After decades of failed efforts to reshape the nation’s healthcare system, a consensus appears to be emerging in Washington about how to achieve the elusive goal of providing medical insurance to all Americans.
The answer, say leading groups of businesses, hospitals, doctors, labor unions and insurance companies — as well as senior lawmakers on Capitol Hill and members of the new Obama administration — is unprecedented government intervention to create a system of universal protection.
At the same time, those groups, which span the ideological and political spectrum, largely have agreed to preserve the employer-based system through which most Americans get their health insurance.
“Consensus emerging”
There are few things that make me as angry as the attempt to push opinion. One of the reasons that it makes me angry is that it works and that this is yet another evidence that our public schools have failed us. If people were well-educated such propaganda would not work and if it did not work we would see far less of it.
We are seeing continued evidence of a Democracy at war with itself. The majority of voters now believe that government exists to make their personal lives better rather than to protect the nation and deal with evil leaving the individuals free to work and produce. As the snake continues to further swallow its owm tail (and more), there is nothing but the growing possibility that the snake will kill itself.
Don
For many years, due to my spouse’s employment, my family and I were covered by “governement health care”. While we were very glad it was there, because it was directed by the government, it was only the bare necessities. There was little preventive treatment for families other than vaccinations, and of course there was NO interest in the overage since all were of military age.
I will give only one instance of how it worked. I had four children under the care of government doctors in four different military hospitals. During all four pregnancies, I NEVER saw the same doctor twice. In the system, one is only what is on a paper history(maybe computer now). The children were delivered by strangers, never to be seen again once we left the hospital. Any follow-up, was also by strangers.
Granted, I will be forever grateful that the program was there, and have no particular horror stories about it. However, the average person had no idea what they are asking for.
All I’m saying kiddos, is it is NOT what it’s cracked up to be, especially when it will be run by bureaucrats.
Grandmother in SC
I have to admit I remain dubious about the government getting involved in the healthcare system. Yes, I will concur that the current system needs some serious work, but I am not sure the US government has either the expertise nor the money to fund such an enterprise. The thought of injecting partisan wrangling and discord into the medical profession is the answer.
As soon as the government gets involved in providing direct healthcare to all not covered by employers, employers will stop offering health care – why should they pay when the government is picking up the tab?
There is a proven model that addresses all these concerns: HIPC – the Health Insurance Plan of California, implemented under former Gov. Pete Wilson. CA allowed formation of a purchasing consortium of small businesses, whose combined membership was so large that member employees received rates better than Fortune 500 companies. The state was simply a facilitator, and each company paid a small fee for overhead; so there was no net cost to the state.
I’d expand this model to allow individuals, eliminating the pre-existing condition problem. In fact we should move away from employer provided to pure individual. There would be a tax credit for those who proved coverage; otherwise the credit would pay the premiums directly.
The more informed political observers will note that my proposal combines elements pushed by McCain and Obama. But I do so in a proven, pragmatic way. Having personally implemented a HIPIC plan, I was impressed with how superior it was to every other model. But as other posters have noted, the problems of the automakers persuade me we need to modify it and move out of the employer-provided health plans, which are an historical accident of the WW2 economy. But the fundamental basis of the model’s success is that it utilizes government in its best role – facilitator, rather than its weakest role – provider.
There is a term for Government provided and run health care. It is called the V.A.
6. The VA is a useful system. It also is much fairer than the current system to physicians.
I agree. An appropriate national health system would look like the VA. That means physicians should be civil servants (like police or firemen) should have immunity from lawsuit, and should be paid a salary and have benefits similar to other civil servants of their education and training. There should be a cap on hours. If there is overtime, it should be compensated. There should be a cap on work load. Nobody expects the same policeman to respond simultaneously to three different critical emergencies, everybody blames physicians if they “don’t get there in time”.
Most physicians would do significantly better in a VA type system if one calculated pay/hour as distinct from total pay. However we will not get such a system, because under a VA type system, the government would spend far, far more than it does now. It is much easier to make physicans the US tax collector for health, requiring them to charge for selfpay and Blue cross in order to support the inadequate government health benefits (medicaid/medicare) for the chosen of the electorate. Then one can simultaneously attack physicians for price “gouging” while suing them for inadequate care.
This, like running a country or a household on debt can go on a long time. We are in an economic hole because we borrowed from the future in order to live better in the present. Right now we are borrowing from the good will of the current generation of physicians, expecting them to put up with this, while still doing their best to save our lives and health. Most of the generation that is over about 40 has been heavily socialized by the generations before them to put up with abuse, and to think of their duty. (Queen Victoria who disliked sex said “I lie back and think of England”. We too lie back, accept what amounts to legalized rape, and think of our patients. The next generation will not be like us. (And that’s a good thing. No abuse should go on forever, and the US deserves the medical system that Obama will soon put in place).
But I agree that the VA is attractive. I am considering taking a thirty percent pay cut to join her. I just worry who will take care of my patients when I do. Right now docs are bailing, left right and center and I do not see anybody who will fill my shoes when I depart.
While there are some positives with VA, it is hard to extrapolate from its performance with the current narrowly-defined patient base to performance if VA covered the entire population.
I am sympathetic to the problems Clueless notes. Health providers are indeed being victimized by govt in Medicare/Medicaid. But it seems oxymoronic to suggest the solution is turning the entire healthcare system to the government that performed so poorly in the first place. That is why the model in my #5 seems to be more promising.
There is a reason that physicians are fleeing California. It is because in a third party system, open to the trial lawyer industry, the patient has no reason to not demand “the best” or to litigate if he/she is disappointed in any way. A large number of physician groups have gone bancrupt.
It would be better to simply have catastrophic insurance (with a 10,000 dollar deductable) with patients expected to pick up everything else. Then folks would be willing to accept a low fee doctor and sign a form agreeing to mandatory arbitration for issues of malpractice. With lower costs in malpractice and record keeping, and no insurance billing, costs could come down. We could also permit non physicians (med techs) to offer health care at cut rates. Again, no records, no suing. Right now, the multiple insurers and the liability insure that costs stay high and that only the most experienced and educated (read physicians) will take care of sick patients. If Grandma knew she wouldn’t get sued if she popped your shoulder back in place, she’d do it. She’d also take care of your burns, set minor fractures etc. That was the situation we had before the governement decided to “provide” medicare/medicaid. It wasn’t because folks weren’t getting care. All physicians had a tradition of charity. It was because the government felt that it was dehumanizing for folks to accept charity. So we have medicaid which is basically charity care that insults the physician who provides it by pretending that it covers costs when it does not.
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Copays now, are far greater than the entire doctor visit was when I began as an intern in 1981. You could see a pediatrician and pay 15 dollars for everything. That was before the lawsuit epidemic got started, which required that every visit be minutely documented in preparation for a potential lawsuit and that every test that might possibly result in a change in care be done, lest there be a “bad outcome”.
My mentor once told me “physicians get the patients they deserve” (meaning that if what you really care about is safety and money, you will end up with a stableful of the worried well who bore you to death with their hypochondria).
Countries also get the healthcare they deserve. Right now the generation of physicians who grew up before America became greedy, whiny, litigenous and ungrateful are greying. The new generation does not have the fond memories that we have. Every day new patients come to me saying that they can’t find a doctor because they are “too complex”. The new generation prefers the worried well. But they deserve them. And the patients deserve the physicians they get.
Well, of course we want the government to run the medical system. Look at how good they do with education, homeland security at airports, EPA, energy policy, etc. And think of the money saved if they don’t pay much for it. Like the Russian peasant said, “The government pretends to pay us and we pretend to work.” All that is needed is to get rid of that pesky thirteenth ammendment, so those doctors and nurses have to work in the new system. The voters in the US deserve such a system. Enjoy