILLEGAL for a doctor to treat a medicare or medicaid patient without filling out the paperwork even if it is for free (bureaucrat full employment act)

I hate the thought but perhaps a system where the PATIENT is responsible for the paperwork would relieve the doctors of the busy work and cut back on Mom rushing Johnny to the emergency room because he stubbed his toe.

Also one of the doctor's suggested making the free care tax deductible. From the comments by other Doctors, that idea was met with enthusiasm.

Originally posted by buddhasystem

Our government rations and controls nuclear weapons, and you don't seem to be losing much sleep over it. The Interstate Highway system is also the province of the Fed. The interstates seem to be in somewhat acceptable shape, too. Somehow, if the govt steps in to improve conditions of the uninsured and (hopefully) try to cap the astronomical expenses, you are up in arms.

How come they spend 40% less in the US and the citizens are happy with the care provided?

Should i not be "up in arms" when the government will decide what surgery and treatments Americans should have instead of doctors making this decision?...

Should i not be "up in arms" knowing that the Obama administration has made deals with big pharma, which Obama claimed would stop, and he kept denouncing about?...

Should i not be "up in arms" knowing that more Americans will be uninsured, and many more Americans will die because the government gets to choose who lives, and who dies?...

Tell us, what should we be "up in arms" for then?.....

reply to post by ProfEmeritus

Good evening Prof! I appreciate your kind words.

That post was (by necessity) a synopsis; many many factors played smaller roles than the ones I mentioned, but I believe it represents the jist of how we got to this place to start with.

As to your specific suggestions:

First of all, as you stated, malpractice lawsuits are certainly a part of the problem. Any solution requires a complete overhaul of the entire torte system. One of the ways that auto insurance attempted to control costs due to lawsuits, was the limited torte waiver option for those buying insurance. Perhaps this could be tried with health care insurance.

One area in the proposal I mentioned was that every civil medical case would have to be brought before a special court assigned to deal specifically with medical cases and the members of this adjudication board would be rapidly rotated from the community. medical professionals would be bound by this board's decisions, but plaintiffs would be able to move into higher courts if they were unhappy with the results. Also, no fees would be charged and no attorneys would be able to argue cases for either side unless, of course, the plaintiff was an attorney.

This would accomplish two things: one, awards would be limited, but available for those wronged. Since a segment of each board would be made up of medical professionals, they would be under personal conviction to award as little as possible, but also would be loathe to send one of their own to the regular court system where awards would be astronomical. therefore, their own interests would be to award a fair settlement, but not an outrageous one.

For the plaintiff, this would represent a faster route to resolution, since they would bypass the regular court system and all its delays, and a way to recoup damages without the expense of a high-priced attorney. It would typically be in their best interest to accept any fair award offered.

A second benefit would be to track incidences of malpractice and remove doctors (as well as other medical personnel) from service should they make too many of those errors I mentioned earlier. That should decrease malpractice rates by removing the highest-risk doctors from the pool and limiting awards simultaneously.

Generic drugs are another issue that deserves serious consideration. Any reform should require the use of generic drugs, if available, unless there is absolute proof that the name brand is superior in the treatment.

I recommended placing a price restriction for pharmaceuticals, limiting them to a price tied to the lowest cost sold in any other country. If we are talking about everyone sharing the cost as Obama wants, why not have the other countries share equally?

What's good for the goose is good for the gander. This would decrease the costs pharmaceuticals could charge here because they can't really raise the prices to other countries and maintain sales.

Of course, I would exempt the cost where true charity donations are made.

Focus should be on prevention. Everyone agrees that the cost of preventative messures such as PAP smear, mammograms, colonoscopies, annual blood tests, in the long run will save money and lives.

Very true, however it would be difficult to enforce such preventive measures. Rather, programs allowing for easier use of preventive care, such as requiring a no-deductible yearly exam from all insurance policies, might prove beneficial. Such an exam could include those common tests you mention, targeted by age, gender, etc. to specific high-risk groups. Of course, doctor's recommendation would be a reason to include them as well.

Government has a role to play: judicial, of course, and to make sure there is truth in advertising. Anything beyond that starts to worry me.

TheRedneck

reply to post by TheRedneck

One more thing that needs to be done, in order for any reform to be successful. Partisan politics needs to be eliminated from this entire issue. As long as it's a "us versus them" battle, there is no way a solution will come about that truly serves the American people. A PARTISAN solution will only serve the needs of the lobby groups associated with the "winning party". The thought of POLITICIANS deciding on what health care should look like, truly is INSANE.

reply to post by crimvelvet

I think maybe just making the paperwork less heinous would go a long way towards satisfying that concern.

You bring up an excellent point though, as to how government tends to accomplish the opposite of what they state as their intention:

Also it is now ILLEGAL for a doctor to treat a medicare or medicaid patient without filling out the paperwork even if it is for free (bureaucrat full employment act)

So by giving socialized tax-payer funded health care to those unable to afford it, they manage to make it impossible for doctors to provide health care that is truly free. Typical.

As to the tax deduction, why not? When I ran a design service, I was able to write off the estimated cost of plans done gratis for charitable organizations (i.e. Habitat for Humanity). Why should doctors be any different?

TheRedneck


[edit on 8/17/2009 by TheRedneck]

reply to post by ProfEmeritus

Partisan politics is the single most useless diatribe I can even imagine, my friend. That's why I will in the future refuse to even discuss a subject that turns partisan. Hopefully, this attitude is in line with the new guidelines. As stated in the movie Dirty Harry, "Harry isn't racist. Harry hates everyone."

I'm not partisan. I despise and distrust all parties.

TheRedneck

reply to post by TheRedneck

I'm not partisan. I despise and distrust all parties.

That is the only attitude that makes any sense lately.
The entire batch of bills in Congress now should be scrapped. None of them are non-partisan, although the Senate did make a minor effort to add some non-partisan thoughts to their version.