The Quest For Quality Health Care
Michael Ramirez, IBD
I have heard Democrats continually scream that the rest of us (who in their eyes are generally evil or ignorant conservatives) lack the moral compass to want universal health care at all costs.
They are right.
I don’t want universal health care at any cost. I frankly almost want nothing at all cost. This is apparently a line which the Democrats are willing to cross: they are not concerned about quality, but only quantity (i.e. universality).
I say, you can have both…but not without some cost.
Ted Kennedy has an intriguing editorial in the most recent edition in Newsweek. In it, he says the following:
Now I face another medical challenge. Last year, I was diagnosed with a malignant brain tumor. Surgeons at Duke University Medical Center removed part of the tumor, and I had proton-beam radiation at Massachusetts General Hospital. I’ve undergone many rounds of chemotherapy and continue to receive treatment. Again, I have enjoyed the best medical care money (and a good insurance policy) can buy.
He then goes on to say how everyone should have this level of care…without understanding the reality. For example, the 5 year life expectancy for someone with a tumor like his is around 10-20%, depending on whom you talk to. So you don’t think some bean counter somewhere is going to figure out that it is more cost effective to let these people die, than spend the approximately $100,000 it cost for the surgery and after care? And then he talkds about proton beam radiotaion. There are very few of these centers around the country, because they are massively expensive. For example, some investors considered building one in Columbus, OH, my hometown, but have since reneged. Why? Because without massive funding, primarily from private insurers, such endeavours are never going to solvent.
So, it is nice that people like Senator Kennedy can get access to these types of treatments; and with specific exclusions for Congress, I am sure even after Obamacare is passed, that they will have access to top notch care. There are limited number of dollars in the system, and once the system goes broke, major cuts will arise. And that will force rationing. So whether the rest of us have the same access is highly doubtful.
The reality is, under the Democrats’ current provisions, the care that Mr. Kennedy received for his brain tumor would be reserved for the priviledged few.
Then there is the Mayo Clinic. Obama has used Mayo as an example of how to give top notch care, while maintaining costs. Obama continually points to the Mayo Clinic as a beacon…a standard to point to. So what does Mayo think of Obamacare?
Although there are some positive provisions in the current House Tri-Committee bill – including insurance for all and payment reform demonstration projects – the proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite.
In general, the proposals under discussion are not patient focused or results oriented. Lawmakers have failed to use a fundamental lever – a change in Medicare payment policy – to help drive necessary improvements in American health care. Unless legislators create payment systems that pay for good patient results at reasonable costs, the promise of transformation in American health care will wither. The real losers will be the citizens of the United States.
Again, here is Mayo Clinic, which generally stays out of political fights and thus is a fair and nonpartisan voice, stating what is obvious to many of us in the health care industry: the current policy initiatives by the Democrats will neither provide cost controls or elevate the level of quality of health care.
Mayo actually reiterates what I have been saying for a long time. Any real reform of the health care industry must be focused on patients and results. The Obamacare program, so far, only focuses on one issue: money. That is why we are in the trouble we are in today…everything has focused on money in health care, instead of producting high quality results.
I go back to my initial proposals, which can be seen here. For high quality, with cost controls, we must enable doctors to achieve best standards, that are established by the best scientific knowledge we have. We should have a system governed by science, that ultimately allows the system to pay for treatments that are cost effective and work. However, patients ultimately should have choice; but if their choice lies outside the confines of what we determine are best medical practices, then the patient, and the patient alone, should be responsible for the costs involved. Is this a type of rationing? In a sense it is. But we need to be realistic. We cannot afford to pay for every patient’s whim…we can barely afford what care we really need and require.
Another step is malpractice reform. No one can put a specific dollar amount on it, but the amount of money we waste on defensive medicine in this country is staggering. Every other country in the world accepts that you can’t test for everything. There are standards for which tests are necessary, and which are wasteful. But doctors are frightened not to test patients when they ask, because the threat of a lawsuit looms. Tort reform is the first step, and not the last one, in changing that culture in this country.
And here is my most controversial proposal. We spend 25-33% of our health care dollars in the last years of life. That has to end. But how to end that costs? Surely, almost none of us want our government to tell us to ‘pull the plug’. The concept I and others are pushing (Democrats and Republicans, mind you) is called Shared Decision Making. I and others have proposed that every hospital use their ethics committees (and every hospital has one), and in some way form a group that will help determine when and if costly procedures are worthwhile. Obama got attacked for a comment he made several months ago, questioning if an 80-something year old should be getting a hip replacement late in life. But Obama was right…I have seen hip replacements on 98 year olds. That simply does not make sense. By getting a group of doctors in each community comming together, and with the voice of your own doctor as an advocate, we could come to some rational decisions on what should and should not be paid for by the health care system. President Obama had a similar comment..except in his world, the decision would NOT be made by doctors, but by Washington paper pushers:
httpv://www.youtube.com/watch?v=8WnxsuVqSo8
Now, one caveat…if you wish to personally pay for your care, go right ahead. Elective procedures (non-medically necessary abortions, for example?) should be out of pocket expenses. Personal choice ultimately wins out. But the health care system should only be responsible for that care which is deemed cost effective and productive.
Ultimately, the only solution in health care that will work is a model where individuals are given leeway in choices they make. That is the major factor so far missing in the Democrats health care bill, which takes far too much power from the individual and passes to the government. The system should pay for those treatments and methods that are considered cost and result effective…all else, ultimately, will have to fall on patients. Individual responsibility comes at a price.
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UDPATE: It looks like Obama is backing off his August deadline ultimatum. Additionally, Congress appears to be slowing things down, cancelling a second comittee meeting in 2 days.
Obama further damages his claims of transparency, blocking the freedom of information act from finding out which health care executives visited the White House.
You want proof the Democrats are not creating a high quality health care system? Just look at all the Congressional exemptions preventing them from having to use it. The most recent Congressman to flub the question is Rep. Jerry Nadler (D-NY)…who basically admits that he will NOT use Obamacare. Anyone who supports the current mess in Congress should be asked that question until your face turns blue…and I ask everyone to ask their own Congressman that question. If they won’t accept Obamacare, why should you?
httpv://www.youtube.com/watch?v=NOvncXY0X4w
And you want to prove taht Obama is more concerned about liberal ideology than quality health care? Some of his supporters slipped in a provision (eventually fought off by Republicans) that would have widened the latitude lawyers have to file malpractice lawsuits. Scary stuff.
This is the best case to talk about. My part time colleague is from Canada. She had a knee injury for about a month. She had to walk with splint in pain for couple of months. Her Canadian health care system could not fit her in for knee surgery for at least few more months. Mean while she was down here working in Washington. She just spoke to one of the orthopedist and got her surgery with in days. The only draw back that is her husband had to flight down to Washington and drove her back home in Vancouver, Canada. After this event, she is more appreciative of our health care system after she experienced it herself. I think the congress should take a survey from all Canadian doctors practicing in the US about their experiences before rushing into this new health care proposal. I am only worry about the physicians will not take “new patients” if they carry the State sponsored insurance as it happens now with “new medicare/medicaid patients”. Or better, our senators or representatives offices should make calls randomly to physicians offices to make appointment as new medicare or new medicaid patients to see how often they will success. They may be able to see the specialists because specialists are driven by procedures. But for primary care, good luck.
How to cut healthcare costs? Easy – just check who is making the big profits. Then eliminate all the HBOs, insurance companies and all the other big business parasites in their shiny new office buildings who don’t actually treat patients or provide medicines but who are making billions off of the health care of American citizens – or just tax them at 90% to pay for universal health care for all citizens.
Healthcare in the US is controlled by greedy un-regulated (“free market”) big business profiteers like HBOs and insurance companies who are only interested in making lots of money for their bottom lines and paychecks and to hell with stupid US consumers.
The healthcare ‘industry’ is the only one still making billions in profits in this economy.
Unfortunatly, US politicians, on both sides, are controlled by big money.
Most intelligent post I’ve read on healthcare reform. The proposed house bill is a complete disaster and I believe more input is needed from practicing physicians, since I would argue they are the party most effected by any healthcare reform. Under the current bill physicians are taking it from both ends with decreased reimbursements, higher taxes, and greater patient load all while nothing is done about tort reform and the cost of medical education remains ridiculous.
I am Canadian and I just don’t understand the fear of universal health care. I see the one doctor here who said a friend had to wait months for knee surgery. Yes that is true, but then again there are private clinics if you wish to go and get it done right away so please do get all the facts.
Not sure what is scary about you walk into the hospital tell them what is wrong they send me for tests no checking with an insurance company. Again yes sometimes they say hey come in for tests next month or schedule surgery a bit later but no bill in the mail and no insurance company to worry about saying no you don’t need this test. And if I really wanted it done again I could go to a private clinic at my own dime.
As to picking a doctor I have all the choices in the world in picking any doctor I wish when finding a family doctor. So not sure what the hoopla is about that.
As to my costs I pay 33 dollars a month from my cheque and my employer pays the other half of that for my medical. 90% of my dental bill is covered, I pay $150 a year (deductible) for medications and after that it is free.
Our health care isn’t perfect but it certainly is nice knowing I have no worries that I will be taken care of if I need medical attention and that I wont have to sell my house to get it.
What we need is the government to use its power to help lower or cap healthcare costs and turn over all of healthcare to the private sector to manage it. The govt fails with Medicare today, and we expect the govt to manage even more. Just crazy!
One of the problems, R Jansen, is Americans are unwilling so far to have to wait for things like knee surgeries. If Mr. Obama suggested that, health care would die on the spot. Nobody is facing the realities involved with a system like Canada’s.
Why is obama always trying to do things that are for our good? It is not for my good to leave an immense repayment for my children and others. And why is it that congress and the executive branch will continue to have their own health care system?
My question is. Is everyone that is involved in government, federal, state, etc. also going to be under socialized medicine, or will they be able to have their own policies that we the public will continue to pay for?
For those ignorant in the process, if they think the insurance companies make all the money then they are free to not have insurance and pay for the medical procedures out of pocket. I know, fat chance because people like you want things for free or as I say paid for by someone else. You want to reduce health care cost, then stop the law suits.
What ever happened to proving that you’re able to fix one thing at a time before simultaneously breaking 10 things at once!?
I don’t know the answer generally…but Congress WILL NOT fall under these rules. They are exempting themselves, conveniently enough.
Or at least, not make things worse?
US Postal System. Medicare/Medicaid. Social Security. Amtrak. Fannie Mae. Freddie Mac. Now why would we trust the government to successfully run universal healthcare?
Good day all,
I think the statement “One of the problems is Americans are unwilling so far…” gets to the crux of the issue. My experience is that most of the citizens I speak with are very unwilling. They’re unwilling to stop smoking. They’re unwilling to accept a reasonable compensation for a medical mistake. They’re unwilling to pay for what quality medical care is worth. They’re unwilling to face the fact that LIFE isn’t a right, it’s a gift. They’re unwilling to exercise more, eat better and pass on better habits to their kids. Not all mind you, but enough to make problem solving more difficult than it has to be.
I don’t want the government involved in our healthcare process, but I see too many people that say that when they’re healthy and then change sides when they’re sick.
When the citizens DO take responsibility for themselves, this problem will be solved. Until then, I think it’s just politics.
Be well and stay safe all.
Both Democrats and Republicans have it wrong. The polititians, medical doctors, medical universities, scientists are all controlled by big and evil pharmaceutical companies. The Health Care System in all western, industrialized countries is a disgrace of our times and will one day be referred to as the darkest days in medicine. As long as the number one objective of pharmaceutical industry is PROFIT nothing else will count. In fact, the more sick the society gets the more money they make. So, do you thing it is in their interest to find real cures for different diseases such as cancer, arthrities, artherosclerosis, diabetes etc.? Do you know that about 75% of the medical costs are related to the diseases I mentioned (so called degenerative diseases of the old age)? The paradox is that all those diseases can be easily prevented, cured or substantially delayed by excercise, healthy diet and supplements – of course the pharma doesn’t want you to know it. What’s worse, in recent years they started to feel the threat and have been trying hard to destroy the supplement industry.
You want a real health care reform? It can only happen if all the pharmaceutical companies are all turned into Non-Profit, Government-Controlled Organizations. Only then, will they focus on finding real cures, on prevention and on making the society healthier.
I don’t really care about the health care system. My health is very important to me and I will do whatever it takes to be as healthy as I can for as long as possible. I don’t think there are shortcuts or magic pills that will give you optimal health. It means a life-long commitment to a healthy lifestyle. It is not easy, it requires some sacrifices and discipline. It is up to you to a large degree how long you will live and how you will age. It means excercise, eliminating junk food, eating healthy diet, using supplements, juice-fasting (or using caloric restriction) staying up-to-date with new anti-aging research, etc.
At the age of 50 I am as fit or fitter than when I was 25.
EVERY ONE THINKS THEY ARRE GOING TO GET THE SAME INSURANCE COVERAGE AS THEIR STATE WORKER’S THE GOVT. EMPLOYEES
JUST TELL THEM THE TRUTH ( THEY ARE NOT ) AND LEAVE IT AT THAT
DON’T GIVE THEM FALCE HOPE YOU ALL KNOW IT WILL BE LESS THAN WHAT SOME ARE GETTING PRESENTLY HAVING TO PAY FOR THEIR’S
HOW MUCH COPAY IS KENNEDY PAYING FOR HIS OPERATION’S ?
THEN LET THE WHOLE POPULATION KNOW
YES for Health Care Reform. It’s way past time this is addressed to strengthen America again as a world leader. Plus it makes CENTS for the future of our economy to fight the rising costs and wastes. GO USA!
I am so tired of hearing that in Canada we can’t choose our doctor, we can’t get health care when we need it and that is costs me so much.
Time to get your facts right…
I have never in my 40 years of life recieved a list of doctors from my government telling me what doctors i must pick from. (unlike many HMO’s) I can sellect any doctor i like as long as their accepting patients. I can go see my family doctor with an appointment just like anybody else, and i don’t get a bill for it. I can go to any emergency room in any city in canada and get fixed what ever ails me and again… no bill! I can spend weeks , months a year in hospital and no bill. I have had 2 kids for a total of 10.5 days in hospital (in another city than where i live) NO BILL! Went to the hospital for genetic couciling based on family history during our first pregnancy… no bill. We had Amniocentesis test performed for both pregnancies… “seeing a patern yet?” NO BILL. I can go the USA, any state any city and pay for my health care while visiting and when i get home my health care will reimburse my costs (cost deemed reasonable, excessive costs i must pay) in most cases covering 80-100%, not bad!
Does it cost me more? Not sure, I pay 10 – 15% more per year in income taxes over my working career (for the health care). Sounds like a lot, but I don’t have to pay for heath care plans if i don’t want too and i never get a huge bill for an unexpected procedure. How much do you pay a year? Never do i have to decide if my life is worth more or less than my wallet.
I don’t have the government looking at my medical records deciding on my course of treatment, I have doctors that decide that. (again unlike some HMO’s that have a board review and possibly deny care based on cost and risk)
The only real reason why there are hospital waits during peek times is because everyone can use it for free!
When it comes to buying votes few of our Sovereign protectors give a rats tail for the rest of us who will: foot the bills, receive substandard care, observe the inequity of the bean counters discount our loved ones and all the while allowing the privileged and those in our illustrious Government access.
MaObama is doing his best to pay back all of the people ACORN and others conned into voting for him. At the end of the day he and his own are taken care of. He doesn’t need to care. If it bankrupts the nation or leaves our children in debt and destitution that too is not his care. In fact, so long as we are completely dependent on his ilk to help us they will have to make us servants to a government that is supposed to serve the population.
First vote them out. Then take away their benefits so Social Security is good enough for them too. What is good enough for us should suit them well too.
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Then explain to me all the stories of people being denied care. For example, I could use the same technique, and say I have never seen anyone denied care in the US, simply because I personally have not been denied care. Neither claim is necessarily factual.
Thanks for the insightful posts on healthcare. It’s not hard to understand why a healthy 40 yr old Canadian thinks his healthcare system is great. When you don’t have medical problems, it doesn’t matter the quality of care you receive. I also love the Canadians who suggest that if you aren’t happy with the public plan you can just go to a private doctor. The problem: you’re basically paying for two health insurance plans (one through taxes, i.e. “free”, and the other out of pocket.) Here’s a basic rule of thumb that I live by: If something sounds too good to be true, it probably is. Free healthcare isn’t free, and it definitely isn’t quality.
I don’t understand what you people are discussing here. You are all victims of the big pharmaceutical companies advertising relentlessly over the last 50 years. They actually got you to believe that in order to be healthy you need a doctor who will prescribe some magic pills for you. Those pills will make you more sick than you ever were (do you ever listen to all the side effects of the advertised medications?) and in more extreme cases they will kill you. Do you know that around 300,000 people die in North America each year directly from the prescription drugs (side effects, overdose, mixing different pills, pharmacy mistakes etc.)? The so called “western medicine” is the biggest scam of our times – luckily I see some positive changes suggesting the end of this terrible
“medicine” is coming to an end. You want to stay healthy you have to take care of yourself.
We have the best quality healthcare in the world. We also have the most expensive healthcare in the world. Despite these facts we also have one of the highest infant mortality rates in the industrial world. Our disabled have shorter lifespans. If you have the money you can get the care you need. If you have good insurance you can get most of the care you need. If you have some insurance you can get minimal care. If you have no insurance you get the emergency room.
I worked for a major insurance carrier as a fraud investigator for most of my career. When I became disabled, I was allowed to keep my health insurance policy with that company for about $500 per month premium. Within a year I was being bombarded with form after form on which I had to prove that I continued to be disabled. They knew I was on Social Security Disabilty and that I was diagnosed with two terminal illnesses, but still the forms came. Finally one came while I was hospitalized that did not get returned in the required 30 days. Bam! I was purged for failing to comply with the demand to prove my disablity. Noclaim was made that I was not disabled. They had my medical records. I was purged because I failed to fill out a form in a timely manner. If they do it to one of their own, what do you think they do to anyone who is costing more than they’re paying in premium?
We have healthcare for the few in this country and that must change. Insurance companies don’t compete. They trade and share with each other. A government funded competitor would force them to compete for policyholders and it would act as a safety net for others like me who cannot get supplemental coverage because of pre-existing conditions.
Conservatives say they don’t want a government bureaucrat determining what care they get. Well, right now we have civilian bureaucrats doing that and letting people die every day to save another dollar of profit. Health insurers are not struggling to make money, but they are making their customers struggle to get what they have been paying for all along.
It is time to try something else!
Before anyone points to my lifestyle: I do not smoke. My cholesterol is 167. I have allergic asthma due to injury, arthritis due to whatever, kidney disease of unknown etiology and I suffer from Chronic Neurological Degeneration. None of this was caused by my lifestyle. Unless I am being blamed for breathing air in our major cities or being born on a military base. There are health problems in this country caused by lifestyle, but that is also true in those countries with better mortality rates and more accessible healthcare too.
I agree…but I still don’t trust the government.
Ultimately, universal care will only work if everyone is covered equally. Yes, it will cost health people more…but there is no way around that.
I’ve been paying into healthcare since I was a teenager and haven’t used a hundred dollars worth and I’m in my mid-fifties. I have smoked and have not had the best diet but I’m healthy and strong. My young children, however, were both sick with serious life-threatening diseases but are alive today. They didn’t smoke, they didn’t drink, they didn’t eat a high fat, high cholesterol diet. They just got sick and almost died. Our health care system saved both their lives and I suspect that they would have died if not for being born in the United States and in particular Massachusetts where the best hospitals currently exist (not an aspersion to other hospitals or medical professionals.) That’s the way life works out. I’ve had two parents, two brothers, and one sister die from cancer not caused by “life choices.” I’m sick and tired of people and “experts” trying to chalk up everything to things they don’t particularly approve of as “life threatening.” I’m old enough to remember when eggs were bad, then good, then bad, then good, then bad, and I think they’re good again (I’m not sure.) I rode a bike without a helmet and survived! I shot a BB gun when I was ten and didn’t shoot my eye out! I might even occasionally drive my car without a seatbelt fastened! I have a very dangerous job! I’ve lived long enough to piss on the graves of friends that were health “nuts” and dedicated their entire lives to living healthy lives and reducing risks. They got sick, cost other insurance payers a lot of money… then died. That’s life. DO NOT let the government start defining “public good” in terms of life style or we won’t be free. It will be the beginning of the end. No horse riding, no smoking an occasional cigar, no drinking, no driving a fast car, no walking down the street…. no nothing! If I die… then I die. If I get sick my insurance will pay for what I have paid them to pay for and will not pay for things for which I am not eligible. Charity and/or the good will of friends will help out. Leave the damn government out of it and let the free market sort it out. Where’s all the billions of dollars that we were supposed to have saved from ultra-taxing smokers? Must be around somewhere, right? I feel a pain in my chest from all the stress this friggin government is causing… where’s the number of my lawyer?