Interesting Take on the Health Care Debate
 

This, in the Huffington Post this morning.

Resuscitating Health Care Reform

What's missing in this as well as most articles I've seen is that if you have health insurance right now, it is not good coverage. Unless you're a member of Congress. Lots of people with so-called pre-existing conditions can tell you that they had good coverage — until they needed it. There are too many ways for the insurance company to drop you and it's too profitable not to.

Lifestyle is certainly an important part of this problem, but we need to recognize that the business of health insurance is mature, and that means there are two ways to increase profits. One is to take healthy clients away from your competition and the other is to cut off your unhealthy clients.

But the gist of the article, CWT, true in Canada as well, is that physicians have a "cure" for everything; an expensive "cure". We don't have a "Health Care System", we have a "Disease Management System"; preventive measures are not in the cards. It's practically guaranteed that relatively painless life style changes, e.g., eating a reasonably healthy balanced diet, getting some exercise, not smoking, managing stress, etc. will extend your life longer than a lifetime of bad habits followed by stents, bypass surgery, and expensive medications will.

Some time ago now, Michael Pollan, writing in the NYTimes article "Unhappy Meals" said: "Eat food. Not too much. Mostly plants." I'll add: Walk a couple of miles every day. Avoid or learn to manage stress. Start young.

I recognize that, but I think it's one of those things that everyone knows. Oprah says she knows what she needs to do: eat right and exercise more. The problem is that she doesn't want to do it. Neither does the rest of the world.

Lifestyle is an easy target to lay blame on, but it doesn't change anyone's business model. The insurance business model in the US is basically to enroll the healthy and terminate the sick. It's just another example of Big Business cost-shifting to the tax payers who have to pay when the uninsured go to the emergency room for basic needs. It's ironic because their push against reforms is that they would be "socialized healthcare."

Agree on both counts. The major difference between USA and Canada is Private vs. Socialized medicine, but in both cases, they cost too much because, as you said:

But isn't this just the malaise of the North American life style? The buzz words are Instant Gratification, Lack of Responsibility for Consequences, Me First.

Everyone hopes for a magic pill.

Clearly, both Big Pharma and the Health Insurance industries both need major cleaning up. They are out of control, but my take on the news to date is that that control isn't going to happen -- Big Pharma has already won and the public option will probably lose. You'll see a few feeble regulations in a gutted bill. Congress is in their pocket.

I believe that with great power comes great responsibility. I look around for Business leaders with real solutions and I see none. Only slick salesmen CEOs looking to sell cheap crap at high prices. One way for the Insurance industry to do that is to place some of the blame (warranted or not) for high costs on individuals.

I mentioned before that I know of at least one person being forced out of a job (suddenly getting poor job reviews: at least one is retroactive after positive reviews! This person put in loads of unpaid overtime.) at a major insurance company because of health issues. This same company promotes "wellness" programs, presumably to lower costs, but I see that as a smoke screen. Better to keep you thinking that what you do matters most. Pay no attention to the bean counters cutting off people who get sick.

Guess I kinda, sorta agree that lifestyle changes can lower the incidence of some disease. Think maybe they overstate the case.

My personal view is stress and heredity are the big factors in heart disease and probably obesity (heart & diabetes), too. It is easy to take a deep breath, count to 10, and quit worrying so much about that promotion you may or may not get. A lot of stress, however, is real and uncontrollable, like when the stressor (not necessarily a person) is right in your face and you cannot walk away, control the situation, or even fight back.

No doubt the stents & bypass surgeries are overdone. But if the patient has 98 to 100 percent blockages in all arteries going to the heart and has chest pain, I'm going to come down on the side that says restoring blood flow has got to be a good thing.

Is it now govt's and/or the employer's job to make us happy? Is doubling everybody's taxes to pay for a new health care system going to relieve stress?

I fear where we are in the health care debate is, as the article says, insurance reform and far away from any meaningful overhaul of the whole system. Everybody will pay a lot more, and the insurance companies will continue to get their 40 percent admin fee for processing the claim. We could do a lot better and a lot cheaper.

I think that the only way to tackle the whole system is to tackle the worst parts of it first. That would be the insurance. Fix it, and all the other problems become less severe. For example, insurance done right would make smoking and obesity financially untenable because their true costs would be passed on to the individuals responsible for them, through a combination of significantly higher premiums and taxes on sodas, candies, etc. At the same time, anyone with heart disease or diabetes would get the care they need.

All states have a Medicaid program that provides basic inpatient/outpatient insurance coverage to the poor and disabled. Why not just make everybody eligible for that and just charge a premium based on income? Or, do the same thing with Medicare? Sure, there would have to be some tax increases to cover the addl people but basically this is not rocket science.... rocket science is easy because there are no lobbyists.

My state already runs a similar program to provide health insurance for severely disabled children who cannot get coverage elsewhere. That is the child gets the insurance and needed medical care regardless of the family's income and assets and then once a year the state looks at their tax return and tells them what their premium is for the next 12 months.

Medicaid & Medicare programs, on average, operate with an admin cost substantially below what the private insurance companies get by with. Only one thing wrong with this plan.... the insurance companies oppose it.

Those are public options. Limbaugh would call you a Socialist!

The real problem is the insurance companies. It's not that they're evil or inefficient. It's just that they make Billions of dollars with the current system and any real reform threatens their cash cow. Naturally, they're against it!

And they oppose it to the tune of $1 million a day lobbying Congressmen and Senators.

I wouldn't call it an entirely public option.... those providing the care don't work for the government. Providers who don't want to participate can opt out, just as they do now. Individuals who don't want to participate can opt out, too.

I don't believe that providers work for the government in any public option being considered.

Agreed. But I understand that is the case with some of our European friends, e.g. France.

Wouldn't a true Socialist system require that all involved work for the govt except maybe the beneficiaries?

If Ms Sarah says there are "death panels" to determine which citizens are worthy of receiving health care, then by golly there might be something to that!! :eek::eek:

Whole debate is getting out of hand. Facts are being totally lost in the campaign to discredit the health care reform effort. Suspect that means not much is going to get done.

I actually see it as a good sign! It means that the crazies are going to be seen as so crazy that they should be ignored. The louder they yell and the more they lie, the better I think the chances are. The only wild card is how much damage that the insurance lobby and the right wing can slip into the final bill.

You mean, the same way the crazies who claimed that Saddam Hussein ordered the hit on New York were ignored?

In 1945 a new British government was formed under Clement Attlee. In one parliament they created the National Health Service and the other components of an early and exemplary welfare state. I am no historian of that period, but I do know that the doctors screamed blue bloody murder and were simply steamrollered. Labour had won an election with a mandate to do this, and so they did it, end of story.

It's not just that the American system, for all the pomp and circumstance of the Presidency, diffuses power more than the British; I don't think that anyone could be an Attlee in the UK now either, or perhaps anywhere in Europe. It seems to me that the only allowable "reforms" nowadays are the neoliberal; that is, the dismantling of the state and the worker protection legislation, plus the destruction of civil liberties. Such reforms are enacted at the double, with little opposition except from Attac, whereas with the kind of reform that Attlee created, all the pundits immediately say that they are impossible, and that creates its own reality.

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There is a bizarre notion that Health Reform requires 60 votes in the Senate. That is not the case.

I think if we could sit like a fly on the wall, we might hear some mighty strange conversations these days, not to mention payoffs and outright blackmail.

Nevertheless, I actually think Obama and Congress will enact a Health Care Reform bill this autumn -- and that it will be far better than the pessimists fear.
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No need to be a fly. Just listen to the people talking about death panels. I get the feeling that they really believe that junk.
Depends on which pessimists: the death panel/birther people, or those of us that think the insurance industry is going to have too big an influence on the final bill.

I am one of those pessimists. Sure, they will enact something and it will be better than what we have. Democrats have to do that or they are in deep, deep trouble down the road I think. And, they have the votes to do it if they can get the blue dogs democrats to come along.... without their support, Dems don't have the votes and so far they do not have their support.

So, what's the real test as to whether or not the reform was as good as it should have been or is just lip service to say Congress did something? Keeping in mind that the insurance industry actually supports everybody getting coverage (that's a lot of new customers, right), what should we be looking for?

1. Anybody who wants health insurance can purchase it at a reasonable price without regard to pre-existing conditions. Big step, but no where near universal and for sure that won't cover the poor or the homeless and probably not some of those between jobs.... no job, no income and no savings = no such thing as a reasonable rate.

2. Mandated fixed premiums (based on age, sex or something but standardized within a group). Another big step. Could happen.

3. A standardized set of services/coverage that all insurance policies must provide. We should stop the practice of capping services at a set dollar amount or set number of visits, days, etc. Do away with crap like you can have a wheelchair covered up to $500... when a good one for someone with severe disabilities will run closer to $5,000. Do away with medically necessary, but not covered services. Good luck on this one, too.

4. Standardized caps on out of pocket expense from co-pays, deductibles and such. This is key if we really are going to stop people from going bankrupt over health care. Again, good luck.

5. Is a public option based on income/assets made available? This is my key... if we don't get this, we got lip service and did not address the problem in any big way because everything is still tied to your economic situation and your employer still has you in a very tight choke hold.

Others?

The US Senate is a strange place with arcane rules, loop holes, and exceptions to loop holes. I suspect (but don't know for sure) that the 60 vote thing is referring to the number of votes necessary to override a filibuster and force a vote on a piece of legislation. I'm no expert in such things, but I wouldn't be entirely surprised if the Republicans found a procedural way to block a vote or force an override of a filibuster. It's called invoking "cloture." Originally, forcing cloture required a 2/3 majority, but was later reduced to 60 votes.