Brent Nyitray
Fairlington Blade
Let the mutherfuker burn!
jnc4p
Kevin S. Willis
Michigoose
lmsinca
markinaustin
Arcanaut
novahockey
quarterback
ScottC
yellojktI came across an interesting piece this morning and while I am already in a reflective mood I thought I might just share it. Today would have been my nieces 34th. birthday. Some of you know a little about her story but that’s not really what I’m interested in sharing today. There has been a lot of criticism from the Plumline about what we are attempting to do here at ATiM and so I thought I’d share both my thoughts and a quote from a piece I read this morning.
I love a good ideological fight and I appreciate both passion and resolve. What I don’t find particularly beneficial to the fight is pitting citizen against citizen. We have a long tradition here of right vs. left and consequently we end up with a lot of middle of the road legislation that doesn’t always solve our problems. I think the health care debate was one such battle. In the midst of demeaning and knocking the feet out from under our enemies, each other, we ended up with a bill that could only have been drafted by someone in the middle. I blame Obama and a dysfunctional Congress for that and I’ll tell you why.
He and others were much more interested in defending and preserving a system that is putting access to health care out of reach of many Americans. Instead of defending and championing the people he was fighting for Obama was appeasing those who were fighting against him, while the rest of us were laying claim to self-righteousness. In the midst of this epic battle great animosity was created, sides were taken, superlatives embraced and those of us who hoped for a healthier tomorrow for all citizens lost our leader and our way. We consequently ended up with a bill that only inches our way forward when we needed a bold design for the future.
I believe we can embrace our enemy as a fellow traveler without impugning their motives or humanity. That’s what drives me. I will fight and advocate for those who have and are suffering but choose not to make such an enemy of those I disagree with that I lose sight of their genuine belief that their solutions are, or may be, better than mine. I hold out hope that citizens can come together and form a more perfect union. I also believe the greed of a few has changed the future of many and to me that is the epic battle I want to fight and hope that others will realize that championing the middle class, working class, working poor and uneducated is what will bring prosperity back to this country. We may disagree on how to do this, therein lies the battle line, but as long as we all want a prosperous nation again I don’t see a reason to disparage the motive of other citizens. I do think however the motives of our leaders can be called into question and is another venue for a great ideological battle and legitimate questions as to who actually benefits from legislation can and should be raised.
My niece died 3 years, 7 months and 2 days ago at the age of 30. She was sick, but her insurance coverage was rescinded in the middle of a fight for her life, and I believe most people who are mothers, fathers, aunts, uncles, brothers and sisters would agree that we need to find a way beyond a health care system that carries such a risk. Maybe I’m wrong but I believe most other Americans wouldn’t intentionally wish this on a family. The question is how do we move forward in a way that does the most good with the least amount of threat to both individual freedom and prosperity.
Here’s that quote:
Before you disappear, before you can no longer hear
my words from beyond the beyond and inside the ground,
before your run ends in downfall and rout and retreat,
let this old heart beating with the Earth and the stars
and the need for not one child, not one, to die for lack of love,
let me tell you one last secret found in the abyss of despair.
It is true that he who is mighty is he who makes of an enemy
a friend, mighty and wise is he who offers the foe
a way out, a bed to sleep in, a meal to share.
But not without a fight. Not without a fight.
LMS, I tried to post the following as a comment, but I was thwarted. So forgive the appendage to your thought provoking post that follows. Mark.
The ACA would have put your niece in a better position to maintain coverage.
Let me defend moderation, here.
1] Every nation that is “like us” that has developed UHC has done it by evolving from what went before.
Canada has socialized insurance. UK has socialized medicine. Switzerland has private insurance, regulated; and regulated hospitals. Switzerland evolved in the 90s from a system just like ours in most ways. Germany, France, and Japan have mixed systems with private regulated insurance, private docs, and widespread clinic care. All these nations have UHC which costs half as much as ours, or less, and which has gross statistical results as good as ours, or better.
2] We have a shortage of docs and of nurse practitioners, and pharmacists. In our “like” countries, nurse practitioners and pharmacists do pick up more of the first response than we have them do here.
These shortages must be addressed if we are to achieve widespread clinic care [and we know that even here, clinic care is far cheaper than the “national average” and a relative drop in the bucket when it can substitute for ER care].
3] Certain end of life choices must be borne by the individual rather than by the group, because the cost/benefit is individual, not societal.
I am 68 and my five year colonoscopy, by my count, is the first time that I have cost the system as much as one year of my continuing pay into it. In other words, I am still a net contributor to the group plan and hope to be until I die. My friend Jimmy, who turned 66 on Thursday, has been treated for cancer the entire year he has been on medicare. His 20% [he had no gap or advantage policy] will likely not be paid by him, or his estate, most of which is exempt from creditors [homestead, truck, tools of his profession]. There came a point when further chemo was considered irrelevant, 9 weeks ago. He has chosen hospice since. The trickiest propositions are the end of life balloon of cost and the nursing care balloon. Rosanne and I have nursing care insurance. I do not know how Switzerland and Germany do this, but I am interested to read about it.
THE ONLY REALLY TOUGH PROBLEM, IMO.
4] I think it is natural to evolve to the Swiss-and-or-German model but not toward the UK or even toward Canada. In any case, ACA was a step in the direction of Swiss, not the direction of UK. It will address near universality and pure insurance cost, but not basic medical cost. For that we have to go back primarily to
INCREASING SUPPLY AND REDUCING DEMAND.
5] While we are evolving and training the suppliers, and promoting healthier lifestyles, we can address the efficiency issues as well.
a] automated computerized record keeping;
b] doctor-lawyer evaluation panels for malpractice claims, aimed at reducing actual malpractice, but also at filtering out the weak claims at an early stage;
c] first dollar payment by the patient, and co-pays, to reduce overindulgence as described by NoVaH;
d] ending price discrimination by the pharmaceutical manufacturers by opening the borders to pharmacy inports – I note that we are actually subsidizing Euro drug makers as much as we are American ones, now;
e] attempting to have an adult discussion about what a “basic” care package entails;
and
f] getting the non exigent poverty cases OUT of the ERs.
6] As a lawyer for small business folks and employers I actually had to read the bill. It is intentionally not onerous on small business; it will not be a job killer from that perspective. But it cannot contain basic medical costs because of the shortage of basic medical personnel, which it only addresses in “pilot” programs.
If instead of evolving toward Switzerland we had chosen the UK model, the shortage would have been immediately and shockingly felt as docs scrambled to leave the program, unless it had been structured at such a high cost as to simply absorb most of the tax resources of the federal government.
Max Baucus had in mind the evolution of which I speak, according to some interviews with him that I saw during the period. I think BHO did, too. In short, I argue “Fuggedaboud” single payer.
———————————–
The Libertarian view questions the government’s role in HC. If ECA were repealed and Medicaid were repealed; if the VA was shut down and Medicare repealed, at least prospectively; does anyone posit that the supply of medical services would expand to meet the need?
No. No one suggests that outcome. Ron Paul hopes for it, but he does not predict it. Would the body politic accept that as status quo? What do you think? LMS’s niece, 100 times over?
Filed under: Uncategorized |
All Things in Moderation 
I'm sorry for your loss. I'm a bit reflective myself these days. Unfortunately, our current system grew out of circumstances (wage and price controls during WWII) that bears little resemblance to life today.BB
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I guess I'm just really trying to make the point that politics isn't a battle between good vs. evil as so many portray it. That's not to say there isn't evil in the world just that it's not easily recognized or defined and I think too many assume the worst rather than hoping for the best.And I just realized today is a holiday……..Go Columbus.
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I'm very sorry to hear about your niece, lms. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/Great Frontline/PBS program on how health care systems are structured around the world. Lot's of details on the German and Swiss models.
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lmsinca- One thing I try and keep in mind is that for the most part we all want the same results, but see different ways of achieving those results. Our republican/libertarian friends here don't want people dying in the street and we liberals don't want everybody to ride the coat tails of the productive members of society. To go off on a bit of a tangent, I was speaking with the ethicist for one of my clients and in discussing various end of life issues he mentioned that when he and the other members of the ethics panel show up to a patient's room to discuss end of life issues with a patient and/or family it is common for people to say something to the effect of "so this is the death panels they were talking about." So not only does the evil v. good dichotomy inhibit progress, it also can have very negative long term effects.
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Based upon the findings recently by the Kaiser Foundation I'm willing to entertain any serious suggestions to reform the way we deliver health care in this country. I agree with most of mark's suggestions but don't see an avenue to get there in the political climate. If we're talking about privatizing or voucherizing Medicare I don't think we're serious about dealing with rising costs. I also agree with the first dollar concept in an abstract way but don't know how to implement it when the costs of care are so high. I thought increasing co-pays and sharing the cost of plans, which are both rising by the way for most of us, would guarantee less utilization. I'm afraid they will in actuality encourage under-utilization which will lead to higher costs in the long term.I'm glad there are people working on implementing the ACA so that we have a starting point for reform, but I wish it was moving faster and that it wasn't such an incremental process in the way of reform.
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ashot, as a volunteer for Hospice, I'm very familiar with the "death panel" comments. I generally deal with the families of patients post death but I hear the nurses and doctors who work in Hospice care discussing the impact of those two words.
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If you haven't seen it, this is also a good read on the core problems of the current system, which are mostly left unchanged by the ACA."How American Health Care Killed My FatherAfter the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem.By David Goldhill"http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/
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Thanks jncI actually remember reading that when it was first published but I will read it again to refresh my memory. It was the death of my niece that set me on this quest for determining the best and most equitable way to repair our health care system, so I'm sympathetic to his journey.
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OT:Robert Reich on OWS and the Democratic Party.The Wall Street Occupiers and the Democratic Party
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I re-visited that piece that jnc linked from a couple of years ago. I think we know a little more now than he knew then, but even so some of his ideas sound like a conservative's dream scenario, except the part about one catastrophic plan that everyone either buys or receives based upon age and income. I don't believe the health care system will ever respond to the market based approach and conditions he finds so intriguing.
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I haven't read the whole thing yet, but …"work in a heavily regulated, massively subsidized industry full of structural distortions" ….I don't think this can be repeated enough. To lms' point about the system responding — I don't think it will response to piecemeal reform. Has to be a total overhaul from the ground up. nuke it from orbit and all that.
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"In the midst of demeaning and knocking the feet out from under our enemies, each other, we ended up with a bill that could only have been drafted by someone in the middle. I blame Obama and a dysfunctional Congress for that and I'll tell you why.He and others were much more interested in defending and preserving a system that is putting access to health care out of reach of many Americans. Instead of defending and championing the people he was fighting for Obama was appeasing those who were fighting against him, while the rest of us were laying claim to self-righteousness. In the midst of this epic battle great animosity was created, sides were taken, superlatives embraced and those of us who hoped for a healthier tomorrow for all citizens lost our leader and our way. We consequently ended up with a bill that only inches our way forward when we needed a bold design for the future."The other thing about President Obama's political approach to passing health care reform, is that he overlearned the lessons of the Clinton's failed attempts in the 1990's. I.e. the first thing he did was to get all the special interests on board (insurance companies, pharmaceutical companies) and let Congress drive it. These were decisions taken specifically to avoid the problems that Clinton had with Congress and the insurance companies. However, this approach necessarily limited the amount of actual "reform" that the ACA would include. In terms of where do we go from here, Steve Pearlstein's article about merging Paul Ryan's changes to Medicare and Medicaid (i.e. vouchers) with the ACA exchanges makes the most sense along with converting the employer tax deduction into an individual tax credit. This pretty much converts the ACA into Wyden-Bennett.Mix Obamacare and Paul Ryan’s plan to get a better safety net for Americans
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I enjoyed reading Pearlstein's article last week and found some issues of compromise that might actually work if Congress wasn't so far apart on the issue. I did wonder if the numbers would support his ideas though. It would be interesting to get a better economic perspective on it I think.
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A fundamental point that I still do not understand is the basis for the belief on the left side of the debate that health care is something that is unique in somehow existing outside the "laws" of economics that apply to everything else. We've debated this many times, but I still have no idea how this belief can be justified.I also think that it is only partly true that we all have the same goal. Hopefully, we all do want people to have health care they need, but there are other values involved as well. Conservatives and libertarians generally value freedom from government interference in this area as in others, meaning that a purely instrumentalist approach inadequately accounts for their (our) values.
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QB, are you arguing that the supply of health care providers would increase to meet the demand absent all of the federal involvement that I listed? Do you not see the shortage of providers as perversion of competitive market theory?
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I should also address your question about medical services and the free market from one other view.While a defective widget can injure a user and bystanders, failure of a health system can lead to plague and mass illness and death. Germs are not respecters of the market. Thus we all have a vested interest in a public health program [whether operated by government[s] or otherwise] that treats infectious disease in the population regardless of ability to pay.As I understand it, the completely private, but regulated, Bismarckian approach of Japan has one major governmental component: public school nurses. Stopping infectious disease in public schools is said to be very cost effective and lowers the medical costs to the society at large. State public health programs, including statewide support of local sanitation, backed by a USPHS with it Disease Control Center, seems cost effective here. I am old enough to recall when my rural public school had a nurse, and she was the first responder to everything from measles to polio. That was probably a good idea, too. But we do not have enough nurses now. Not enough to make a either a private enterprise system or a governmental one work.
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Mark,I don't know how to answer that, because I truly don't know what you are saying or asking. I'll take a stab at it, but this may be missing the pont.Perhaps the best answer is to fall back to economic first principles. I would contend that there are supply and demand curves for health care goods and services. Absent government interference, there will be a market equilibrium price and quantity, so, although these markets are complex, yes, in this sense supply will absolutely meet demand. This may not be a satisfactory "solution" to many, but if so it is not because there will be unmet "demand" absent government intervetion.What do you mean by a perversion of competitive market theory? What is the evidence of a shortage of providers, and if there is a shortage what do you think is causing it? If the supply of providers is shrinking, then presumably it is because something is diminishing the returns available to providers. If demand is increasing, then what is causing it to increase? Could part of it be that consumption and payment responsibility are delinked or perceived to be delinked?Are you conceiving of government programs as demand or supply? It looks to me like you conceive of them as supply, but in fact aren't they just as much or more sources of demand?
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"QB, are you arguing that the supply of health care providers would increase to meet the demand absent all of the federal involvement that I listed? "I think clearly the supply of health care providers would increase to meet demand, with a sufficient drop in barriers to entry. Too many drops in barriers to entry, however, too many of the folks rushing to meet demand would end up being quacks. Additionally, some procedures would simply not make it to market, at least absent numerous innovations that bring the price of the procedure down. Without insurance coverage, there's be a lot less hyper-expensive cancer treatments, heart surgeries, and imaging machines. At least, I'd suspect.
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