On Health Care Reform – Moon of Alabama

May 11, 2009

On Health Care Reform

What is Obama is trying here? A voluntary pledge by health care providers will do nothing. Industries never adhere to such pledges. The 'issues' page on health care at whitehouse.gov has nothing of substance and sends one to healthreform.gov which has also no real substance but presents some tinkering on the margins as reform.

Meanwhile the high costs of health care in the U.S. is ruining its industries and is killing its people.

How should a decent health care system look like? Here is my opinion.

Any health care system should be universal, i.e. give everyone full access depending on needs not means. Pay for this by asking more from people with high means and nothing for people without any. Just add a few percent to all (progressive) income taxes to pay for it.

Any health care system should be restricted in its coverage. There are lots of medical procedures that are 'nice to have' but not necessary to be healthy. Cosmetic surgery is just one example. About 20% (German number) of health care costs occur in the last six month of a person's life because there is some universal aim to prolong peoples live as long as possible. My father, against my protests, was one of those who were treated very expensively even though it was certain that he would die soon. We really need to think about this. Is it justifiable to 'invest' so much into a likely soon dying person?

If people want more than the basic care offered by the system, they should be free to insure themselves for additional care. If the usual hospital stay is in a three bed room with a two meal choice and someone with additional private insurance can get it pay for a one bed room and a four meal choice, let her have it.

I do not favor to have all doctors working as salaried workers for the health care system. Instead doctors should be licensed as system doctors but run there own business. People should be free to choose their doctor but pay a price for just shopping around to get the opinion they like. A $10 flat direct charge for any first consultation may be appropriate to keep away hypochondriacs from running up costs for all.

I do favor a strong position for the health care administration against drug companies. The most effective drugs for most illnesses are already out of patent restrictions and cheaply available. Doctors need to be restricted by the system to prescribe certain drugs for pharma bribes. A standard diagnosis most get a standard therapy with the cheapest and effective drug available. For other drugs hard bargaining must occur before these get payed for.

There is more to say about this, but that is my rough outlay. What are your ideas and what are your experiences with the sytem you live with?

Posted by b on May 11, 2009 at 19:21 UTC | Permalink

Comments

I concur with most of your ideas in regard to healthcare, b, if not all of them that you listed. I will add that for any Universal Healthcare system to be successful and effective it must practice preventative healthcare, first and foremost.
Here’s an informative article on treating symptoms versus preventing illness.
An ounce of prevention – A pound of cure for an ailing health care system

Contemporary medicine is witnessing the juxtaposition of increased life expectancy and reduced mortality from acute illness alongside staggering rates of chronic degenerative affliction and disability among both the young and the old.1,2 The World Health Organization (WHO) recently released an important document entitled Preventing Chronic Diseases: A Vital Investment,1 that expounds on the global pandemic of chronic affliction, as chronic disease now accounts for an estimated 72% of the global burden of illness in adults 30 years old and older.7 Recent American figures reveal that, in the pediatric domain, about 3% of children were born with major congenital anomalies,8 about 17% of children have experienced developmental disorders,9 the incidence of childhood cancer increased by 27.1% between 1975 and 2002,10 and an unprecedented 1 in 12 children lived with a mental or physical disability.11 Among adults, chronic illnesses, including cardiovascular disease, diabetes, arthritic ailments, mental health disorders, and rapidly escalating levels of cancer,12 are dominating medical practice. With escalating costs, more sick people, a pandemic of prescription-related illnesses,13 and limited resources, a thrust toward incorporation of preventive health programs should be considered…..
Contemporary medical education and clinical practice allocate consistent attention to relief of suffering, providing ongoing care for the infirm, sustaining life, and attending to the needs of dying patients—the health professions prepare for illness with resources, diligence, and creativity. Prevention of illness and promotion of health maintenance, however, are often not pressing priorities.
Much illness originates in alterable lifestyle factors; the way individuals choose to live often determines the way they die and their health and well-being along the way. Escalating pediatric malignancy and neurologic illness from prenatal exposure to toxicants,14,15 pervasive cardiovascular and respiratory disease related to chosen habits,16 exploding rates of diabetes subsequent to sedentary lifestyles and poor dietary behaviour, and major congenital anomalies consequent to maternal nutritional deficiencies17 and exposures18 demonstrate that health is often a matter of decision making, not a fluke of nature or predetermined genomic destiny. With high rates of preventable illness, many health care advocates are demanding intervention-by-prevention and health promotion in such areas as lifestyle, environment, and nutrition, so that, as well as dealing with illness, physicians will need to become skilled at facilitating optimal health. There are substantial challenges, however, with increased focus on preventive health care, as it is questionable whether people in our contemporary culture can be maneuvered into healthy lifestyles.
While suffering patients might be motivated toward action to feel better, people who are not suffering might not. Many consider health and illness to be entirely independent of behaviour and, regardless of unhealthy practices, perceive that health can be purchased in a medicine bottle. The far-distant benefits of health education are commonly not a priority in a culture where dietary and lifestyle recommendations are looked upon as primitive therapy and where success is celebrated by a nonevent. Even among afflicted patients, health promotion through lifestyle intervention can be a difficult sell. Because the rewards of good habits are often intangible in the short-term and because the effects of unhealthy behaviour do not subside immediately, there is often no instantaneous relief.
For physicians, it can be awkward to challenge apparently healthy individuals with undesired intrusions into their lives, especially when assistance is not requested. Patients cannot usually be enticed to revolutionize their modes of living when they see no need for such revolution. Health providers are frustrated because patients are often not compliant with lifestyle interventions, in-depth education is labour- and time-intensive, and patients expecting magic bullets might question the proficiency of doctors who dispense pharmaceuticals cautiously. Therapeutic action by prescription provides hope of rapid resolution and is rewarded with gratitude; a lack of pharmaceutical intercession might be met with disappointment and dissatisfaction with the caregiver.
Recognition of the urgent need for health promotion and preventive medicine as necessary elements in a sustainable health care system, however, does not represent an epiphany; such admonitions have been expressed before. Although common sense and extensive research behoove the medical establishment and governments to promote interventions and health policies designed to supplant injurious circumstances with salubrious ones, current educational and economic policies fail to provide a milieu conducive to implementing such initiatives. Most clinical research (predominantly funded by industry) focuses on lucrative maintenance therapies rather than preventions and cures,19 most medical education focuses on sickness rather than health, most medical journals publish articles about disease management rather than about strategies to promote health and wellness,20 and most publicly funded health care systems reimburse physicians to treat disease, not to prevent it. In fact, many remuneration schemes do not consider preventive medicine to be medically required and therefore exclude funding—thus penalizing doctors who take time and expend effort to educate patients about strategies to avoid illness.

Posted by: Obamageddon | May 11 2009 20:50 utc | 1

I will also add that it’s never going to happen in the United States. The window of opportunity has closed, and if we think it’s bad now….just wait.

Posted by: Obamageddon | May 11 2009 20:52 utc | 2

The problem of drug costs, as Dean Baker has pointed out, is that we have an economically inefficient way of paying for them. All the costs of drug discovery and development are loaded into the marginal cost of each dose, via patent rights enforcement. But for paten
t rights, the marginal costs of making a new drug available to everyone who might benefit from it would be very small.
There are various ways round this. One would be for the the US, EU and Japan to buy the worldwide patent rights from the drug company for a flat fee and make the manufacturing license freely available worldwide. They already end up covering most drug costs anyway, so this wouldn’t increase total government outlay. Even the pharma industry would benefit – they could forget about marketing, and concentrate on Ra & D.

Posted by: pmr9 | May 11 2009 20:58 utc | 3

A voluntary pledge? hahaha…
I’m seriously beginning to think that the O man is nothing but a place holder for what or who ever is next in their –the corporate party’s– plans and designs for whats left of Merica.
What’s worse, and adds insult to injury is that O man thinks, nay, knows that the media saturated victims of this fast devolving and unraveling country will buy anything these fucks present.
Yeah, voluntary pledge, just like the banksters would do it for the economy. We have long past the event horizon in this theater of the absurd. However, the audience encores for more. More first year drama school acting.
“There are many humorous things in the world, among them the white man’s notion that he is less savage than the other savages.” -Mark Twain, “The White Man’s Notion”, Following the Equator (1897)

Posted by: Uncle $cam | May 11 2009 21:11 utc | 4

A $10 flat direct charge for any first consultation may be appropriate to keep away hypochondriacs from running up costs for all.
This is not a universal health insurance system. Any means test, and $10 is a means test – is not a universal health insurance system. Even a $2.00 charge will serve to limit health care.
I do not have any direct information about the cost of such shopping around in Canada, but it does not seem to have raied expenses anywhere close to the costs of US health care.
A two tier health care system creates a system where some people die for want of medical care that the rich have at their disposal. If we believe in universal health care, then we must reject two tier health care. This is different than allowing non-health care extras – such as private or semi-private rooms; or for that matter gourmet meals. The line that must be drawn is on the receiving of health care itself. If the rich can not receive any better health care than the poor, then the poor will receive better health care. Otherwise there will be consinuous pressure to lower the quality of health care for those who do not pay.
My impression is that there will be abuses, like those who shop around or otherwise abuse the system, but to try to head them off at the pass, so to speak, creates more problems than it solves.

Posted by: edwin | May 11 2009 21:32 utc | 5

Yes, big farma has a stranglehold and Obama, nor anyone else, can’t break it even if he wanted to. I’ve noticed the recent (5 – 10 years?) saturation of teevee and magazines with drug ads, and that drug salesmen do have a lot of power with doctors. MDs don’t have the time nor wherewithal to do their own research into which if any works best so they follow the drug industry’s advice until the claims are proven or not.
On govts buying drug patents: sorry, it’ll never work here in USA.
In my opinion, changes will come, but not within the present system, which is much closer to collapse than is generally recognised (also my own opinion naturally). In any case, lobbyists – at present – will prevent govt control over almost any profitable business. They have the $$; they control.

Posted by: rapt | May 11 2009 21:32 utc | 6

I just caught the tail end of a documentary called The Business of Birthing and it offers a very critical look at how pregnant women are treated in this health careless system.
cost alone is staggering. the cost of going through a birthing center (if your town is lucky enough to even have one) from personal experience is around 5,000 dollars. that cost includes all prenatal visits. my wife was unable to birth naturally at the center, and ended up having a c-section at the hospital. we have health insurance, so didn’t have the unbelievable stress of getting saddled with a cost exceeding 15,000 dollars.
we recently had friends who birthed at home: 1,800 dollars.

Posted by: Lizard | May 11 2009 22:04 utc | 7

Peter Orszag was on MSNBC with Andrea Mitchell shortly after Obama’s pronouncement on how very much the Big Playahs were doing to assist in healthcare reform. When she asked whether there were any regulations or enforcements which would hold the Big Insurers, et al, to their pledge to cut increases by 1.5% over 10 years, he said there were not.
When she asked what would happen if the pledges were not met, either reneged on or for whatever reason, Orszag said it would be up to people like her, MCMers*, to “publicly shame” any players who didn’t do what they said they would do.
Really, that’s what he said.
And that has worked so well with the Big Bankster Boiz.
It seems Big Medical Industry players have learned from how the banksters rolled the Obama administration and are working that play book.
*MCMers–Members of the Mainstream Corporate Media

Posted by: jawbone | May 11 2009 22:36 utc | 8

Obamageddon @ 2–I do so fear you are correct. If it doesn’t get done now, it will be another couple decades. And the Democratic Party, the parts of it that still see FDR’s programs as valuable, will be just as smeared by the failure as the Moneyed Party part of the Dems*.
Without a president who cares about actual fairness and acts on that, the Democratic Party is incapable of doing it from the legislative side. Ted Kennedy, apparently, has thrown in the towel on even the “public plan,” which while undefined at least initially meant allowing people to buy into Medicare or Federal employee health insurance plans at cost. Which would be high, but much less than individuals now pay.
I think Obama is looking toward his next job–becoming part of the Uberwealthy. He can’t depend solely on the banksters at this point, so is making sure he and Michelle can get some well paid board memberships, etc. Obviouisly, I cannot know his mind, but I can try to understand his actions.
Money, money, money. It’s a rich man’s world….
*Lambert at CorrentWire.com refers to the Moneyed/Blue Dog/DLC parts as the Formerly Known as Democratic Party…the FKD Party. Definitely includes the Obama takeover.

Posted by: jawbone | May 11 2009 22:46 utc | 9

b, Nancy Anne DeParle was on NPR this evening saying that what the Big Playahs had pledged was “huge, absolutely huge.” The interviewer actually sounded somewhat skeptical, but she was ebullient.
Obama has the cover he needs to do what he’d hinted at to private gatherings during the election: Put the universal healthcare/public plan/single payer types under the bus.

Posted by: jawbone | May 11 2009 22:55 utc | 10

So how many people were mentally lining up for flu shots or antivirals after the big media diddle?

Posted by: rjj | May 11 2009 23:22 utc | 11

So how many people were mentally lining up for flu shots or antivirals after the big media diddle?

Posted by: rjj | May 11 2009 23:22 utc | 12

*Lambert at CorrentWire.com refers to the Moneyed/Blue Dog/DLC parts as the Formerly Known as Democratic Party…the FKD Party. Definitely includes the Obama takeover.
The FKD Party… Jawbone, thanks for sharing that.

Posted by: DavidS | May 12 2009 0:12 utc | 13

my understanding of this is primary if not primal
if i was not living in france – i would be dead
the care i receive here is both expert yet human.
the cost of my medicines are completely covered – otherwise it would be equal to the meagre salary i earn
every day i am mindful – that france fought for these right to health care – it did not fall from the sky – it was fought for aft§er a long struggle & there are still those who would prefer that the poor die more quickly

Posted by: remembereringgiap | May 12 2009 0:40 utc | 14

A little healthcare reform, here or there, isn’t gonna cut it; the entire system needs an overhaul. And the only way to do this is to enact single payer…
Because most of the unnecessary costs come from the administrative (as opposed to the delivery) side of healthcare, and because insurers generate most of these costs, they should be cut out of the healthcare picture all together. Think about it, insurance companies make their money by insuring as few sick as possible and as soon as any of their insurees get sick, they’ll drop them like a hot potato and hand over the bill to Uncle Sam.
Drug companies also add a lot of unnecessary cost to healthcare. They’ll swear up and down that they must jack up the price of drugs in order to fund R&D. But if drug R&D were really in a world of hurt, drug companies should take most, if not all, of the funds from their fat and bloated advertising budgets and put them to good use beef up their sickly R&D programs. No one needs an MD after their name to know that watching those stupid ass drug commercials on teevee doesn’t do one iota to improve their overall health and well-being.
Let me also mention that healthcare workers (from orderlies to MDs) are one of the very few groups of workers in the US who are largely immune to outsourcing. Because of this, they are pretty much insulated from the downward spiral of wage deflation experienced by most other types of workers, especially those working in IT and manufacturing. Healthcare jobs, unlike ones in IT and manufacturing, can’t easily be shipped to, say, India or China. So its hard to deny that wages in healthcare do play a role, though a minor one, in inflating the cost of healthcare.

Posted by: Cynthia | May 12 2009 1:20 utc | 15

Yup. I agree. With all of you.
People in the U.S. have had it high-on-the-hog for a long, long time.
It’s going to be a long, long time before enough of them wake up and say, “Hey! We need to fight this!”
Once that happens —
i pity the suburban middle class.

Posted by: china_hand2 | May 12 2009 1:57 utc | 16

The cure to good health is riding your bicycle? Eating less swine could also help?
Modern day health care was once described to me as “managed neglect”.

Posted by: jim e | May 12 2009 4:45 utc | 17

Real reform of the FDA. A doughnut tax. Maybe tax food by the number of ingredients. Real health education shows on TV and the internet so that people can make informed choices on their own health care.

Posted by: biklett | May 12 2009 6:33 utc | 18

This article from the New Yorker in January provides a useful historical overview of how various countries achieved universal coverage:
Atul Gawande: Getting There from Here: How should Obama reform health care?
Here in the Netherlands, the system has a hybrid public-private character not unlike Switzerland; the government determines coverage of the base health insurance policy, which is for everyone obligatory. The insurance itself is managed by private insurers, who compete on the basis of deductibles and restricted or unrestricted doctor-choice (restitutiepolis versus naturapolis); they are of course prohibited from refusing coverage to anyone. Depending on the insurer, the base policy for an adult runs between €60 and €90 per month, with an obligatory €155/year deductible.
The interesting point for me is the that chief argument made for a single-payer system in the US is far lower administrative costs, yet in some countries, like Holland and Switzerland, administrative costs are kept down without removing the private sector from the loop. It would appear that the way HMOs in the US are currently structured is particularly inefficient (or lucrative, depending on your perspective).

Posted by: Colin | May 12 2009 11:34 utc | 19

health care? yuk. gruesome topic. generally i avoid it. lately i’ve had way too much of it on a daily basis because of my 82 yr old mom. she’s got the runs and they keep shuffling her around. 2 months ago her doctor ordered her a colonoscopy and the GI finally got around to scheduling her, for next month. she’s decided to switch her provider and we’ve been deluged w/ paperwork. she spends half her time on the john. i’ve been burying my head in the sand regarding my own and have none. i keep meaning to sign up but i cringe when i read the list of things it doesn’t cover. why pay the monthly fees when you know 1/2 the stuff on the list isn’t applicable. full coverage outrageously expensive. its cheaper to fly to thailand and pay cash. i keep thinking by the time i really need it they’ll have figured it out.
burying my head in the sand. it’s just disgusting. my mind is so twisted when i heard about the latest ‘swine flu’ i immediately wondered what politicians had invested in the latest vaccinations. then i wondered if the vaccinations had some hidden test in them, or quirk that makes all yer offspring susceptible to autism.
moving along, i am not the most rational voice on this topic. i should just shut up.

Posted by: annie | May 12 2009 12:41 utc | 20

I like your attitude Annie. It doesn’t help solve the immediate problem maybe, but it at least recognises that there is one. And I do like your solution of flying to Thailand too. Long trip.

Posted by: rapt | May 12 2009 16:07 utc | 21

A doughnut tax! Biklett, you deserve a good stoning! Sorry, just another poor attempt at humor. It’s been months since I’ve eaten a doughnut anyway. Some of the other things I’ve read here that sound real good include eating less (or no) swine, riding a bicycle, and preventive medicine. I’ve been almost eight weeks without a cigarette, so the bicycle in my garage needs to be used. I also have a garden out, although not too much in it yet (potatoes, onions, spinach, green beans and roma tomatoes. Oh, and Italian parsley and bell peppers.)
It’s good to find my favorite bar still open. I had to cancel Time-Warner, so I was off line for a week or two. I’m about a month away from going back to school, but I’m trying to spend time outdoors and away from the computer. And I have the deepest respect for anyone taking care of an elderly relative. My own mother passed away back in December, after a year of my taking care of her. Actually several years (she was diagnosed with Alzheimer’s in 2005, and I never left her alone after December of 2007).
Bernard, I’m afraid I don’t understand your comment about your father’s treatment, unless it was against his will or painful for him. I lost my own father in 1997, but he was pretty much paralysed from a stroke for the last year of his life. There’s so much I could have learned from him, had I known what was going on. My sisters and mother kept me in the dark though, since I was going through a big mess with the woman I was living with at the time. That’s why I made up my mind to live with my mother, and see to it she was cared for.

Posted by: Jim T. | May 12 2009 20:19 utc | 22

Bernard, I’m afraid I don’t understand your comment about your father’s treatment, unless it was against his will or painful for him.
My dad was put on dialysis and kept in hospital against his (earlier) declared will when he was already near a terminal state. They did some quite expensive, experimental and useless stuff with him even in his last days. It was a huge waste of money and an assault on his dignity. Luckily he mostly wasn’t conscience enough anymore to get that.

Posted by: b | May 13 2009 9:45 utc | 23

My Ma did a living will after my father passed away which stated no extraordinary measures were to be taken to prolong her life, and when her poor care of her diabetes and poor general health caught up with her, she specified no dialysis. And I backed her up on this, against the doctor’s wishes. So we were looking at 6 months to two years of slow but relatively painless death through renal failure when she had a stroke on the first night of December last year. She was almost totally unresponsive, and pretty much unable to move. The people from Hospice kept her on enough morphine that she never suffered her last eight days, which is what it took her to pass away from lack of food and water. She still lived to be 83.

Posted by: Jim T. | May 13 2009 13:10 utc | 24

Wish to comment in a constructive way on the VERY FEW instances where your English is not idiomatic, but don’t wish to do so publicly – what would you suggest?

Posted by: Jay Jaxon | May 13 2009 14:36 utc | 25

@Jay Jaxon – please email me: MoonofA_at_aol.com (_at_ = @)

Posted by: b | May 13 2009 17:26 utc | 26

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