Child of Illusion has a number of posts on her blog about the health care crisis. As she will be leaving her position by the end of the year and is not yet old enough for health coverage under Medicare - covering the uninsured hits her personally. Out of respect for her future situation and the situation of the 50,000,000 or so uninsured Americans, I wanted to start this post by directing folks to her blog.As a health care worker in this country, I don't see how we can fix this situation. I saw a news item today that President Obama wants more concessions from hospitals. I shook my head - in the past seven years, I believe the non-union employees of my hospital have gotten raises only two times (maybe three). The last raise was over two years ago and we are finally getting a whopping 2% raise this July.
I read somewhere recently that a major part of the problem has to do with the concept of insurance. In every other aspect of our life, we purchase insurance as protection against an unlikely tragedy. If we are fortunate, we pay into our auto and home owners insurance plans and never need to take advantage of them - that would mean that we have no wrecks in our vehicles, no fires or major damage to our homes.
There was a time where health "insurance" served the same purpose - in the event you ended up hospitalized with a lengthy illness you had coverage. Of course, back then many folks with serious illness didn't survive to end up in a hospital bed for weeks on end - if not months. The model still worked in the early days.
However, now we have a completely different situation. Science has brought us highly accurate (and expensive) diagnostic tools. Pharmaceutical companies have developed medications to treat our common ailments. Life saving surgical techniques, emergency medicine, defibrillators, etc. all keep people going when in the past they would simply die. However, this is not what the insurance industry would routinely cover.
Think about it. Let's apply this concept to our automobiles. How expensive would our insurance premiums be if State Farm or All State had to pay for oil changes, new tires, brake jobs, new head lights, etc.? In other words, routine health maintenance for our vehicles. How much would our home owners insurance cost if it paid for the new furnace, the new roof, new windows - routine maintenance to keep the house "healthy and strong?"
We need to differentiate between health care and health insurance. There really is a difference. The insurance model doesn't work any more. Child of Illusion's post discusses cherry picking as a potential problem of having competing public plans next to private plans. The comment she references is most likely spot on - the insurance companies would dump the "sick" folk to the public plan and take the healthy folks only. Auto insurance companies are not forced to insure bad drivers with multiple accidents and moving violations at the same terms as drivers with good records, are they? The "insurance" model no longer works for health care.
IMHO we need to work towards a universal health plan that provides basic coverage for all with co-pays in the way that Medicare does for seniors. The private insurers should retool to provide supplemental policies only. Even then, we will likely have a situation develop similar to what I understand has happened in Britain. Boutique hospitals, clinics and doctors will spring up where individuals with "Cadillac" supplemental plans or the cash reserves to pay up front will be able to obtain state-of-the-art, personal care on demand. The rest of us will have long waits at the other facilities.
In typical fashion, we in this country want it all. We demand the best health care available - no matter that as science develops new and better treatment options at escalating costs - Medicare only reimburses hospitals at rates for simpler less accurate treatment options. For example, in the arena of cardiac care new and improved stenting in the cath lab has significantly reduced the need for open heart surgery. However, despite the fact that costs for the new treatment are thousands of dollars more than the recent (and now outdated) procedure, Medicare continues to reimburse at the lower rate. Hospitals are forced to not offer the current, best option and have patients choose to go to a competitor or they take about a $3,000 loss every time they perform this procedure. We want it all.
Doctors feel obligated to order many many extraneous tests out of fear that if they miss a diagnosis, the family lawyer will be dragging them into court. They're not wrong to do this. How many of those obnoxious lawyer "trolling" commercials have you seen on television - where they are fishing for potential clients? We want it all.
Look at me - I am not high and mighty by any means - I am fat and sedentary and now I have diabetes. What? You mean that if I had kept my weight down and exercised regularly I might have PREVENTED this? Really? Wow! Why didn't anyone tell me...you get my point. We want it all.
Look back at that cartoon at the top of this post. Imagine that our auto insurance had to pay for repairs to our vehicles - even when we ignored engine lights, failed to get the oil changed, pretended the transmission took care of itself...and now, they have to pay for the repairs. How expensive would it be for that kind of "insurance?"
4 comments:
Careful here. It sounds a tad SOCIALIST like us wicked folk from Yurp.
I suppose it does, Jack. IMHO it is the only thing that will work.
There's a place I go almost every evening to get a soda. One of the women who works the counter there has become pregnant. So this afternoon I took over a little suit of clothing and some bibs, you know, like ladies do. In the course of our conversation I asked how on earth she was able to afford all the medical care involved. She's had a couple sonograms, and what sounded to me like the regular round of doctor visits. Want to know what she told me? Really, think about it because you may not want to know. Ready? "No, Miss. It no cost. You no have to pay to have a baby." My hand to God, that's a quote. OK. I am not going to bore you with the fact that I can no longer afford the joke of an insurance policy I once had, or tell you about the the thousands of dollars I've spent this year on really necessary health care. But, here's the thing. I paid for mine. I paid. A lot. So, someone please explain to me, and I am just on a rant now so this is a rhetorical question, but please explain to me why it is free to have a baby, even with an expired green card, even though you've been in this country nine years and still can't speak English but I, a full-on American, can't afford to go to the doctor. I mean, why is that? And this is the point at which I shouldn't say anything about immigration...
This is a good post, Larry. You raise some very good points.
Thanks for your comment, Lindy. In the work I do now, I encounter many many patients without coverage. In the infinite wisdom of the govt. home infusion antibiotics are not covered by medicare. (A three week stay in a nursing home is though) Folks whip out their supplemental policy and we have to explain that the policy only supplements what Medicare covers - they won't pay a dime for what isn't covered by medicare. Just admitted a patient who hopes to be Medicaid pending (rumor has it that they own a camp - cabin for most folks). His IV medicine will cost him about $2,300 a week, on top of his hospital bill and the bill for home health nursing visits. His medical bills will cost more than the camp is probably worth, but he won't be able to get assistance because he owns some small place in the woods.
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