Outraged at the Politics of Healthcare
July 26, 2009 by Will Marre
I’ve really tried not to write this. I’ve said my peace on a national health care make over (see Will Marre’s Radical Solution to Health Care), but now my hair is on fire. Those framing the debate are focused on all the wrong things. We cannot repair a completely broken model. We must re-think and thoroughly re-invent health care. Arguing about projected costs made by assumptions that can’t be validated is pretending to know the unknowable. Trying to close a $1 trillion gap is an exercise in science fiction. It is also strange that Republicans are so concerned about costs when they gleefully agreed to pay drug companies a trillion dollars in a deal George Bush made on Medicare drug benefits. They weren’t concerned about the trillion-dollar cost of a non-strategic war, but now when we want to end our Neanderthal ways of health care, they are wringing their hands. Right.
The financial interests that currently thrive on our broken system are reportedly throwing $10 million a week at keeping their flood of money flowing. The current system is constantly escalating costs and shrinking benefits for those that can afford insurance. Most people have no real idea what costs are actually covered by their policies because they are so complex. And the whopping bottom line remains—we have the most expensive per capita health care system in the world with the worst results in the developed world. Yet this is the system that is being defended by the brainless mouthpieces on right-wing radio and television. This is not the best we can do.
How bad is our system? Well, the American Medical Association estimates nearly 1000 people a day die from mistakes made in our state-of-the-art hospitals. Die. That’s not a problem. That’s a tragedy. The FDA approves drugs for wide use and promotion on television that kill people. Vioxx anyone? Last year my mother-in-law was hospitalized for four days. She never saw the same doctor twice. Instead a team of hospital-based doctors strolled through her room cluelessly looking through paper charts muttering questions about the previous doctors’ prescriptions. Their big achievement was completely disrupting her blood sugar levels that she had spent years controlling. She was released but never was able to get them under control before she died nine months later. Our current “system” is polluted with toxic self-interest at every turn. And the competition of competing self-interests has not produced high-quality low cost care, but it’s opposite—low quality, high cost industry. And the answer is not some medical version of the post office, an expanded Medicare system or a mish-mash of compromises of special interests. To re-invent the system we must revolutionize it.
First we begin with the premise brilliantly articulated by the philosophers who inspired the American ideal of life, liberty and the pursuit of happiness. The father of moral capitalism, Adam Smith, argued that the purpose of any economic system must be to maximize human benefit, to maximize the quality of life for the most individuals. He opposed slavery, child labor and all forms of economic exploitation. Jeremy Betham proposed that the best society was the one that created the most opportunities for happiness. This means that as governments form to promote public policy they ought to be focused on reducing avoidable suffering. That’s a big idea. Reducing avoidable suffering. And history is clear the most efficient way to do that is to empower individuals to be self-reliant by eliminating or controlling special interests, powerful cartels and a monied aristocracy while providing a public and private infrastructure of education, transportation, electricity, technology, access to capital, and yes, health care. This doesn’t mean the government has to provide these services; rather, our government needs to provide a system of enforced laws that prevent the powerful from manipulating and exploiting the middle class and the poor and provide infrastructure when the common good is served.
An American version of universal health care should:
- Make each of us responsible for our own health care up to 3% of our household income each year. This responsibility will reward healthy lifestyles and promote service providers like Minute Clinics and keep us personally responsible.
- Make all citizens part of the 300 million member group that dilutes individual catastrophic health care risks across our entire society. We need to be committed to our common good.
- Tax harmful habits, food and beverages so that people who consume them contribute more to health care.
- Create a non-governmental non-profit citizen co-op to manage health benefits whose employees are highly bonused to create six-sigma quality service.
- Radically increase the number of nurse practitioners and physician’s assistants to lower the cost of routine care. Increase incentives for preventive care and eliminate incentives for redundant, wasteful testing and lab work.
- Bring the cost of all prescription medicine to be no more than the average paid across the 20 most developed nations.
- Eliminate the strange connection between employment and health insurance. It’s both bad for business and traps people into jobs they don’t want. It makes us less competitive internationally.
- Allow and encourage a competing private insurance, private hospital, private doctor system to spring up so that no one can claim health care is rationed. That is, anyone who chooses to afford extra tests, extreme measures and other services our society cannot afford should be able to get it on their own terms.
Obviously these are broad ideas, but they serve as a framework for common sense thinking about American health care. Meanwhile, what are we likely to get? Most probably a hodgepodge of deals and compromises that enable the medical aristocrats to continue to make billions of system inefficiencies while ignoring the real opportunities for healthy change.
Our mutual quality of life depends on more of us understanding that the most important things in life are more than the sum total of commerce. Health care and commerce are simply not ideal partners. When we try to make it so, corruption is the sure result. This is what gives capitalism a bad name. We need bolder leadership. Moral vision and clear ideals. Frankly, regarding health care we need to go back to the beginning and start all over again.
The government needs to fix the countless number of other Consumer protection agencies which are complete failures and money pits before it adds another in the form of Health Insurance. The solution to making life economical on all levels of existance in our Country is to abolish all government which arbitrates. Until the full government budget is put on the internet the private sector shouldn’t be required to pay another tax dollar!
Will presents many good ideas for health care reform. I too am very angry as should all Americans be. Nobody’s health care is safe-insurance companies can cut you out or make the cost so high it is unaffordable.
We need to get special interests out of the debate. Why should insurance companies, pharmaceutical companies and the legal lobby determine our health care? These interests do not just influence health care legislation-they actually write the bills. We already know that they will always act to increase their profits.
The big question is: How can individuals overcome the powerful influences of corporations and their lobbyists? I have contacted my senators and representatives, talked with everyone I know. But how can we win over the power of campaign contributions? The cost of elections is so high and congresspeople need the special interest money to get elected.
What can we do to overcome this? We need a massive populist movement and we need it now. If we do not act now, we will never get adequate health care for everyone.
Fixing health care really isn’t that hard if your intent is to truly be of service to people and not just how you can maximize profits. Just model it after fire departments and fire insurance. My local fire department doesn’t care if I have fire insurance, it provides service without questions and I pay for it with my taxes. And I think they are are doing a hell of a job! Oh, and by the way, another name for their service could be, “Single Payer Fire Care”, and nobody seems to be having a problem with it. Yet, I still buy fire insurance. Why? To help me out with the effects of a fire, rebuilding cost, etc. And that would be the same reason I would buy health insurance, to help me out with the effects of an illness, like lost wages, etc. NOT IT’S CARE. Just extend an improved Medicare to everyone from the President on down, problem solved!
Will, about two years ago I stopped believing in your version of the “American Dream.”
You have it SO wrong. There is no “right to health provided by the government.” People created the government; wealso create our health. There is a personal responsibility for one to stay healthy in order to be a productive citizen. If one– most people– know that “S_ _ _ Happens,” then knows to be prepared and get insurance from a private company that cares about your interests. Keep the government out. Many people (note I am not sayingg citizens) take advantage of government give-outs instead of exercising and eating well, I think. Why should “the government” support these people? WHY!?
If people do not want to take the EFFORT to “pursue happiness” perhaps they should look elsewhere for a place to live, or go back to a government reeducation center and learn how this country works: it’s not might makes right, but self-reliance. Stop crying. This is not Nirvana. A hospital aspirin costs $40 and a brief ambulance ride costs $1700 because there are so many people who soak the government-infused system, causing others like me to note only pay for my family but theirs as well.
You go deeper and deeper into bashing Republicans as the months go on.
Before you submit your comments, you should re-read what Bill has to say. Not everything is perfect, but the majority are solid ideas. Unless your job hinges on the status quo of the insurance industry, (and you therefore have that agenda to keep your useless job) you seem to have missed most of his points.
More of the same (if everyone were required to get a disease care plan) would only spread the problem wider and deeper. The main reason there is a broken system now is due to the “for profit” nature of the insurance companies. They keep taking a bigger slice of the pie and blaming it on something else.
The main reason there is so much confusion about the issue is that people are believing the public relations spin about insurance. When the public relations companies hired by the insurance industry tell you (covered as “news”) that premiums are high because others don’t have insurance, wake up and realize that this is public relations spin, and crafty salesmanship. It is also an outright lie. Anyone who parrots these lies is a fool, or is scared of losing their job within the insurance industry.
You are not Republican bashing…
It just seems to keep happening that when one really studies an issue currently being debated rather than simply listen to the radio/tv blame mongers we see that certain sectors regularly create a partisan argument rather than solutions.
Their goal often is to maintain the status quo and the corporate cash-flow (but the people who repeat their bathering don’t even get it) at the expense of logic and real thoughtful attempts to move the society as a whole forward in a successful manner.
Anyone who doesn’t recognize the healthcare cost and mess to our society must not be paying attention. Perhaps it is a case of “I’m okay and it doesn’t matter about anyone else”. Medicare has allowed people that attitude, because that ‘gov’t healthcare’ has solved THEIR problem.
It is so frustrating……………..
The responding comments to Will’s post reflect why we are having so many problems with getting something done about controlling health care costs and making health care affordable to everyone.
This country has divided itself by putting labels on people: Republicans/Democrats, Conservatives/Liberals, Various religions/agnostics, etc. Enough! Let’s stop the labeling, start working on commonalities and solving issues that concern us all.
Regarding health care, until you or a loved one has a health issue; you may not realize all the problems that exist with our present system. But some day you will have a major encounter with health care then you will understand. We need a system with reduced cost and more efficient operation.
And, yes, everyone needs to be covered because eventually everyone needs health care. Free care is ultimately paid for by those who pay out of their own pocket. If you have employer paid health care, you are dependent on that job.
No matter how well you take care of yourself, you will still eventually get sick (everyone succumbs to something and you can’t control genetics). Some of the most preventive-oriented people I know have encountered serious health problems. Prevention is only part of the solution. And prevention results in people living longer and they will eventually have health care issues related to advancing age. Do you know anyone older than 80 that has had no health issues?
Let’s work together, find ways to cut costs while providing good care, and make sure that people do not lose their homes and livelihoods because they can not afford the health care they need.
This is a moral issue as well as a social one. You can’t wall yourself off by saying you will take care of your family and let everyone else fiend for themselves. This attitude will come back and haunt you at a later date/age.
Instead of criticism and name calling, let’s all get deeply educated about health care. Did any of you see the Public Broadcasting (PBS) special on Frontline in April of 2008 called “Sick Around the World”. If not go to http://www.pbs.org/wgbh/pages/frontline/sickaroundthe world/.
Then another great source is Bill Moyer’s Journal on PBS starting on May 9, 2009 and going through July 24th. A series of programs on Health Care Reform and very informative on all the real issues which Congress and the President seem to be keeping to themselves.
Why has the World Health Organization rated the U.S. 37th in terms of quality and fairness in health care (France is #1)? Why do we have administrative costs of 25% and France who is ranked #1 above only have 3% admin costs? France has 100percent digital record keeping, we are years behind in this technology. Pharmaceutical companies spend more on marketing than on R&D.
There are many successful healthcare models around the world (see Sick Around the World above) but yet here we have Congress and the special interests tinkering at the margins of a system that needs fundamental change. Successful national systems have settled on one model for everybody. This is fairer, chaeper, and far more efficient than our badly fragmented crazy-quilt system.
Let’s not be among those that say that anybody who dares to say that other countries do anything better than America is liable to be called unpatriotic. We have a lot to learn in this area and there are lots of examples to learn from. We don’t have to rush like Congress and the Pressident are now but we need to start transformational change of health care for all.
Steve’s post on 7/27 is excellent. The Bill Moyer’s series presents different viewpoints. There are multiple websites describing and rating the health care systems internationally. Using multiple sources is the best way to find out the facts.
Perhaps, Will, you could post this info and/or provide links from your website.
Regarding French health care, I had a friend (Now deceased from breast cancer. She lead a very preventive lifestyle regarding diet, exercise and preventive care.) who had to go to the ER while vacationing in Paris. She said she had only a ten minute wait, received excellent care, physicians contacted her US doc and the bill was zero.
Such crooked approaches from those are presenting us!
How can we debate logically and orderly to anyone assuming that he/she does not have the basic understanding or ability to prioritize? On the other hand, could we be dealing with people whose have severe corrupted minds and ferocious hidden agendas? Make no mistake, they seem acting as if they determine seeking for solutions, but aiming at the wrong target in time of the real debate. They have neither real nor genuine efforts resolving the problems head- on instead of creating lots of noises. What a cover up that is! They know how to tick us off and where to push our button. It just makes us more frustrating and crazier all over again. That is why we are kept writing to voice our comments and I am no exception. There is so much talk but no action at any level either constructively or effectively. As we all know “The do don’t talk and the talk don’t do”. The health costs are out of control and problems occur in many directions. Therefore corporations are lobbying very hard to pass it onto the government. They have made health issue is one of their top agenda for cost cutting and free from their obligation. They have created many crisis by shedding jobs in US and continued running the show for the sake of $$$$$$$$$$ regardless the existence of others or country. I am not an expert but just a concerned citizen like most; therefore I would like to contribute a few notes here:
1. Priority
We are in the great recession and experiencing the horrific jobs loss across the nation. So we need to focus diligently on the job creation and make it our 1st priority. When a person has no job then he needs to find work to feed his family and himself first before thinking of remolding his broken house. Broken healthcare or broken home in this situation is the same during this crisis. It is very clear, isn’t it? Job provides health insurance and so the rest. No bail out needed as well as unemployment checks. Jobs are steadily shredded. There is no sign of stopping and when it will be enough. Just look around you.
2. Planning and budgeting
Cost is associated with head-count. Legal and illegal issues need to be addressed. There is no way around it. Do we really know how many people and who they are in this country? How could one find the solution at this scale and expect to be successful in reforming health care and dealing with many major problems? Everything is interconnected like a chain link. Emergency services are shrinking and operated at the huge lost due to unaccountable and unrealistic laws. Under this law, emergency rooms “hospitals” are obligated to treat to anyone regardless of citizen status. Well the cost is not simply disappeared like magic but it is passing onto insured patients, insurance companies, state and federal. Nonetheless we cannot plan unless we know exactly the number of people, the cost and the source of money. Stop debating on money issue, planning and budgeting are first and required to be deal with in an order and thorough manner. If we don’t have the courage to deal with the root of the cause of falling health care, then we are doom to our death. Same goes in dealing with education and many others that are crippled this nation by minute. Sadly truth we cannot build until it’s being destroyed or “broken”.
3. Unethical practices, endorsements and charges from physicians and hospitals
It is all about “Greed” and everyone loses. Needleless to say since there are so many of these kinds of people whom are not only bold, fearless and unlimited demanding for wealth.
4. Set a standard
For annual check-up/visits, the charges are varied even with an identical common practices or minor procedures conducted by a regular doctors or hospitals. For complicated issues, specialists are deserved to be paid more. It is justified because of their knowledge and skill level. I do not mean one price fits all concepts, but it is time for correction, and the insurances can handle this issue better than anyone.
In sum, enforcements are the real solutions and no need for wasting time for more rules and regulations which will be broken in the end since many people want to break for the sake of their own interest. Unlawful people will not obey any rules so why we need to create more so rules so they go on breaking. What an illusion! We’ve heard about the games people play but no one has ever thought about this game. This game has a distinctive model “non-stop playing and no winner”. There is no end to it. One continues making for others go on breaking around and around in a circle. What a “Genius” for being destructive and causing a distraction to fool people. Very effective indeed!
1) Remove lawyers from the process.
a) Eliminate frivolous law suits and penalize those who
introduce them.
b) This would substantially reduce the cost of malpractice
insurance!
2) Eliminate politicians from all aspects of health care reform.
They have way too much at stake and are too far from the
impact of their decisions.
3) Involve those that actually provide the care, such as
Respiratory Therapists, Nurses aides, Nurses and other
allied health professionals.
4) Change from reactive system to a proactive system. ie
promote wellness.
5) Increasing the number of PAs and NPs would require;
a) Making the education affordable.
b) Creating fast track programs that allow Respiratory
Therapists and Nurses with several years of experience
to transition to PA or NP.
6) Practice evidence based medicine. Empower, those
providing care to do so without having to contact the
physician at every turn. Treatment protocols have
demonstrated and increase in the quality of care while at the
same time reducing costs.
7) Eliminate regulatory agencies such as JACHO and Medicare
which do little to increase the quality of care but drive up
operating costs.
Simply stated let the business of health care occur with the goal of providing efficient, affordable quality care with as little government involvement as possible.
cd
Some very good ideas Charles. However, getting rid of lawyers and politicians, albeit a great idea, probably isn’t going to happen since they are all so intertwined with each other and all the special interests involved in health care that they are inseparable.
Has anyone wondered as I have, why none of the politicians in Congress has mentioned anything about maybe how all Americans might get access to the same healthcare program that covers all of them? And why is it that the most successful healthcare programs in countries around the world are all single payer programs and yet again our people in Washington aren’t even considering that method as a possible choice?
There is total lack of transparency in this so-called healthcare reform process being carried on behind closed doors as usual by our dimwitted and openly for sale senate and house members. This sure meets the definition of insanity - keep doing what you are doing but expecting different results.
All the facts and information and smart people are out there to do this healthcare thing right for the benefit of all the people but if they are all locked out and blocked out of the decision process, as we basically are also, then who knows what kind of bigger and more costly and less effective mess we will get stuck with.
You’re so right that “Most people have no real idea what costs are actually covered by their policies because they are so complex.” I once knew health insurance policies well–so well that I confidently wrote articles on health insurance for national magazines years ago. But after drowning in policy addendums, I lost interest in even trying to keep up. I just threw up my hands and started shoving the addendums into my files, hoping I could locate and decipher relevant info on my own Blue Cross policy when needed.
I appreciate the 8 points you outlined in your article, Will. And re #7, readers may want to consider Matt Miller’s ideas on employer-sponsored health care from his book The Tyranny of Dead Ideas.
To start with, I continue to be enamored with Will’s idea of creating what we can have rather than keep trying to “fix” what’s wrong. There aren’t enough band-aids in the world.
The U.S. Constitution went into effect on March 4, 1789 and just 205 days later, Congress proposed the first 10 “amendments” (a.k.a. The Bill of Rights) to it. I was unable to find even an estimate of the number of federal laws that govern us today but rest assured, we’ve come a long way from the 10 Commandments.
So we have a long history of tinkering. We’ve had only 27 amendments: one was repealed by another just 13 years after it was enacted (prohibition) and another took 203 years to be enacted. I fear, Will, that we shall never see the courage and consensus necessary to scrap something and start anew as you suggest. Why annually, it takes some 9,000 earmarks (or deals) to be added to the budget before it gets approved. For heaven’s sake, that’s almost 17 “fixes” per legislator.
It wasn’t that long ago when my similar hopes were dashed (along with Steve Forbes’ presidential candidacy in 1996). I thought that just perhaps, Americans would come to their senses and stop tinkering with the 13,458 pages (according to the US Government Printing Office) of the Internal Revenue Code and adopt a new simpler tax system. Every time a candidate makes it part of his campaign, they don’t even make the finals.
Why would Healthcare meet any better fate? Is it less controversial? Listen, it took thousands of lawyers hundreds of years to get us here and it would take a violent revolution to get us out. The ubiquitous media has polarized almost every issue you can think of. (How can NEWS be conservative or liberal in the first place? Isn’t it the same news?)
Will, the best you can hope for in this world as it is today, is to have an impact, to promote ideas, to raise awareness, which is what you are about anyhow, isn’t it? I haven’t seen your name on any ballot lately.
I said in one of my earlier comments that I think we Americans get what we deserve. There are so many great ideas out there on countless issues. Haven’t you ever watched a program and said to yourself “I sure hope the powers that be are watching this?”
We’ve all seen shows about successful ideas that actually work. There’s no lack of examples and solutions already working. Just recently there was a segment of “Black in America II” about a successful school program for young black children that WORKS. It’s got a $40 million budget, the majority of which is privately raised. They absolutely erased the so-called “gap” between minority and white students. (Interestingly, all the kids wore uniforms…it looked a lot like the Catholic School I went to 55 years ago.)
On 12/7/41, our nation came together for a common cause and sacrificed, worked and bled for four years. On 9/12/62 JFK chose “to go to the moon” and on 7/20/69 we did, and a proud nation watched in awe. On 9/11/01, we were again brought together in a unified spirit. But unlike the past, this unified spirit had no staying power. In short order, the nation began bickering about the reasons we were attacked and the appropriate course of action.
We have become a FEDEX world, expecting everything to be delivered overnight. If it isn’t, well then, let’s move on.
So I’ll tilt at windmills with you Will, and hope and rail with our hair on fire. One truth emerges: You CANNOT expect a broken government to fix a broken healthcare (or tax, or educational, or judicial) system. To fix this healthcare mess (or the other messes) you’re going to need better tools and better mechanics than our messed up government has.
[...] Outraged at the Politics of Healthcare [...]
I couldn’t agree with Werner more: You CANNOT expect a broken government to fix a broken healthcare (or tax, or educational, or judicial) system. To fix this healthcare mess (or the other messes) you’re going to need better tools and better mechanics than our messed up government has.
It is amazing to me that 535 people (count them in comparison to the populaton of the US) have the authority to change such a vast, complex system and We The People are forced to sit back and watch their politicing as usual and take whatever they give us - like it or not. I say sit back because these folks sure aren’t listening to the people. These people stand to gain much from this bill. A bill they don’t want us to see - so much for the “promised” transparency. In a country with vast technology, brains and the fortitude to put a fantastic health care plan in place, we stand at a crossroads to do something right and not on Obama’s tight deadlines. My gosh - do it right for heavens sake-what is the all fired hurry? But will we? No, because our elected officials want it their way, for what they stand to gain and to heck with us AND they want to give Obama what he wants. As I recall these folks serve at the pleasure of the people…they work for us…not him. They get the insurance they want and we get hosed. Wake up people - let your voices be heard.
[...] to blend personal responsibility with citizen lead social responsibility, see my other posts: Outraged at the Politics of Healthcare and Will Marre’s Radical Solution to Health [...]
[...] I have stated months ago, as well as many great comments from the rest of you, (see Outraged at the Politics of Health Care and Will Marre’s Radical Solution to Health Care) the fundamental problem with a financially [...]