I am more than tired. I am in fact weary of the divisive and destructive politics our system has nurtured for the last 30 years or so. I am frustrated with Washington; I am highly annoyed by the entertainers masquerading as political commentators who have built very nice businesses out of the division. But, I am sickened by myself and my fellow citizens. We are the ones who allow all of it to take place.
Hateful division is not helping our nation and is not helping us as individuals. It is, literally, killing us. Our problems, the healthcare debate being no exception, require and deserve more thought than self righteously repeating the rants of television and radio personalities. We owe it to ourselves and to our country to participate productively in the current healthcare debate.
The right to voice differing opinions is a coveted and cherished right in the United States of America. Intelligent debate is the true engine of an effective democracy. Hateful, unproductive comments are simply not American--or it is not the America I want to be part of. Our country, our people deserve better.
In this spirit, all opinions are welcome within this blog. Hateful, meaningless words and accusations will be removed in order to foster an environment within which ideas might be exchanged. Hopefully, our country has what it takes to fix or improve the healthcare situation. To allow politicians and commentators to, again, shut down progress on this issue would be criminal.
The central question of this post, of the entire healthcare issue is:
Do you believe that every American citizen or legal resident has the right to affordable healthcare of reasonable quality?
In other words, should every American have access either—via health insurance through the private sector, a government plan or a combination— to competent and appropriate healthcare?
Please Note: I did not say free, I said affordable.
If you do not believe that every American has the right to access to the healthcare system, if you are not concerned about your own ability to pay if serious illness strikes you or one of your family members, you might want to spend your time doing something other than reading this post. However, if you are interested in exploring ideas to this challenge, please read on. I would love to hear your ideas.
Why are healthcare cost rising so rapidly? In my opinion, several reasons including:
1. Our litigious society—we all know that the “legal machine” is an “industry” to be reckoned with in the United States. Everyone has a right to competent and safe products and services and has the right to claim damages when they have been truly wronged. I think most of us have reasonable common sense when it comes to these issues. If your spouse’s surgeon performs surgery drunk and kills your spouse, you are entitled to reasonable damages. If your doctor uses his/her best judgment and knowledge and your situation does not end as hoped, the situation probably should be chalked up to the complexities of the human organism and to the mysteries of life.
2. Longer life expectancies—longer life spans mean more medical costs over the course of ones lifetime.
3. Advancing medical technologies—medical technologies have given us wonderful life saving advancements, but these technologies cost a great deal of money. In addition, these technologies contribute to longer life spans and often extend disease state life expectancies. These advancements are fantastic, but also present there own challenges. It is wonderful that we have in some cases greatly extended the amount of time people can live with a terminal disease. And, we have in many cases greatly improved the quality of that time. The challenge is that it is expensive. Who is going to pay for this?
4. Preventable diseases—obesity, poor nutrition, smoking, excessive drinking all add to society’s overall cost of healthcare. The percentage of obese Americans— men, woman and children is alarming.
5. Tremendous inefficiencies in the healthcare system. Our healthcare system has not responded like a true market-driven market because, it isn’t a pure market-driven market. The healthcare market is subsidized by different sources namely corporate American (i.e. employer provided health insurance) and local, state and federal governments. Players at every corner of our healthcare system have not addressed inefficiencies because they do not need to—why would these entities look for cost savings when they are very, very profitable without having to change their operations.
A great deal of the medical system still operates using paper record keeping and the horrendous inefficiencies that exist within the pharmaceutical manufacturing and development are just two examples. On top of the fact that many sectors of the healthcare industry have not needed to maintain operational efficiencies, sometimes regulatory bodies create conditions in which making operational improvements is unaffordable given the revalidation of processes and procedures that are necessary if changes are made.
6. Lack of taking “ownership” for personal healthcare issues. Due to the litigious nature of our society, many unnecessary tests and medical procedures are done. Patients need to take greater ownership and responsibility for their own care including the risks and rewards and the costs of those decisions.
Patients need to partner with doctors in order that joint decision making may transpire. Frank and difficult conversations need to happen more frequently. Is it worth $200,000 to extend a terminal cancer patient’s life one more month? When the patient is yourself or a loved one, these costs seem to be worth every penny. But, as a society we are all paying for these decisions in the form of unaffordable health insurance costs and sky rocketing healthcare costs.
My Thoughts/Solutions Ideas:
1. Caps on malpractice settlements.
2. Due to longer life expectancies, individuals and governments need to budget for these new realities—this will mean, for most individuals, working more years.
3. A Health Savings Account approach should be adopted as the norm—preventative care would be covered fully, encouraged and perhaps demanded. A high deductible insurance program is coupled with a savings account that accumulates over time. Care above and beyond preventative care is paid for from the savings account until the deductible is met. After the deductible is met, care is paid for 100%.
If this move is coupled with caps on malpractice suits, billions of dollars of unnecessary spending (CYA spending) will be removed from the system which will lower costs. This approach also shifts some of the decision making back to the patient so that more of a doctor/patient partnership might be reached. For more information on a Health Savings Account approach, please click here.
4. “Sin” taxes should continue to exist for tobacco and alcohol products. And, in my view, a “sin” tax should be applied to “luxury” unhealthy foods (ice cream, fast food, high calorie/low nutrition foods). HOWEVER, the revenue from all sin taxes need to go into the healthcare system and not be used as they are currently to support the lack of financial discipline amongst local, state and federal governments.
I do not support, for example, using tobacco sin taxes to fund road construction. If sin taxes were continued on tobacco and alcohol and applied to unhealthy foods, this would be an extremely fair way to fund healthcare for all. People who statistically are causing the most strain on the system via preventable diseases, pay more into the system through the sin taxes. A “Fair Tax” for healthcare.
Private insurance policies held by high-risk patients could be subsidized in some way by the sin tax revenue. Government provided healthcare for the elderly, the disabled and other identified groups would be funded via sin taxes and the current system of payroll deductions.
5. Every corner of the healthcare system MUST be dedicated to and rewarded for operational efficiencies. Regulatory bodies must not impede this progress and competitive pressures must be realized across the system. The current situation of private/public subsidizing of the system must stop immediately.
6. As individuals we must take ownership of tough decisions. Not playing an active role in our own healthcare decision making is driving costs through the roof and contributes to the frequency of malpractice suits. Americans don’t seem to like to be open and realistic about the realities of life. We seem to like to think of ourselves and our society as invincible and tend to sweep the unpleasantries of life under the rug.
As a society we must be willing to have uncomfortable conversations like—at 90 years old, is it fair to ask the system to spend $50,000 to extend my life a few more weeks? Would we be better off as a society and as a nation if we could come peacefully to terms with the inevitable ending of life?
Maybe a more harsh way to pose this question—at a certain point (whether this point be caused by a disease state or age), is it more fair for us to come to peace with our mortality, to gracefully bow out of the game so that someone else might live?
Let’s get really crass—is society better off paying $50,000 to extend the life of a deteriorating 90-year-old by a few weeks or a few months or spending those dollars to assure quality healthcare for children?
Money does not fall from the sky. When as a society we make decision that life should be extended at all costs, the price of health insurance becomes unaffordable and/or tremendous financial pressures are experienced by governments. Currently, we have both situations—unaffordable private health insurance and government budgets under extreme pressure.
Final Comments
For those crying “communism” and denouncing out of hand a revamp of our healthcare system, it must be acknowledged that we have a form of universal healthcare today—a pretty unpleasant form. Half of all bankruptcies are cause in full or in part by medial costs. These bankruptcies cost our system (eventually individual taxpayers) a great deal of money each and every year.
For those who are railing against the idea of the government having a role in making healthcare decisions for individuals—is the current system of health insurance companies making healthcare decisions for individuals a good system? I argue not. The reality is I want to be in a system where I have more control over my own care—neither the government nor insurance companies controlling the care I receive or the decisions I make.
Misc. Healthcare Facts/Stats
-Best estimates suggest that healthcare costs the typical American family between $12,700 - $20,000 per year.
http://economix.blogs.nytimes.com/2009/07/21/how-much-does-health-care-cost-you/
http://www.nchc.org/facts/cost.shtml
-Healthcare costs are outpacing inflation by a factor of 2 – 3.
-Although in 2008, healthcare spending accounted for 17% of GDP—a greater percentage than any other industrialized nation— 45 million Americans remain uninsured.
-A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses.9 Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.
-According to a recent report, the United States has $480 billion in excess spending each year in comparison to Western European nations that have universal health insurance coverage. The costs are mainly associated with excess administrative costs and poorer quality of care.14
-The United States spends six times more per capita on the administration of the health care system than its peer Western European nations.
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I am interested in your take on how efficient the goverment has been at setting the cost of rental wheelchairs? When in some situations...it has cost the American Taxpayer thousand of dollars to help pay for one wheelchair rental when an individual consumer could buy it outright for $250. My point is this, there are so many loopholes and companies like Apria Healthcare, benefiting from government stupidiy and naivite. The goverment is not strong enough to balance their own budget, and make good financial decisions or even at setting up basic cost structures...really would you trust the goverment to balance your checkbook? or to use your check book to buy even one wheelchair?
ReplyDeleteAs you probably have gathered from my post, I do not hate government. I do not worship government either. The government has its place, as the private sector has its place.
ReplyDeleteThe government is not effecient, it generally moves slowly and "fat" builds up in the system fairly quickly. Some of the most negative parts about our government (the slowness, inefficiency, etc.), are also positive characteristics. Democracy/representative government is a messy system of checks and balances.
Local, state and federal governments, on whole, are driven by elected officials working to stay in office. I believe most officials start their polital careers with a pure desire to make a positive difference. To serve their country/community. Some get corrupted along the way, nearly all find themselves navigating compromises to get anything done.
The private sector is driven by profit. The private sector does not and should not do things that do not deliver a fair profit. Most private business people start their careers wanting to build a nice life for themselves. Some get corrupted along the way and end up doing some pretty unethical things.
The point is that neither government nor the private sector are immune from corruption and wrong doing.
The healthcare challenge requires participation from both governments and the private sector. Everyone knows that both the government and the private sector are needed--the bulk of the debate is where the balance is and what are the specific roles of the government and the private sector.
How do we allow the private sector to play its most effective role in healthcare? The roles for the private sector in healthcare are many and would solely include areas where there is a fair profit to be made.
The government needs to step into areas where there is not a profit to be made--high risk patients where private insurance companies will lose money, appropriate coverage for Americans unable to work, etc.
Very indirect response to your point...I apologize. I don't believe that we can allow the challenges that lie ahead of us stop us from working toward solutions.
I fully agree that the government (using our tax dollars) should not be paying thousands of dollars to rent a $250.00 wheelchair.
In the end, I think individual citizens need to become productively involved. Possibly it would work or help to build some sort of internet-based reporting mechanism. Some sort or forum where incidents could be reported and could be viewed by the public.
A solution of this nature would require a level of trust and coorperation across our citizenry. We would all have to approach the situation with a spirit of wanting to fix the problems rather than to just be "right."
If the reporting was transparent and visible, elected officials at every level would be under a lot of pressure to fix the problems.
On the healthcare issue, I think that many, many citizens want the same thing. There are small areas of disagreement to be sure, but on some of the large points, I believe most of us agree.
There is too much politicking, ranting and raving and in many cases out right lying going on. This makes it very difficult for you and I to wade through the "noise." This noise, I am convinced, in many cases is intentional. My sole hope is that citizens/everyday people can learn to talk calmly to each other about our ideas and concerns. The strategy of division has built a lot of polical careers and made some people an awful lot of money. However, for common citizens....there is nothing it in for us that I can see. We have to keep our representatives in check.
Thanks so much for your comment.