Simplifying the Health Care Debate
I have had a lot of friends ask, “What the heck are they talking about?”
Health care, even for physicians like myself, is a very complicated issue. There are so many intricacies involve, many that our political leaders don’t comprehend at all.
1. Universal coverage.
This is a moral issue for many, including myself. I don’t think health care is a right, but many do. Fine. In the end, most of us want everyone to be able to afford health care insurance if they want it.
Obama and the Democrats would like you to believe this is the hard part. They are wrong. Anyone can solve this part of the equation. Write a check, and it is done. It is extremely easy to cover everyone; either you provide a socialized care system, or refundable tax credits with a mandate to force people to buy insurance. The problem is solved.
Of course, there is the question of cost (anywhere from $1.2 Trillion -$2 Trillion, depending on whom you listen to). But cost has never been an issue for this Democratic President, has it?
2. Cost control
This is the the really, really hard part.
This is a multifaceted problem. Insurers have not been able to responsibly keep cost increases down. Physicians order too many tests. There is too much litigation. And patients demand too much.
Here is the bigger problem: of the above issues I describe, NONE of them are really being discussed in the halls of Congress. Why? Because each has solutions, but those solutions are painful…and politicians do anything to avoid pain. This includes the President.
Right now, Democrats would have you believe that a public option would magically solve these problems. It would solve the universal coverage problem; I think everyon admits that. But no one, including Barack Obama, can explain how it would answer overall costs, which is the big enchilada.
Mr. Obama continually says that the public option would create more competition that would drive insurers to reduce costs. This is, in my mind, ludicrous. There are right now 1,300 or so health plans that are competing. You really think a public plan would dramatically increase competition?
There is a bigger problem. Let us say that they do compete. The private plan cannot compete with a government plan that has a virtual monopoly, has a tax advantage (they don’t pay taxes; they are the government, after all, and have no intent to make a profit)….in the long run, private plans simply will disapppear. Profit margins right now are slim…what do you think they will be with this?
The other half of the cost debate is where is the new funding for this extra coverage going to come from. Democrats would like this to be budget neutral…and they can only do that with massive new taxes. And unfortunately for them, taxing the rich won’t be enough. Democrats will have to impose a broad range tax increase, likely on all people’s health benefits. That will not be popular, because it will raise taxes on a large segment of people that Obama promised would not have tax increases.
So this is the big picture. Covering everyone, reducing costs and increasing tax dollars. The problem is, they have guaranteed the first part; are not discussing the second; and third part is almost universally despised.
Democrats surely can pass a bill covering all Americans. I don’t doubt that for a second. Whether they can actually reduce health care costs right now seems highly questionable, especially since they are not even discussing the issue properly.
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UPDATE: Obama held his 1 hour infomercial (or whatever the ABC News equivalent is) on Wednesday Night.
Frankly, Obama’s arguments make less and less sense over time. First, his argument was that a government bureaucracy would decrease waste and red tape…um, huh? On top of that, he is using even scarier scare tactics, which convinces me that the is getting more and more fearful of failure.
There were a few pointed questions. Dr. Orrin Devinsky, a neurologist and researcher at the New York University Langone Medical Center, asked the president pointedly if he would be willing to promise that he wouldn’t seek such extraordinary help for his wife or daughters if they became sick and the public plan he’s proposing limited the tests or treatment they can get. The president refused to make such a pledge, though he allowed that if “it’s my family member, if it’s my wife, if it’s my children, if it’s my grandmother I always want them to get the very best care.”
That really gives you confidence in his plan, doesn’t it? A common phrase that doctors use when trying to convince their patients? “If it were my wife, or my mother, this is what I would do.” Apparently the President can’t make that promise. Jake Tapper stated that the President ’struggled’ to answer the question…damn right.
John Sheils, senior vice president of The Lewin Group, a health care policy research and management consulting firm, estimated that up to 70 percent of those with private insurance would end up on the public plan.
Another neurologist, Dr. John Corboy of the University of Colorado Health Science Center, asked the president, “What can you do to convince the American public that there actually are limits to what we can pay for with our American health care system and if there are going to be limits, who’s going to design the system and who’s going to enforce the rules for a system like that? “
Obama, however, didn’t directly answer the question. Once again, avoid the toughest question, Mr. Obama.
“There are a whole series of ways that we could design this,” the president said, arguing that employers would be given a “disincentive” to shift their employees to the public plan.
Numerous people asked Mr. Obama how he would pay for the plan. He gave no specifics, and criticized CBO and other organizations that discounted his prevention plans and health IT effects on decreasing costs. Of course, there is no proof anywhere, in any scientifically researched way whatsoever, that either would reduce costs. But as long as Obama believes it, it must be right, right?
Additionally, Obama came off as heartless when the talked to a woman about her 100 year old mother.
Jane Sturm told the story of her nearly 100-year-old mother, who was originally denied a pacemaker because of her age. She eventually got one, but only after seeking out another doctor.
“Outside the medical criteria,” Sturm asked, “is there a consideration that can be given for a certain spirit … and quality of life?”
“I don’t think that we can make judgments based on peoples’ spirit,” Obama said.
If a Republican did that, he would have been burned at the stake (although ironically I agree with him).
Ultimately, I think ABC did a pretty pathetic job. And that is being polite. There were at least a few tough questions, but I still would have preferred some conservative political voices. Others there did raise valid questions. Below you can see the breakdown of the ABC audience…not exactly representative.
But Mr. Obama did nothing to bolster the public support for his plan. Maybe instead of pushing for more media outlets, he should actually work on the nuts-and-bolts of the plan itself. When push came to shove, he could not answer how he would pay for it, what he would restrict, how he would determine how to restrict care; basically, every important question. And most important, he wouldn’t even promise that his own family would be taken care of under the plan he is proposing…which should make every American fear this public option.
By the way, appareantly no one saw this infomericial.
TheCato Institute has a great article comparing different worldwide systems, that can be seen here.
And Michael Ramirez of IBD...genius:
rightly said hair loss is a common problem and even difficult to deal with. Vitamins are good if taken care to prevent hair loss. even there are other methods for hair restoration, these days different techniques are being used for hair loss.
I refused to watch the state-run infomercial on ABC. In fact, I may never watch ABC again…including The View! With that said, I totally agree with you in that the problem doesn’t lie within the insurance companies, it lies with the doctors over-prescribing and over-testing and more importantly, with changing the public attitude that you don’t go to the doctor with every itch, scratch or cough. Obama isn’t addressing the real issues, as you said. They could start putting limits on these types of visits and make the customer pay for the excesses. Then the ones that abuse the current system can be the ones to pay for it. We, the people have put ourselves in this spot with all of our abusive visits to doctors and hospitals. Take the 9 people in AZ who went to one hospital over 2000 times in the course of 6 years. This sort of thing must stop in order to control costs. The insurance companies are trying to cover a nation of irresponsibles and make a profit in order to stay in business and pay their employees. That seems to be disdainful to the Obama administration. On the topic of drugs…why not make them more affordable? Why should 1 pill to end a migraine cost $27? Let’s put some limits on the price of a single pill. But, big pharmaceutical is in bed with Obama. Our country is very broken…..sigh.
It’s laughable how everyone keeps asking how we’re going to pay for it. You’d think the federal government was broke. It’s not. Its spending priorities should to change, but we can probably afford this without raising taxes. Retooling Medicaid and Medicare to fulfill this purpose is a good place to start.
Public support for this proposal is already here. You think we have a choice in coverage now? Unless you’re exceptionally wealthy, you take the health coverage your employer offers to you, if you’re lucky enough to get a job with health benefits, regardless of what it costs out of your own pocket or what it covers. THAT’S the reality. Anyone who thinks the middle class has a choice about what health coverage they get is smoking something. All of these arguments seem to be coming from physicians, hospital executives, and insurance companies who sleep every night on big piles of our money and don’t have to worry about making a choice between buying groceries and paying their doctor bill. Isn’t it wonderful to become wealthy from human misery?
Honestly I was disappointed in Obama’s forum last night, he offered nothing new and as you said answered none of the questions. Hes reverted to the same scare tactics that he often accuses of Republicans stating that the cost of inaction is too great. I don’t disagree that the long term cost of inaction is indeed bad, but where else have we heard this same tactic? Obama’s stimulus bill that promised to keep the unemployment rate below %10? It is now pretty clear this won’t happen.
Look, everyone understand something: I am for universal health care. And I believe we need reform. But Mr. Obama and the Democrats, just like Hillary in 1993, are screwing this up. If they took a moderate bipartisan approach, and were willing to take on the tough questions, they could easily get a bill.
Considering all the changes government has given us thus far I don’t trust the league of self serving lawyers to help us in any way whatsoever. We have programs now which cover people. We need tort reform. We need to cap lawsuits which make lawfirms wealthy. We have the trial lawyer lobby running the country but when do we hear about the damage done by ‘big attorneys’?!? We won’t, see the credentials of nearly every elected official in the Congress and Senate to see why… they take care of their own as they write legislation.
As a proud purveyor of abortion at any time or place our ‘dark lord of the vacuum’ has little interest in life, spirit or anyone’s well being. Make no mistake folks this is all about him.
There is plenty that is broken that can and should be fixed before we ever start a new catastrophically expensive program.
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I was in health care for about 36 years and saw health care change over this time. It is higher tec now but cost are out of control wast is a way of life in health care to the point people who deliver health care no longer see it.
Cost is a major problem we in the US spend over 17% of our GDP for health care but we are rated well below Europe and Canada in outcome who spend less than 50% of what we spend. How do they do it and can we? Well Yes and we can save maybe 1/3 will little effort and improve outcome with this cost savings. Below are a few changes which will save large amounts of money and improve outcomes.
Stop (make illegal) for any health care giver to charge different amounts for the same service to different people — Yes this happens ever day. It is like everyone at Walmart paying a different price for a bottle of Milk. There is no question this is unfair.
Have every one in health care post cost so you know the real cost before you buy.
Insurance and Manage Care etc cost about 1/3 of the total health care dollar spent, what other business does such a bad job with addministrive cost? None it should be caped at about 5% which is what Canada pays. Look at the facts sence Manage Care has been in the picture cost have go way up not down and most of the money has gone to them. They are the one biggest problem.
We need more MD, PA, RN and others — alot more — our education system is in the way and holding back the number of new MD coming out.. enough already. we pay for this with tax now is the time we should get our money worth.
Laws need to change as to gate keeping of Rx and other care. Many Rx which are safe (and there are many) need to be controled by PA and RN not just MDs. We need at least 3 clases of Rx MDs can Rx anything, PA and RN should be able to Rx a large number of treatments without MD contol. Some drugs should be controled by pharminist and many more safe drugs and treatment should be OTC. Such safe devices like CPAP should be OTC. Often it is not needed to go to an MD to get what is needed.
All health care providers must post there price for any service so anyone can price shop before the service is given.
All info about all health providers should be on line so you can see what you are buying before you buy. Things like outcomes. what they do and how many, and cost.
All medical records and the like should be on line so you and your MD etc can see everything that has been done. This will keep us safe and stop doing test etc twice or more times. This is easy to do why has it not been done?
Anytime any Governemt spends any money for any type of health care or health care product it should go up for bid… common sence but we do not do it now.
Do these simple things and much of the health care cost problem would go away. All other parts of our ecomony do most of this now, and things like this are done in other countries who have much better outcomes than we do in the US.
The Obama health care plan is a fiasco that even the Democrats themselves can’t understand. Bottomline, nobody should be given a free ride. Make low-income people pay–something. The rich will get soaked, the middle class will get to bend over and grab their ankles. Can we move on to the Cap and Tax climate proposals to increase joblessness? The GOP will sweep into power in 2010 & 2012 because the Democrats will realize (belatedly) that the government cannot be the end all for societal woes.