The Way I See It - Healthcare, A New Lesson

Paul de Armond  //  Wed, Nov 11, 2009, 8:57 am

What we need is consumer protection for medical insurance consumers.  By opting for market solutions from the top down, the bottom up demand for quality commensurate with price has been ignored.

The medical profession no longer works for their patients, they work for the insurance companies.  Patients are just a financial resource to be bled financially and then buried as mistakes.

We’re paying top dollar for an inferior product.

One solution would be market reform, but that doesn’t seem to be on the table in the current debate.

Another solution would be taxing the crap out of insurance profits - which are obscenely high.

A third solution would be to put some competition into the market by linking federal monies to medical education to an increase in trained medical personnel - why should a large portion of the country be unemployed or underemployed while the medical schools create an artificial shortage of practitioners to keep prices high.  Get a little competition going to lower prices.

The significant thing about the rest of the world getting a better bargain on medical care is every single country that does better than we do - and there’s quite a few of them - have better access to care.  Which means supply is not artificially limited to drive up prices.

Craig Mayberry  //  Wed, Nov 11, 2009, 2:31 pm

Ham,

Thanks for the insights on our health care system.  The current reform debates have become very disconcerting recently as the approach now seems to pass anything, even if it is bad or else we will lose political power, not exactly the recipe for successful improvements in the system. 

I have always been a little concerned about using life expectancy and infant mortality as measurement of a good health care system.  As someone with a statistical and academic background I recognize that there could be many drivers of life expectancy and infant mortality, yes the health care system is part of that, but so is lifestyle, diet, stress, genetics, etc.  I personally think that our lifestyle and diet have a big negative impact and if it were not for the health care system that we have the numbers would be a lot worse. 

Reducing the cost of health care will only come through rationing or lifestyle changes that mean we get sick less often.  I am not a fan of rationing and would rather spend more money then deny people treatment.  I am not really into government mandated lifestyle changes either so I am not convinced the cost issue is really addressable. 

I do think we would be well served by having a discussion on fairness of who pays for healthcare.  The current system has considerable unfairness, but it is hard to imagine the reformed system being “more fair” given we do not even understand what the reforms mean.  I am certainly in the camp that believes people should not lie awake at night worrying about how to pay their doctor’s bill or be forced into bankruptcy to deal with a sizable medical bill, it was not their choice to get sick and they should not be financially punished for a decision that they did not make.  I also do not believe that medical care should be free either as we will always consume more of something if we do not have to pay for it (a sliding scale based on ability to pay, but everyone pays something).  I have also experienced the British medical system of universal coverage and I would not wish that experience on anyone. 

I believe the answer lies in a few simple truths.  We are better off dealing with health care locally instead of nationally (it will be less bureuacratic and we can look decision makers in the eyes instead of on the phone) and we are better off dealing with it without the involvement of insurance companies and the federal government, both of which have proven themselves to be incompetent at solving health care issues.

Ham Hayes  //  Wed, Nov 11, 2009, 3:38 pm

Both of you point out the issue with regard to insurance companies.  They now have too much control over the treatment plans which effectively rations care and drives prices up. 

Another factor is the pharmaceutical industry and specifically the cost of R&D;.  I suspect the most and the best R&D;is done by US companies.  These costs are passed on to the “consumer” who is (drum roll) The Insurance Companies, not the patient.  The folks who pay get to play.  One way to reduce R&D;costs is to extend patent protection, allowing the Pharms to recoup their investment over a longer period. 

Frankly the approach of “o, let’s just pass this bill and fix it later” is insane thinking to me.  Let’s unravel the economic mysteries and get at solving the problem.

Craig Mayberry  //  Wed, Nov 11, 2009, 4:47 pm

It is a critical point that needs to be clear in everyones mind.  There is no difference between the government and insurance companies when it comes to deciding health care decisions.  Yes, insurance companies have way to much control in health care decisions, but there would be nothing fundamentally different about the public option and having the federal government now control health care decisions.  Both government and insurance companies are going to make decisions based on their own interests and not those of the person receiving care.  If anyone (especially Rep. Larsen) believes that the government will be more altruistic in deciding health care policies than the insurance companies then you are living in a fantasy land (to put in bluntly).

Paul de Armond  //  Thu, Nov 12, 2009, 8:34 am

There are significant differences between a health care system with a public component and the privatized system that has failed to delivery quality health care at a reasonable price.

The greatest flaw in the current economics of health care is the system has evolved into an unregulated natural monopoly.  Consumers have little freedom of choice when it comes to either insurance providers or service providers.  Those with medical insurance don’t have many options available when it comes to insurance or medical providers.  It’s not an open marketplace where services are widely available at differing levels of cost.  Closed medical practices, limited or no choice of insurance providers produce a system that is highly constrained in access or availability.

Most importantly, consumers are not buyers in this market, they are rate payers with unavoidable fixed costs set by a single insurance company.  This is a monopolistic market without significant competition as seen from the consumer’s point of view—assuming that one is a member of the privileged class allowed to participate. 

Small business, the self-employed, the unemployed and the underemployed are mostly excluded or are presented with a take-it-or-leave-it situation.  Health care is not a level playing field on the demand side and is rigged by closed markets and price-fixing on the supply side.

The difference between public and private health economics is similar to other natural monopolies contrasted with public utilities.  For example, just because the Bonneville Power Administration and Enron are both large institutions doesn’t not mean they are going to perform similarly in the market they share.

If, as Craig says, there really is no difference, then he has removed the major objection to complete nationalization of the health insurance. 

There are significant differences between unregulated predatory monopolies and publicly controlled utilities.  The most significant distinction is that a public system would be subject to public audit through access to public financial records and budgets.  And the sovereign power of the citizenry would be continually vigilant through the process of public debate by elected representatives.

Ham has, I think, missed an important point about waste, fraud and abuse.  The entire system is rife with opportunities for defrauding the consumer and the situation in private health insurance is far worse in the private sector than it is in the public sector.  It is just more protected from exposure and examination.  There is plenty of fraud, double-billing, unjustified denial of service, embezzlement and waste in the private systems of care and insurance.  It is just more shielded from scrutiny and open audit.

Which, when you come to think of it, is exactly why we are having a national debate over the flaws, inequality and corruption endemic in the current state of affairs.

David Camp  //  Thu, Nov 12, 2009, 10:19 am

I think you guys are dancing around the main issue here.

The issue? The federal government is completely in thrall to corporate interests, in this case the insurance, pharmaceutical, and hospital industries. All policy is for their continued prosperity. Clients (patients) are useful only as sources of profit.

Consider this: over 50% of Medicare spending is in the last 6 months of the patient’s life.

How does this make sense as social policy? I don’t think it does - it only makes sense to me because the dying patient is the most profitable and the least risky (all corporations exist to maximise profits and minimise risk).

I’ve almost come to the Grover Norquist view of the federal government - because it is so corrupt, it is incapable of doing any good for the citizen. All it seems capable of doing is converting public funds into private wealth, or taking the country’s treasure and blowing it up in the middle of a foreign desert.

The health bill that just passed the house is actually worse, IMHO, than the current situation because it forces all citizens to buy corporate health insurance, and obligingly takes all the patients the insurance companies don’t want (because they’re sick) into the “public option”, which will actually be more expensive than private insurance as a result.

Take a look at this interview with MD and Harvard Prof Dr. Woolhandler - she says it better than I:
http://www.democracynow.org/2009/11/11/study_over_2_200_us_veterans

Tip Johnson  //  Thu, Nov 12, 2009, 1:15 pm

Not that I’ve done extensive research, but from what I’ve read, the best health insurance in the world is provided by private companies.  This is the case in the Scandinavian countries whose health stats we all admire.

However, they are regulated in much the same way we regulate electrical, gas, telephone and cable utilities.  They must have major purchases approved, so they’re not paying off a cat scan on every floor, and every clinic is not funding it’s own lab to skim off more test charges.

They must have expenses approved, meaning managers do not receive obscene bonuses.  They operate on a fixed rate of return. They must provide the service to all in their franchise area, etc.

I am unsure of how they manage liability - another insurance market - but I believe that’s one of the unspoken issues balling up the current reform effort.

It’s funny how easily, with other utilities, the rate base recognizes the inherent efficiency of adequate regulation. It’s amazing how difficult it is, even with the current financial and medical crises, for folks to draw the parallel for these essential services.

I think, too, there remains the issue of distinguishing between the companies providing insurance coverage and those providing actual health services.  Creating a larger pool is a good first step, but reigning in insurance companies will accomplish only so much. Probably, standards of service will need to evolve at the insurance level and trickle down to doctors before we start seeing real cost benefits. 

At the end of the day, whatever they pass will be a good start, even if it is only opening the door.

Doug karlberg  //  Thu, Nov 12, 2009, 3:09 pm

In this health care debate, Mr. Camp has hit the nail on the head.

Our lawmakers no longer represent our interests. They represent the “special interests”, that fund their re-election campaigns.

Asking our legislators to then be regulators is simplistic and will not work either.

You cannot change our legislators from “sinners”, into “saints”, by calling them regulators. This is simplistic and naive at best. Congress will happily regulate, but their regulation will only further enrich their Special Interests, which they have bedded down with.

Parties no longer matter, as Special Interests infect both parties equally.

Health care systems have been carefully measured and ranked. France has the best system when measured by cost and life expectancy.

If we simply copied France’s system we would live longer, every one would be covered, and our costs would decrease 33%.

So why don’t we copy France’s system?

Because vested special interests will not give campaign contributions to legislators who vote for a French system, and our legislators do not have the backbone to buck the special interests.

Even with literally our lives at risk, legislators cannot put us first.

Our legislators when given a choice between what is good for us, and what is good for their campaign contributions from special interests; WE LOSE.

This deep systemic problem manifests itself in all legislation, not just health care.

This is a very serious crisis, and this plague has infected Washington DC, and is creeping quickly into state and local politics.

Not convinced, well then how else could we get health care reform that forces every person to purchase health care insurance from private companies, with no limit on what they can charge, and if you cannot afford it the government fines you, so that you really cannot afford health insurance now?

This is the House Plan, simplified for dummies like me. If the above paragraph is factually incorrect, please someone correct me. If not then this is not reform. This if forcing us through the cattle gate, charging us what they desire, fining us, and then leaving on the side of the road to die.

Our government is sick and this is the root cause of our health care problems.

David Camp  //  Thu, Nov 12, 2009, 6:02 pm

I think the ultimate solution to much of what ails (or has killed) our republic is to strip the federal government of the powers it has usurped and reassert States’ rights. Canadian single-payer medicare-for-all was first implemented in the Province of Saskatchewan by the Canadian Coalition of Farmers party led by Tommy Douglas. It worked so well, despite the frantic politicking of the corporatists, that it was adopted by the federal government. It was however easier than it will be here since in the 1950’s there was no profiteering health insurance industry that owned congressman and no corporatist propaganda outlets like Faux News.

Other institutions that would benefit from State control, IMHO, include education, financial regulation, militias, food safety, and police. Some states would be run into the ground like banana republics, run by corrupt corporatist racketeers, and people would vote with their feet leaving them to the dupes and retards. But most would be run sensibly by legislators closer to their constituents and therefore more accountable.

I don’t know how to describe these here United States of America other than as a failed republic, subverted and betrayed and appropriated by the greediest most corrupt scum on the planet, sleepwalking in fascist pyjamas.

Craig Mayberry  //  Thu, Nov 12, 2009, 6:57 pm

Now you are starting to talk like tea-partiers, I thought that was politically incorrect.

I believe that the Canadian systems is still run and funded at the providence level, although every providence has some version of it.  In some of my travels to Canada for school I have heard that various providences are considering reforms, which implies the providences still exert a lot of control over how it is done.

Doug karlberg  //  Thu, Nov 12, 2009, 7:40 pm

Mr. Camp,

I don’t buy into the failed republic doom, but the a clear understanding of what has failed, is the required first step towards fixing it.

Americans have a history of bucking up, and working together to get through adversity.

Although we have gotten a little fat, and aquired some bad habits, I would not bet against American, at least those I know…

... who do not live in Washington DC.

David Camp  //  Fri, Nov 13, 2009, 9:10 am

Craig,

The tea-partyers have legitimate issues with the federal government. But their legitimate anger is very skillfully misdirected by a manipulatively partisan corporate mind-control media. The same issues existed under the Republican regime - but they don’t get this because they are mindlessly partisan.

I try to tell the truth so I say fie on PC wimpiness.

FYI in Canada, the provinces administer medicare, so each province has its own regime. However, the federal government has oversight, and makes sure that all provinces follow national rules. For example, no user fees can be charged, which I find not sensible. But it’s based on the principle that every citizen is entitled to equal access to health care, which I find fair and just. The federal government maintains control through the purse strings - it funds much of the cost of medicare and withholds funds should a province step outside the guidelines.

The guidelines are principle-based, rather than rule-based, so there are significant differences between how healthcare is delivered between the provinces. For example, in Quebec (probably the most socialist province), the provincial government maintains centers called “CLSC’s” (centre local de services communautaires, local community service centre), where government services are delivered. In small towns this includes periodic doctor hours - in the township where my son is living (population about 1,700), two different doctors serve the (aging) population, one on Tuesdays and the other Fridays. In larger centers, doctors maintain traditional office practices. In each case, the doctor is paid on a fee-for-service basis. The government provides CLSC facilities to the doctors to ensure that smaller towns have their services. Good idea, eh? Consider how medically-underserved rural areas in this country are.

The CLSC, to my imperfect knowledge, is unique to Quebec. Similarly, the Medicare Act allows different provincial/personal share funding regimes. Ontario used to collect a medicare premium. When I lived in Toronto 25 years ago it was $146 a month for my family coverage, which may seem low but at the time I was supporting my family on $16,500 per year. In Quebec, it is paid for out of income taxes.

This system is certainly much cheaper than the US system (about half the cost), and everyone is covered. It is not perfect by any means, but it sure looks better to me than the greed-based US system, where the indigent and the rich and the old get health insurance, but those working outside the corporate system get nothing. This is what the T baggers should be up in arms about, if they would stop watching TV and open their own eyes.

David Camp  //  Fri, Nov 13, 2009, 9:16 am

Mr. KArlberg,

Perhaps I did get a little poetic on the subject of the federal government. I’m a recovering Wall St Journal reader.

I agree with your appraisal of the nation, which is a different thing to the government. The nation is rich and resourceful, populated with intelligent, very hard-working practical people. They need to figure out that they’re ruled by interests antithetical to theirs.

Doug karlberg  //  Fri, Nov 13, 2009, 10:00 am

Mr. Camp,

You now concede that the “Tea Baggers” may have legitimate complaints with the Federal government. Excellent.

Now if I can just convince you that some of the Tea Bagger’s are humans with the ability to think for themselves, rather than be herded by the “corporate mind control media”.

It seems like all too often any one who disagrees with our self appointed “politically correct” thinking, is either evil, or an idiot.

Bad way to begin a discussion don’t you think?

The Canadian system cost approximately 66% of the US system, and if given a choice, I would vote for the Canadian system. It is probably not the “best” choice, but it is better than what we have.

Let’s be clear about two things though, I attended both Tea Bag events in Bellingham, and THESE ARE NOT THE CHOICES THAT PELOSI IS GIVING US.

The bill on the table would require us to purchase insurance from the same private evil insurance companies that we now have. There would be no limit to what these companies could charge us. If we could not afford insurance, the government would fine us to make the insurance more affordable.

The required health insurance policies would require government certification to avoid fines, and the policies are so larded down with benefits, that they resemble the policy requirements in New York, which cost $39,000 a year for a family of four.

This is precisely why reading the details matters. Yes, Tea Baggers can read.

This is also why the hurry to pass this before any one actually read the bill.

President Obama promised that our medical insurance would become more affordable, more fair, and cover more people.

Without any coercion from the evil mind control media, it doesn’t look to this simple Tea Baggers’ mind, that the plan on the table will accomplish any of these goals.

Additionally the Trial Attorneys have been protected, which from this idiot, is the epitome of “greed based” systems. The more crippled the client, the richer the attorney becomes.

Our doctors practice in fear of attorneys, which should not be the case. Defensive medicine it the single largest cost that could be eliminated, and it got a free pass.

You think campaign contributions had any thing to do with this free pass?

Obama could have done better than this plan, if he had put our needs first.

This is a bill of the special interests, for special interests, and written by the special interests. Much of this bill has literally, been written by special interests.

How can we get any reform that serves us, until our needs come first?

David Camp  //  Fri, Nov 13, 2009, 11:00 am

Mr. Karlberg,

I’m not convinced the T-baggers would agree with your favorable report on the Canadian system - it is Socialist after all, which is a baaaaad word!

I think that they would oppose pretty much anything that came out of a Democratic Congress, regardless of its merits.

I challenge you to refute this. IMHO manipulated partisanship is destroying reasonable political debate in this country.

If what you’re saying is correct, why are the T-Baggers not advocating for a single-payer system? This is the least-cost solution - but it is not even part of the “debate”. Why not? Because it is anathema to corporatist interests, which the corporatist media, including the odious moral degenerate Rush Limbaugh, represent.

David Camp  //  Fri, Nov 13, 2009, 11:03 am

Incidentally, every time I see Max Baucus’s smirking face as he sells out his constituency to the insurance industry I want to puke.

Doug karlberg  //  Fri, Nov 13, 2009, 12:41 pm

Mr. Camp,

I believe the political parties are all too happy to see us fighting with each other. The parties assist this destructive bickering among camps of Americans by framing the debate in a way that ensures argument.

Here is an example. Politicians ask us what we want, with no price tag attached. This lets them spend freely, which is where their power comes from. (Can you imagine a politician with nothing to spend?)

Then they give us the price tag and blame us for asking for too much.

This is backwards to how we approach our own life problems. We begin by asking what we can afford.

Here is my solution, and I think that even to Tea Baggers would have to give this serious thought.

We get together and instruct our elected representitives to give us the French system and spend no more than 12% of GDP. If the elected officials do not produce this legislation, we mutually agree to vote their arses, out of office.

It is a proven system that works, it insures all, and it is 33% more affordable then the current system. A little socialist? You bet. Does it have market competition too? You bet. Is it an affordable compromise? You bet.

Does it work? You bet.

If the left, right, and center got together, this would put the fear of God in them.

Our bickering sends the politicians a message that they can have their way with us. When we get together on an issue, trust me, they will notice.

One of the reasons this would appeal to the conservatives, is that it would have costs capped. This is not an open checkbook.

All legislation is about compromise, and there is nothing in the current bill that is a compromise to the conservative side. Controlling the costs of the program would definitely appeal to at least some of the conservative goals.

Personally, I think the Republicans should stand clear and let Pelosi have her way with Americans. Democratic supporters will evaporate by the droves once the cost of this monstrosity becomes apparent.

I doubt the current Republicans would do better. Both parties are mistreating the American public on an issue which can legitimately be a life or death issue.

If France can do it, we should be able to also.

David Camp  //  Fri, Nov 13, 2009, 1:18 pm

Mr. Karlberg,

I’m not familiar with the French system, although I think it is more expensive per capita than the Canadian system. This may be for demographic reasons, or due to some inefficiencies due to the mix of public and private, or it may cover more - prescription drugs, for example, which are covered only by private insurance in Canada.

I agree with your view of the entrenched political parties - a plague on both their houses - but I think that because of this, and the control of the political process by corporate interests, this is not going to change soon.

I’m just not buying their BS anymore. I have better things to do like make a living and keeping healthy and having some fun.

I consider it my duty as a citizen not to support a corrupt system. And, since I have the gift of reason, and value the freedoms hard-won by my ancestors, the duty to defend liberty with the truth. If I don’t do it, who will?

Doug karlberg  //  Fri, Nov 13, 2009, 2:43 pm

That’s the spirit, Mr. Camp.

You are sounding more like a Tea Bagger all the time. Of course you are in good company, as so did Thomas Jefferson and John Adams in their day.

Thanks for the conversation.

David Camp  //  Fri, Nov 13, 2009, 4:12 pm

Mr. KArlberg,

Jeez, thanks, I guess, for the warning - I’m not sure I want to sound like a T-bagger since I consider the whole “movement” to be astro-turfed, a victory of partisan rhetoric over substance.

The proof of the pudding for me is that when the Bush regime crapped all over the Constitution with illegal signing statements, illegal wiretaps, illegal wars and invasions, where were the T-baggers? Cheering it on because he was on “their” side.

Here’s a link to an entertaining video on health care reform:

http://www.markfiore.com/

Paul de Armond  //  Fri, Nov 13, 2009, 8:04 pm

One event that followed the House passage of the health care bill:

http://tinyurl.com/yhv39c3

Oh, the humanity!