From the Trenches, II

Monday, August 03, 2009

From the Trenches, II

Being a continuation of Healthcare... in a Comment by Mr. Overton and Response by Mrs. Speir format.

"One of my greatest concerns with the health care debate in this country are com­ments like our 'health care is DOA.'

That, in my view, is far from accurate.

Our care is some of the best in the world, not only in urban areas with access to research hospitals like Sloan Kettering and Dana Farber Institute, but in less popu­lated areas as well.

There are still pockets of problems, but when you consider the size of our popula­tion and the diverse makeup of that pop­ulation, we need to recognize that we are well-served. When evaluating cutting edge drugs, we need to recognize that the U.S. has more drugs available that have been on the market less than five years than any other country evaluated. We also perform more heart related surgeries than any other country as well as quality of life surgeries like hip and knee replacement."

Okay, I'll refrain from glib catch phrases like "DOA" as long as the opponents refrain from using the phrases "free" health care and "rationing" and scaring folks into staring at the headlights instead of moving out of the way.

We don't have "free" health care now, we won't have "free" health care tomorrow. We'll hopefully have national public options that will decrease the amount we pay for service.

"The biggest public complaint is the cost of our health care.

Politicians regularly state that we have the highest per capita cost for health care as anywhere in the world. Our costs are typi­cally reported at 50-100% greater than the rest of the world.

What gets missed is the relative wages of our medical professionals vs. those operat­ing in other countries.

In reading Dr. Emanuel’s report, he illus­trates that our doctors get paid on average 80-300% more than doctors elsewhere (in US dollars). While I cannot find data to sup­port this assumption, I think it is rea­sonable to assume that the compensation for our other medical professionals (nurses, researchers, lab techs) is also greater than their counterparts in other countries.

This difference in wages might just provide an explanation for the significant difference in per capita costs.

Personally, I don’t want to either reduce or freeze the wages of medical professionals, but people have to re­alize as these wages go up, so do expenses."

The USA ranks, like, twenty-seventh in quality health care, Mr. Overton. How does that qualify us as having the BEST? It took me over three weeks to see my "regular"doctor. We throw money at the system at 150% of what other industrialized nations pay. This is stupid.

"Pockets" of Problems? How about flashed open overcoats of problems? This is NOT a small problem; it's huge and ubiquitous.

"When politicians refer to 45 million people uninsured in this country, they often fail to review the reasons for this.

Approximately a third are young, relatively healthy people who have made the choice not to purchase health insurance.

For many, this is an issue of priority as they could afford it but choose not to.

Think about the people you may know without insurance. Do you ever hear them talk about their trip to Disney or some other vacation? Do they go to Vermont skiing in the Winter (if they don’t have insurance and do, they are nuts)? Do they drive around in a $50,000 SUV?

I know I have run across many of those people and while I like them, I cannot respect their priorities when it comes to this issue."

"Cutting edge drugs" are not made by Big Pharma. For years they've been making fake Gucci imitation drugs to capture a share of the market.

The big fish eat the little fish and their patents. It's carnivorous in that profit-sucking industry!

Ask how Lipitor was kept on patent w-a-a-a-a-y past its time. Ask about rushing drugs to market behind bad, in-house research, and discovering the lethalities after the event.

Perhaps the reason other countries are not rushing drugs to market is that they're really looking for the new treatments. France and Germany have always been at the top of the game.

Big Pharma's killed a lot of Americans with their Cheaper-China outsourced blood thinners and dog food, not to mention lethal milk products.

"Another third of the people qualify for public coverage such as Medicaid or Medicare, but have simply not signed up for the programs. This has to bear the question why?

The answers are many but some include too much paperwork for many people who are relatively uneducated, lack of helpful assistance from the people in the Govern­ment offices in completing forms, or the possibility they may be experiencing other types of issues (unpaid tickets, child sup­port, etc.) with the Government that causes them to want to avoid Government offices.

A portion of the final third (approximation) are legitimately without health coverage or are illegitimately in this country. In most cases, these folks are cared for without payment to the practitioners when atten­tion is necessary, so they receive care. Their costs are often offset by those of us with insurance coverage or by donations made by wealthy benefactors who support things like free clinics, etc."

I believe the compensation of health care providers in other countries is more balanced than you assert, and the rate of compensation not that much different.

The Obama Administration seeks to increase the income of primary care providers in this country--a woefully underpaid group. If you haven't found substantiating data to the contrary, "it doesn't count for much."

When you speak of the uninsured as amor­phous masses of other people, it is clear you don't know any. I do!

At any moment one of my children lacks health insurance because of the current market conditions. I have patients I am not allowed to see or treat when they lose their job. My eldest, who makes a lousy $12/hour as an ambulance EMT is considered too wealthy for subsidized health care.

I do know an electrician who went bankrupt when he had a heart attack in his 30s. Broke up his home, too.

My kids aren't skiing or going to Disney; nor do they drive SUV's or new cars – one doesn't own one – too expensive.

And they're healthy – their burden on the health care system literally lightens the load for the rest of us. It is an insult to Americans to allege these Marie Antoinette assumptions comprise a huge number of the uninsured.

Illegals are not counted in the "Americans without health insurance" data. And there are over 12,000,000 of them.

"The health insurance industry is one of the most regulated in the country, so much so that it really no longer qualifies as an insurance industry. Government regulations have removed the ability to underwrite or rate individuals either by age, sex or habits.

This change occurred about 17 years ago. Companies held on for a number of years, but eventually gave up on the health in­surance market because of it.

Assets were swallowed by larger compan­ies and the reduced competition led to in­creases in premium. This lack of compe­tition combined with the cost shift of Government programs and these private carriers started to limit their reimburse­ment levels to near Medicare rates.

These phenomena were predicted by health insurance professionals when government legislation imposed new requirements on the health insurance industry. HMOs were supposed to be the cure for this problem, but quickly became consumed with the same issues as private insurance carriers. It is my belief, based upon nearly 25 years of either insurance experience or business management experience placing employee health insurance policies, that the same fate will befall a federal government plan."

Yes, Medicare regulations are difficult to fathom. So are regular insurance regulations; and you often find out the bad news after you have signed on; that is, if they'll even have you (pre-existing conditions?)

You're right, the larger companies have swallowed some of the health care pie; and they didn't do that for altruistic reasons. They want to make money. Medicare was actually the first program to look at health costs, duplication and waste. This we need more of, not less of this.

"So what's the answer. Again, the key element is to recognize what we have, not always focus on what we lack. People also need to take personal responsibility for their health (not just financially, but practically).

We have developed an attitude that every­thing can be overcome with a pill or sur­gery or chemo or radiation. We have this attitude that our bodies are like cars that can always be fixed. We need to start taking care of ourselves through good diets, regular exercise, moderation in things like alcohol and tobacco. Those elements will do more for less than any health care changes the Government can legislate.

Unfortunately, that means people are going to have to make an effort and since there is no reward for living a healthier life, I am extremely pessimistic about its success."

We already agreed Americans need to start taking better care of themselves.

"Just so you are aware, I come from a family of health care professionals. My mother and two aunts were RNs and the uncle I was named after was a physician. I have reviewed my thoughts with many physician friends. While they agree with the basics, they are not confident with the Government ever adopting such an attitude."

To me, the key element has nothing to do with what we lack or what we have. It has to do with what is necessary and what can we afford.

How can we do it better?

I believe the Obama administration has a brilliant solution we'll approve of if we take our heads out of the sand and face the abysmal fiscal alternative

We can't afford this allocation of resources anymore.

We're in a recession.

Do you truly want to sink this country, or will you give the new ideas an inaugural sail?

It is soooo bad out there, I'm climbing aboard.


1. Frank Wheeler said...

I know it's grim out there, and while I have been enjoying this dialogue between two "insiders" (who should get Tim Bishop alone and double-team him!), I remain skeptical that the Obama Administration "has a brilliant solution" in the works!

Mrs. S., you're showing a little of your husband's edginess in spots. Watch that now!

Thank you -- as my husband would say -- I think.

As for that "edginess" thing, perhaps it's a simple matter of what my husband tells me is known as "propinquity."
– Jeanne

2. Dog Lover said...

Jeanne Speir said "Okay, I'll refrain from glib catch phrases like 'DOA' as long as the opponents refrain from using the phrases 'free' health care and 'rationing' and scaring folks into staring at the headlights instead of moving out of the way..."

Unlike our brilliant congress who will vote on this bill w/o reading it, I invite you to read the bill.

You claim that the word rationing is being used to scare folks. Read the bill. And then pray that you stay healthy, especially if you are a Senior Citizen.

If it looks like a pig, and sounds like a pig... even with lipstick on... it is a pig.

If every American reads this bill, it would be DOA. And it should be DOA...........

Hmmm. From your charming conversational style, I know exactly who I'm writing to. Hi, friend.

If Americans were required to read any bill, nothing would ever pass and we would live in chaos. Attorneys DO serve a purpose besides being the most distrusted professionals in the world, afterall!

They read and write this stuff.

We are digging our way out of the worst economic situation we've experienced in decades. One of the most devastating and escalating expenses is that of healthcare as it exists today; especially as we Boomers come of age. This bill is over 1000 pages long because it encompasses massive reform to reign in the run-away costs of health in this country, as well as provide the dry provisions on how to make it work, who does what, and how to evaluate its results. But you knew that.

We and our families need to have the difficult yet clear conversation about how we'd like to have our health affairs managed, while we can still express them. For you see, the choice is left to us. No one is taking away anyone's choice. Now, for me, I don't see how keeping an end-stage, comatose, Alzheimer patient on life-support in an Intensive Care Unit bed enhances anything but the bottom line of the systems who get paid for the intense and prohibitively expensive services of keeping this lost soul "alive," sometimes for months. It happens now, because people don't want to talk about dying. In the meantime, some uninsured young American adult with cancer gets dumped into whatever system they can access, and then needs to declare bankruptcy. That is v-e-r-y expensive on every level.

If one of your beloved dogs was in intractable pain, and neither medication nor any other treatment could make the dog any better, as its guardian, what would you do?

I realize you're more a "dog" person than a "people" person.

But what would you do if your grandmother went blind and suffered crippling arthritis, a stroke, and expressed a desire to die? What if she cried out in pain every time she was moved to change her diaper, because her backbone had turned to dust? What kind of choice does she have when she doesn't call the shots anymore, when she might not be able to speak, and lacks control of her bodily functions? Some families are supportive and loving to the bitter end. Some are not. Others have families at distance, or working so much they can't provide the support required to keep frail elderly comfortable. The limitations today on professional home care services are severe.

Lucky for us, in the Village we've got some terrific ninety year-olds with spectacular health and vigor; their lives are to be celebrated and venerated.

Each person will come into their seniority in different ways. Yes, protecting our health before we hit the golden years is a very good idea.

Those of us who want to be certain after we die that any properties be divided up in a particular way write a Last Will and Testament. We write on our drivers' licenses whether we're willing to share our spare parts after we die.

This isn't any different.


Given: There's very limited money for health care...

Given: There's about to be an explosion of Senior Citizens...

Then: Tough decisions need to be made on a case by case basis, and as a Grandma myself, I'd gladly give up a couple of years on the end of my life to keep my kids and grandkids and their generations healthy and sound.

I, for one, am not afraid of that, so go ahead, and call a pig a pitbull, put lipstick on it, play hockey, resign as Governor, and sign a lucrative book deal, you betcha.


It's not what you look at that matters, its what you see. (Thanks Thoreau).

3. Dog Lover said...

Jeanne Speir asked "If one of your beloved dogs was in intractable pain, and neither medication nor any other treatment could make the dog any better, as its guardian, what would you do?"

As the owner, and the person familiar with the medical situation, I would speak with my Vet and then do what I thought best, not what the Government thought best.

Some Class C Government paper pusher should not have the right to decide what medical care is suitable for me, you, my spouse, your husband, or anyone else for that matter.

The Government has no right to tell me what I can, or cannot do with my body. I would think that you would agree.

Correct. We both agree with your way of managing your dog's care. It should be the choice of each individual how they be cared for. And with the reform bill we'll get that. Today's profit-driven managed care systems actually discourage this relationship; so to call resolutions in the reform bill as "new" and a horrible way of doing business is downright wrong.

As a medical professional, I look forward to spending more of my time with patients, and less on the damn phone and fax, fighting with a million little profit makers as to how much care I can give my patients.

GIVE me one policy standard and forms; do let's buy our drugs in bulk like the smart countries do, paste my electronic medical record on line to a site where I can send my doctors to find out what testing I've had done already. Is it breachable? So is your medical record now, PLUS your bank account and credit cards if you're not careful. It's a reasonable risk. To accomplish it, hire a million unemployed American computer whizzes to enter the data. Will there be mistakes? Sure, but I would bet my Ford stock they will pale in comparison to the Tower of Babel we practice on now.

Here's a portion of an e-mail I received today that's relevant regarding the anti-reform movement:
People are scared because they are being fed frightening lies. These crowds are being riled up by anti-reform lies being spread by industry front groups that invent smears to tarnish the President's plan and scare voters. But as the President has repeatedly said, health insurance reform will create more health care choices for the American people, not reduce them. If you like your insurance or your doctor, you can keep them, and there is no 'government takeover' in any part of any plan supported by the President or Congress.
Special interests realize it cuts a whole lot of pork off their lipsticked pig you alluded to earlier, and they're not happy to be put on a fiscal diet.

Tough. They got too greedy, and we're all paying the price.

That said, the Obama plan, essentially a hybrid health care plan, encourages competition – if you want the customers, make a more cost-efffective, affordable and comprehensive plan than the ones the Senators have. (Personally, that's the one I want. Heck, it kept Cheney artificially alive with a Taser jolt to the chest every now and again for the entire eight years of his shadow Presidency!)

THAT is what is scaring the profit makers; a better, health plan at a lesser cost.

4. Big Mike said...

...and now, if you're fortunate enough to have coverage you've got mega-insurers (big business interests whose interests are put forward, vigorously, every day by Washington lobbyists) and big-pharma (ditto... and thank you AARP) dictating what's covered, what's not... and how much we need to pay. Big medicine is marching to their drumbeat.

What we don't need are the raucus groups, supported and scripted by these same DC lobbyists, shouting down our elected officials to the point where they may be realistically fearful for their safety.

What we don't need is "scare" advertising and puditry, largely from the Far Right.

What's really scary is that the system as we know it now is simply not sustainable. We need clear communication from our law makers and policy makers and calm dialog among ourselves... a careful examination of the facts and the numbers.

Unfortuately, what we're gonna get is likely a partisan and watered down version of something that may not be very meaningful in the lives of many... and a missed opportunity for postive change.

Big Mike,

That's exactly the defeatist attitude that Big Pharma and AARP (those bought-out stinkers) and the big business insurers want to hear.

If you want something done, do it yourself! This month it's critical to reach out, E-mail, call, write if you've the time and stamp across county and state lines, and to all relevent American citizens and legislative committees to let your wishes be known: loud and clear.

To not pass a reasonable and as comprehensive as possible national public health policy option will ruin this nation's economy. The lobbyists are nearsighted, and the election-defeated are bitter. We've got to boot the money changers out of the temple. Speak up to everyone you possibly can, and thanks for writing – this is a good start. Please don't stop here!

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