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Post by Craig Richard Lysy on Oct 26, 2009 9:03:29 GMT -8
Hi friends I hope all is well,
My background. Let me start off by saying that I have worked in health care for 30 years as a Respiratory Therapist. I currently supervise a diagnostic testing department and deal with insurance issues routinely.
My Assessment: The assertion that we have the best health care system in the world is false. All professions must have performance assessed by objective indices, in this case outcomes. When compared to single payer systems, a factual assessment reveals that we have poorer outcomes across the board; 1. We have a lower life expectancy. 2. We have a higher infant mortality rate. 3. We have a higher morbidity rates related to cardiovascular disease, pulmonary disease, diabetes and obesity. 4. Nearly 44,000 people die prematurely to preventable disease for lack of care or care rendered to late in the disease process. 5. The indigent and working poor have significantly worse medical outcomes than insured people. 6. We spend twice as much money to provide care. 7. Nearly 40% of all prescriptions are not filled as people cannot afford them. This leads to complications and early death. 8. Nearly 1 million hard working people go bankrupt each year from medical bills.
Health Care Delivery Insurance Assessment 1. Health care companies are incentivized to make profit, not promote the health and welfare of their customer. 2. One in five claims is denied. Many such denials result in patient harm or worse premature death. I have seen this. 3. Coverage is too often canceled for illegitimate reasons when people file a claim. 4. 30 - 46 million people have no insurance, but another 20 - 40 million have insurance to expensive to use; deductibles too high and/or out of pocket costs to high. They have coverage, but if they use it they go bankrupt. I have seen this too. 5. The fact that extraordinary salaries and compensation are paid to CEOs and that they have 10s of millions to spend paying lobbyists and buying congressional votes leads to only one conclusion - they are grossly overcharging us. 6. Health Care companies are exempt from anti-trust laws which leads to higher and predatory rates.
Health Care Delivery System 1. We do it all wrong! We focus on problem solving instead of health promotion and disease prevention. We should pay doctors and provide performance bonuses on the basis of how successful they are in fostering and achieving good health for their patients. 2. Because of cost, people only go to the doctor when their is a problem! People should be seeing a doctor routinely to promote a healthy life. Hell, we take our cars in for service routinely, we should approach health care the same way.
Solution; 1. I believe that just as we have armed forces to protect all, paid for by all, that we should also have health care for all, paid for by all. It is the same operating principle. All of us should pay for a common need whether it be the defense of our homeland or the health of our citizenry. We are one people, as such, I favor a single payer system. My rationale; 1. It is less expensive 2. By every objective indicator it out-performs private insurance based systems.
But I accept the political reality and so support the following efforts; 1. End anti-trust exemptions for insurance companies to create market forces to increase competition. 2. Allow insurers to compete across state lines to increase competition. 3. Pass a law requiring as they do in Europe, that 90 - 94% of all insurance company income be paid to patients, doctors and hospitals! Why should our premiums go for excessive CEO pay and congressional lobbying/vote buying. We have laws like this for charitable organizations. 4 Offer a Public Insurance Option to those that cannot afford private insurance and to promote competition.
The argument that a public option would drive the private insurers out of business and lead to a government take-over is false. Here are facts that refute this false assertion; 1. In Germany and other countries a government plan competes with private insurers. They are profitable and have not been driven out of business. 2. Private companies UPS and FedEx are profitable and compete with the US postal service. 3. Government/state colleges have not driven private colleges out of business.
In each case private companies thrive because they have become lean and efficient. This helps consumers.
Now the last point. Paying higher taxes to pay for a Public Option. 1. We pay taxes for a common defense of the homeland, paying for a healthy citizenry is equally important and indeed ethical. 2. Folks, my hospital charges people with insurance thousands of dollars more to pay for the under insured and uninsured. I hate to end your illusion, but we are already paying for those that lack insurance. The difference would be that it shows up as taxes on your W2 instead of a higher insurance premium or medical bill. Again, you and me are all ready paying for those that cannot.
A healthy citizenry is a more productive citizenry. We need to do what is right, what is moral and what is consistent with our religious values. We must provide for the common good, the common welfare and the common health of our fellow citizens.
I thank my friend and host Jon for providing me a forum to offer my views and I welcome replies (hopefully respectful) from those philosophically opposed.
With all due sincerity.
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Post by Hook on Oct 26, 2009 9:25:44 GMT -8
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Post by Craig Richard Lysy on Oct 26, 2009 11:55:54 GMT -8
Thanks for sharing. The article makes a number of good points, but also some generalizations and conclusions upon which reasonable people can disagree. People on both sides of the issue should read this.
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Post by Brendan Anderson on Oct 26, 2009 13:20:00 GMT -8
Nice article Hook (though the issue of tort-reform in the realm of medical malpractice is mysteriously absent from its discussion and one I don't believe you can just leave out when talking about healthcare reform). I agree with many parts and disagree with others. Craig, I'd love to get more in-depth on this and perhaps will as this is truly the U.S.'s greatest societal quagmire. Just quickly though, I find your analysis to be overly-emotional and completely ignoring some of the following factors: - More Government involvement further separates the true cost of health care from the market thus resulting in either shortages, or further skyrocketing prices, or both.
- The government has NEVER managed a program without a tremendous amount of waste, lack of oversight and other dunder-head moves along the way. It ALWAYS ends up over-budget and a let-down to those involved in the program (see: U.S. Post Office, Cash for Clunkers, the U.S. Military, etc) - heath care reform on the scale you're talking about would result in one of the largest government programs in the history of mankind....how can you possibly expect it to run any differently than the programs it already screws up?
- Your proposal also removes almost ALL personal responsibility from the realm of health care. This country has seen time and time and time again that simple hand-outs do not work. You will NEVER get every citizen of the U.S. to take an active role in promoting their own health and often times will proceed to be very DESTRUCTIVE to their own health. Is it fair that part of a working-class poor family's income, via taxes, would be poured into treating a heroin addict who chooses to keep shooting up hours after his next release from the hospital? Or for the hospital stay of an emphysema patient who decides that he loves cigarettes more than his own health? There is no way to govern away bad decisions. In a free society, there will always be those who choose to destroy - a system that removes personal responsibility is one that enables that destruction instead of deterring it.
Show me a system that is based on the individual as the medical consumer instead of the insurance company, encourages health personal responsibility through incentives, addresses the issue of frivolous lawsuits, and lets the true free market dictate price and cost, and I would say you're on the right track. Simply letting government jump in head-first will solve none of the true problems facing our health system, and would quite possibly do the opposite. -Brendan
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Post by Jon Broxton on Oct 26, 2009 14:58:25 GMT -8
Your proposal also removes almost ALL personal responsibility from the realm of health care. This country has seen time and time and time again that simple hand-outs do not work. You will NEVER get every citizen of the U.S. to take an active role in promoting their own health and often times will proceed to be very DESTRUCTIVE to their own health. Is it fair that part of a working-class poor family's income, via taxes, would be poured into treating a heroin addict who chooses to keep shooting up hours after his next release from the hospital? Or for the hospital stay of an emphysema patient who decides that he loves cigarettes more than his own health? There is no way to govern away bad decisions. In a free society, there will always be those who choose to destroy - a system that removes personal responsibility is one that enables that destruction instead of deterring it. Brendan, I know you to be one of the nicest and most generous people I have ever had the pleasure of knowing... which whyI remain utterly astonished that you continue to put forward this utterly reprehensible argument as a factor against healthcare reform. What about all the young families whose babies may die as a result of being unable to afford adequate post-natal care? What about hard working low-income families whose health insurance is inadequate to cover their needs, or who face bankruptcy because he had an accident on the job and can't work anymore? Or the person whose insurance company arbitrarily decides that they don't want to pay for his treatment in order to meet their financial projections? Or the elderly person who is forced to make a choice between heating, food and vital medication because their lifelong health insurance contributions are no longer sufficient to cover their healthcare needs? Are you seriously suggesting that these hard working yet low-income, limited opportunity people should be denied access to healthcare simply because some people who you have determined do not 'deserve' free healthcare also have access to the service? I would much rather save the life of one newborn baby, one senior citizen and one heroin addict than allow one newborn baby, one senior citizen and one heroin addict to die because the heroin addict's illness is self-inflicted.
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Post by Brendan Anderson on Oct 26, 2009 15:14:44 GMT -8
What about all the young families whose babies may die as a result of being unable to afford adequate post-natal care? What about hard working low-income families whose health insurance is inadequate to cover their needs, or who face bankruptcy because he had an accident on the job and can't work anymore? Jon, nowhere did I say we need to eliminate ALL government healthcare services. The U.S. should absolutely be helping the legitimately poor and destitute who are making responsible choices just as the unemployment system assists the unemployed who are taking responsibility and in good faith looking for a job. I'm right there with you. I may have gone to an extreme to make my point, but the point still remains: handouts without accountability results in an enabling society and this is a genuine problem that needs to be addressed in ANY government assistance program, from healthcare to food stamps to unemployment benefits and beyond. -Brendan
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Post by Jon Broxton on Oct 26, 2009 15:59:28 GMT -8
But who makes those choices as to who 'deserves' access to a governmental healthcare system? That's as bad as these mythical "death panels" which everyone was so up in arms about, except that this group of people would actually exist.
Also, you keep referring to a governmental healthcare system as a 'handout'. How is it a handout if everyone is paying for it?
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Post by chollman on Oct 26, 2009 16:02:44 GMT -8
Craig, I am really glad to read something about health care reform by someone who has worked in it for so long. I have been trying to read about the reform pros and cons, but I get lost in a lot of it. Thank you for your statements they made a lot of sense to me.
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Jon Lord
Ghostwriter
Calvinism and Hobbes
Posts: 321
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Post by Jon Lord on Oct 26, 2009 16:12:19 GMT -8
I wrote a long post here about my own health care issues but in retrospect I thought it may be construed as self-absorbed given this is an issue affecting millions, so I'm changing my commentary simply to the immortal words of the flora colussus Groot:
"I am Groot!"
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Jon Lord
Ghostwriter
Calvinism and Hobbes
Posts: 321
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Post by Jon Lord on Oct 26, 2009 16:20:11 GMT -8
I find your analysis to be overly-emotional And yours isn't with all the CAPS LOCK absolute keywords like ALWAYS, NEVER and DESTRUCTIVE? Don't get me wrong, not being antagonistic, I just found this humorous.
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Post by Brendan Anderson on Oct 26, 2009 16:40:32 GMT -8
But who makes those choices as to who 'deserves' access to a governmental healthcare system? That's as bad as these mythical "death panels" which everyone was so up in arms about, except that this group of people would actually exist. If you're against some kind of government regulatory body deciding whether or not to give monetary assistance to a poor person who needs healthcare funding assistance, how come you're not then also against a government regulatory body acting as an insurance agency who will decide what they will and will not cover? Same thing, no? And yes, 'death panels' is an absurd concept used by morons to scare people, but you also cannot ignore the fact that wait-lists and a degree of rationing is a fact of government-run healthcare. There are some really large problematic realities that you seem to be ignoring for the sake of being able to say, "We should cover all people's healthcare because it would be a gee-golly great thing to do!" That's irresponsible in itself since that kind of system ultimately would result in worse care for everyone overall - I find that reprehensible. A government hand-out is when you receive money/services from a government program to which you paid a lesser amount into. Over my lifetime, say I've paid $15,000 into the social security system - and let's say tomorrow I'm run over by a bus and my arms and legs are all amputated resulting in me having to live off of social security disability funds of $400/month (what I'm currently qualified for). Given that I'll probably live for another 50 years, I would collect $240,000 of social security funds - far more than I ever paid in. That's a handout. Again, I'm not saying all hand-outs are bad - they are a great tool for helping people to get back on their feet - but handouts provided unchecked are not a healthy thing for a free society... Touche' Mr. Lord. I hate using the italics tag as it slows me down.... -Brendan
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Post by Craig Richard Lysy on Oct 26, 2009 18:19:07 GMT -8
More Government involvement further separates the true cost of health care from the market thus resulting in either shortages, or further skyrocketing prices, or both.
How is then Brendan that the UK, France, Spain and Japan all deliver better health care at half the US cost? Does this not refute your premise that government cannot provide cost effective quality care? They live longer, have less infant mortality, less morbidity, and are healthier. I say model success!
The government has NEVER managed a program without a tremendous amount of waste, lack of oversight and other dunder-head moves along the way. It ALWAYS ends up over-budget and a let-down to those involved in the program (see: U.S. Post Office, Cash for Clunkers, the U.S. Military, etc) - heath care reform on the scale you're talking about would result in one of the largest government programs in the history of mankind....how can you possibly expect it to run any differently than the programs it already screws up?
It runs well in the countries I mentioned. Americans are not inferior to the Europeans or Japanese. We can make it work. Brendan, since human beings are intrinsically flawed, all that is their handiwork will to some extent be flawed. There is no perfect world. I would rather have a government motivated for my welfare than private companies that reward claims adjusters that deny care with bonuses. Companies in business to make profit at my expense. Companies who care nothing about patients - I see this every day - who deny claims, cancel coverage, over charge us and laugh all the way to the bank. If you truly believe they in anyway give a damn about your welfare, than I have a bridge to sell you.
Your proposal also removes almost ALL personal responsibility from the realm of health care. This country has seen time and time and time again that simple hand-outs do not work. You will NEVER get every citizen of the U.S. to take an active role in promoting their own health and often times will proceed to be very DESTRUCTIVE to their own health. Is it fair that part of a working-class poor family's income, via taxes, would be poured into treating a heroin addict who chooses to keep shooting up hours after his next release from the hospital? Or for the hospital stay of an emphysema patient who decides that he loves cigarettes more than his own health? There is no way to govern away bad decisions. In a free society, there will always be those who choose to destroy - a system that removes personal responsibility is one that enables that destruction instead of deterring it.
You argue by exception sir. There will always be a subset of us that are destructive and make bad choices. We should not abandon a better system for all because a few will take advantage. The needs of the many out weigh the needs of the few, or the one.
Show me a system that is based on the individual as the medical consumer instead of the insurance company, encourages health personal responsibility through incentives, addresses the issue of frivolous lawsuits, and lets the true free market dictate price and cost, and I would say you're on the right track. Simply letting government jump in head-first will solve none of the true problems facing our health system, and would quite possibly do the opposite
The market will never provide coverage for; 1. the unemployed, 2. the under employed 3. the working poor 4. middle class families with kids earning less than $60,00 - the majority of the middle class.
We all pay for the common defense which protects us all. That works and government protects us well. Apply the same principle my friend - we all pay for universal health care which protects us all. The market has failed in banking screwing everyone and causing this depression. The market has failed us with health care. The market allows companies to buy the votes of our representative who run like pigs to a trough for their money. I think your mistrust of government overlooks some essential facts; 1. Government ended child labor 2. Government ended 16 hour work days 3. Government mandated bathroom and meal breaks 4. Government ended discrimination in the work place 5. Government supported the family by providing pregnancy and daddy leaves. 6. Government provided women with equal pay for equal work. 7. Government emancipated our black brothers
I could go on, but I make my point sir. Government was created by us to see to the common good and welfare of the governed. Capitalism is by its very nature is predatory in its relentless unstayable lust for profit, destroying all that stands in its way. It is the best system, do not get me wrong, but one that must be tempered and regulated by government, lest it destroy us all and itself.
So I end by stating, model what works. The Europeans and Japanese out perform us, at half the cost and achieve better outcomes. You cannot deny this Brendan. It is time for a better path.
I have enjoyed this discourse. All the best.
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Post by Carlton the Barbarian on Oct 26, 2009 20:05:30 GMT -8
Ah, one against so many. ;D The Post Office always comes up in arguments about health care. Honestly, I do not know much about the history of the United States Postal Office, but according to wikipedia, the government has (constitutionally) managed the postal system since 1775. Of course, the government couldn't foresee the invention of the Internet and electronic-mail, but has the postal system really been a three-hundred year failure? It's hard to google revenue figures, but in past years the Post Office has done well financially. Honestly, I've never had a problem with the USPS, and I've mailed out tons of cd's.... Also, the government is involved in the postal system, yet, private carriers, like Fed Ex and DSL, are able to flourish. Brendan, is it possible for a similar thing to happen with health care? The government hasn't run FedEx out of business, and it appears that the government's involvement refutes the idea that More Government involvement further separates the true cost of health care from the market thus resulting in either shortages, or further skyrocketing prices, or both. It seems to me that the government is able to provide services (free mail for blind people, mail delivered to everyone) because they are not driven by profits. The government is involved with Amtrak, and airline industries, yet these government subsidies haven't resulted in shortages or price increases. Heck, Medicare hasn't led to shortages or price increases. A lot of doctors don't accept Medicaid patients because the government pays a lesser rate for services. How can one "fix" (improve) the current system that refuses to care for the poor, and other's who can't afford it, unless there is some type of government assistance? -CG
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Post by Brendan Anderson on Oct 26, 2009 20:09:09 GMT -8
How is then Brendan that the UK, France, Spain and Japan all deliver better health care at half the US cost? Does this not refute your premise that government cannot provide cost effective quality care? No, it doesn't - your statement that those countries deliver 'better' health care at half the cost has basis in statistics that are either loosely related, not proper comparisons, or not related at all. For every happy Brit who loves their National Health Service I can all but guarantee you an equal number who have either had a horrible experience with it, or had to come to the US to seek treatment. Your statistics such as infant mortality rates are less than reliable. See this from the Congressional Budget Office (http://www.cbo.gov/doc.cfm?index=6219&type=0): "Because of the high quality and widespread availability of neonatal intensive care in the United States, a low-birthweight baby born in this country probably has a better chance of surviving than anywhere else in the world. This paper explores the extent to which the poor U.S. infant mortality ranking reflects a real difference in health status or is the result of variations in the ways births and infant deaths are defined and reported. " - the point is, the U.S. is far more likely to classify a baby as a 'live birth' than other countries because we have a higher success rate in being able to treat severe pregnancy cases. This is just one example. Statistics are only useful if you fully understand the data behind them, otherwise they become simply another fear-mongering manipulative tool. Our morbidity rate due to heart disease does not automatically point to a lack of good heathcare - perhaps it's also because Americans are the largest consumers of unhealthy food on the planet? No amount of free healthcare will save you if you're eating 5 Big Macs per week... It's disturbing to me that this would even be an argument - "we can make it work"? Again, I ask, what Government program can you point to that has functioned so successfully that you think it can work as a tool to successfully provide all people with healthcare? You keep coming back to the military and national defense, but the military has a horrendous record of obscene over-spending, terrible contracting practices, and mis-management that has cost many lives. Is it still the best military in the world? Yes, but it's largely due to an awesome system of personnel training, a healthy incentive for individuals to join (i.e. money given directly back to the individual in the form of college funding), and lots of monetary resources in the form of a wealthy tax-paying nation. Healthcare is not the military. Individuals can afford most of their healthcare expenses they incur (check-ups, prescriptions, minor procedures, etc.). Individuals cannot bomb Iran's government into submission. If government and insurance companies were taken out of the health care market system, prices would become realistic. Say you had a friend who washes your car each week - but every week he washes it, he ends up dinging the bumper, scratching the paint or occasionally ruining your engine by pouring water in the oil. Putting the government in charge of health care would be like asking that same friend to be in charge of washing 1,000 cars at a dealership each week. What part of his work in a small job makes you think he would be any good at the bigger job? Craig, you'll get no argument from me that our current system of insurance is completely whacked. The system of insurance reimbursement is completely convoluted, bloated, corrupt and all kinds of other adjectives. Insurance has its place, but its place is not as the controller of every single health care encounter - it should be in place to do what insurance is for: help out when the big stuff happens. This is where I completely agree with the insurance method put forth by the article Hook linked to. What do you think of that article's proposal of how insurance should work? Medicare is all but bankrupt because of the amount of fraud and mis-management. What would prevent this from happening to a National health care system? Your "needs of the many..." argument doesn't even have to be a factor if we put each individual in charge of his/her own health care just as we put the individual in charge of their own career, how to raise their family, what to spend their money on, and so on and so forth. If a government heath care system ends up like almost every other government program before it (broken and in need of desperate repair), the "many" will suffer (wait-lists, rationing, denial of access, etc.). Perhaps you missed when I replied to Jon to say that obviously a certain amount of government assistance will be necessary - perhaps as the universal "catastrophic coverage" provider, perhaps in an expanded medicaid role, perhaps as a health care provider as a part of unemployment compensation. There would certainly be a role. But as the provider for the entire citizenry? I can only see disaster there... Craig, the market has been excluded from the health care industry for decades! Government and insurance companies have been directly responsible for the inflation in health care costs - just as government created programs encouraging banks to give mortgages to people who couldn't afford them thereby causing the housing collapse we're in today. When government gets involved in prices, trouble follows. Perhaps you may have tried to buy 10 gallons of gas back in the early 70's? How was that line for you? How would you like to wait in a similar line with an appendix that needed removal? You know, Germany doesn't allow semi-trucks to use the roads on Sundays - it makes for pleasant driving on the weekend and it works great for them. Perhaps we should implement that too? Nevermind the extremely negative economic effect it would have on us since, after all, we're not Germany - I think it would be nice to drive on semi-free roads on the weekends, don't you? Japan's doctors are severely underpaid and their average hospital stay is four times longer than in the U.S. Wait times for health care in Spain have been reported to often extend for months, causing most who can afford it in that country to seek private insurance. In France, doctors are again paid far lower than in the U.S., their system is going bankrupt and hospitals are closing across the country. What part of all of that would you like us to model? Again, I put forth: a system that is based on the individual as the medical consumer instead of the insurance company, encourages health personal responsibility through incentives, addresses the issue of frivolous lawsuits, and lets the true free market dictate price and cost, and (I'll add this for those of you like Jon who find me heartless) limited government assistance for the poor and destitute who are held accountable for their health decisions. -Brendan
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Post by Carlton the Barbarian on Oct 26, 2009 20:15:00 GMT -8
A government hand-out is when you receive money/services from a government program to which you paid a lesser amount into. Over my lifetime, say I've paid $15,000 into the social security system - and let's say tomorrow I'm run over by a bus and my arms and legs are all amputated resulting in me having to live off of social security disability funds of $400/month (what I'm currently qualified for). Given that I'll probably live for another 50 years, I would collect $240,000 of social security funds - far more than I ever paid in. That's a handout. So, 401K plans (and IRA's) are handout's? ;D I wish I had more time to organize my thoughts.... -CG
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