Monday, August 31, 2009

Change Is Scary - Part 3

I think Health Care Reform deserves a serious discussion, not soundbites, scare tactics, lies, and ignorance. This is the third of my August Recess posts about health care reform.

Part 3 - But We're the Best! Why Fix What Isn't Broken?

Whose health care system is better? We can quibble about that, with columnists around the globe giving their opinions, analyzing wait times, predicting what will happen if this, that, or the other bill becomes law. These sorts of discussions are peppered with personal anecdotes ("I had this condition and walked right into the surgeon's office, while my friend the Canadian nurse says that up there . . . ") and much parsing of statistics (apparently comparing ANYTHING country-to-country - other than access/wait times - is apples to oranges).

What I know is this: we could do much better than currently we are doing.
  1. "According to a study by The Commonwealth Fund, Americans wait longer to see primary-care physicians than patients in Britain, Germany, Australia, or New Zealand—all countries with strong public-health systems." (Link for more stats.)
  2. "Karen Davis, president of the Commonwealth Fund, says America ranks last overall in the fund's comparative studies, which consider access, equity, cost, quality, and efficiency measures across select developed countries. 'Where we do well is on …selective surgery.'" (same source)
  3. Health care is on track to consume 40% of our national economy by 2050. "Costs are rising so fast that every day more than 10,000 Americans lose their insurance coverage." The number of small businesses that can afford to provide health insurance for their employees is plummeting.
  4. Newsweek's International Editor, Zakaria, also says (sadly, without attribution) "Americans do worse on almost every health measure than most advanced industrial countries, which spend only half as much on health care per person and have proportionately more elderly people."

Ethically. Is health care a right or a privilege? Is it like education and retirement? Is every American entitled to have some affordable option available? Or is it OK with us as a society that there are simply some people (the working poor, people with pre-existing conditions) who are simply uninsurable?

Practically. It costs us ALL a ton of money when the uninsured use the ER for primary healthcare. Those expenses come from somewhere and go to somewhere - they raise the cost of healthcare for everyone else.

Real Choice? It’s Off Limits in Health Bills

"It refuses to pay for certain medical care and then doesn’t offer a clear explanation. It does pay for unhelpful care that ends up raising premiums. Its customer service can be hard to reach or unhelpful. And the people who are covered by this insurer have no choice but to remain with it — or, at best, to choose from one or two other insurers that are about as bad.

In all likelihood, I have just described your insurance plan."

We can do better.

Part 1 - Down Syndrome is a Pre-existing Condition

Part 2 - It Pays to Work for the Insurance Company
Part 3 - But We're the Best! Why Fix What Isn't Broken?
Part 4 - What Does "Reform" Really Mean?

The President's Plan for Health Care Reform


The Phoenix said...

It's almost impossible to compare America to other countries when it comes to healthcare, you're right.

A couple things to note:

1)Wait times are long because we don't have enough doctors, esp. primary care physicians

2)Especially in smaller towns across rural America, more doctors are leaving. Liability insurance is so expensive, and they're tired of getting sued. So they go to larger cities and join a larger physicians network or hospital to cover the liability insurance cost.

3) Reform must therefore include tort reform and getting more applicants into med. school.

4)I worked in medical sales, and every ER I visit - from small rural to the large metro - was congested with drug addicts wanting narcotics and repeat patients with no real serious illnesses. It's costly and time consuming.

5)The insurance industry is like the house in Vegas. It cannot lose. We need to take away their greed factor. They have room to reduce their loss ratios to lower premiums. The threat of a govenment competitor should scare them into doing so. The insurance company will make up for this by actually experiencing an increase in premiums from the increase in customers.

6) Cost of durable goods. I sold a catheter that cost 1 cent to make, but sold it for $1.50 each. It's crazy, and it drives the cost of healthcare. From bandages to asprin, costs need to be controlled. Vendors are raping hospitals, which in turn increase insurance costs, begins the whole domino effect.

7)The Tsunami. Nearly 25% of our children will be obese by next year. A whole generation of unhealthy people will literally bring our healthcare system to its knees. Reform needs to emphasize prevention. However, giving doctors financial incentives to keep their patients healthy will backfire, as physicians will simply not take on unhealthy people. My mom works for WIC in St. Louis, and it's one of the few govt. programs that actually SAVES more money than it COSTS. We need more programs like that.

Sarahlynn said...

Agreed on all counts!

Another reason we have so few primary care physicians is that specialties pay much better - and often have better hours.

It makes sense to make more money for more years of training - cardio thoracic surgery, for instance. But other specialties paying SO MUCH more than primary care? Bad idea.

And the American Medical Association has itself to blame for medical school enrollments and shortages. Not only is the admissions process ridiculous, the AMA (and AAMC) strictly regulates proposed new medical colleges.

People with non-emergency conditions clogging ER waiting rooms are a real problem. Education (it does you no one any good to spread your germs around an ER waiting room if you just have the flu!) and better access to affordable primary care will relieve some of that strain.

cinnamon girl said...

The Phoenix, I was with you there, until you used the word rape as a synonym for overcharging.

Sarahlynn, Australia has had universal Medicare for decades now. There are two reasons we like it - firstly the weight of inertia (it's there, and changing it would be... well... a big change). People are resistant to change. The second reason is one you touched on - "is it OK with us as a society that there are simply some people (the working poor, people with pre-existing conditions) who are simply uninsurable?" Australia would unequivocally say NO, that's not ok at all. In fact, that is one aspect about the health care system in the USA that we find hard to comprehend.

We still have some of the problems mentioned - long waiting lists, few doctors in the small towns, inefficient use of ER. But there are several ways these things are being tackled. A big issue is the potential cost of it in the future, so the government is encouraging people to get private cover if they can afford it to reduce the cost to the public health system. But there is no discussion of ever scrapping Medicare due to it's cost - in fact, it works so well we want to expand it to include Denticare.

Sarahlynn said...

Cinnamon girl, good call! I missed that one. Rape is just . . . rape. Nothing else is really quite the same and I don't like to lessen the horror of the word and the experience it describes by using it to describe unrelated offenses.

One of the funny (funny strange, not funny hah hah) things about the "system" we've got here in America is that we have all those systemic flaws (limited access to care, out of control expenses, etc.) but we're so sure that what you have is even worse that we refuse to even attempt to improve our mess.