Mangled Healthcare

[ShadyMedicine]

Did anyone see Healthcare Around The World on PBS? If I were king for a day, I would make all of elected officials watch this program. And again. And again. And again!

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/synopsis.html

It featured five other capitalist healthcare systems from around the world; the analysis and presentation was incredibly clear. Please try to find it in your local area or just read the web site content.

The points made are many. But one thing is for sure – if we Americans can do what Taiwan did – rebuild the national healthcare system from scratch – there is hope for all of us. For what it’s worth, the folks I know in Taiwan are pretty happy with their quality of care and choice of medical specialists. But we are not Taiwan for a long list of reasons. I fear our collective road to wellness will be painful, given the gridlock in Washington, entrenchment of business interests (big pharma, big insurance) and frankly, how unhealthy we Americans have become as a population of 310 million.

So I ask you, could Americans muster up the will – along with its elected officials – to completely rebuild the healthcare system?! Wouldn’t it have been nice if we spent the $700,000,000,000 on this national problem?

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[facetguy]

Man, fixing healthcare is going to be a HUUUUUGE undertaking, to say the least. The numbers are frightening. Look up David Walker, a former US Comptroller, who knows these numbers very well. Not pretty. He was part of a recent documentary called "I.O.U.S.A.", which discusses our financial crisis, healthcare included. I haven't seen it, but I plan to. You're right. Can you see Big Pharma losing out? Or Big Insurance? How many physicians do you know that would volunteer for a pay cut (the cuts are coming anyway, I know, but salaries can't go so low that med schools find themselves empty). And getting Americans to actually take ownership of their own health by eating better and exercising more will take some kind of magic. I just don't see it all coming together.

 

[psy]

Maybe it would take a Depression for this to happen. With less money to use they won't be able to visit McDs and pizza places as often. They would have to buy food in bulk and cook at home. Big changes usually come when there are disasters abound, and we can only hope that change is for the better. =/

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Parts that I like:
1. "Every person in Taiwan has a "smart card" containing all of his or her relevant health information, and bills are paid automatically."
2. By law, everyone must buy health insurance -- either through an employer or a community plan -- and, unlike in the U.S., insurers cannot turn down a patient for a pre-existing illness, nor are they allowed to make a profit.
3. In 1994, a national referendum approved a law called LAMal ("the sickness"), which set up a universal health care system that, among other things, restricted insurance companies from making a profit on basic medical care.

It boils down to providing free basic medical care, a quick and simple payment system, forcing people to get insurance (depending on their income of course), easy access to medical history with the smart card, and making insurance companies into Non-profit. If we can get all that, our healthcare wouldn't be such a mess right now. I know some people would hate to be forced to get insurance, but I've seen workers (mostly immigrants from my experience) who refuse to get health insurance even if their work place provide it for them for just 50-100 dollars from their pay check per month. If they needed medical attention, they go to the ER. =/

 

[facetguy]

Maybe it would take a Depression for this to happen. With less money to use they won't be able to visit McDs and pizza places as often. They would have to buy food in bulk and cook at home. Big changes usually come when there are disasters abound, and we can only hope that change is for the better. =/

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I like this part of the article: Every person in Taiwan has a "smart card" containing all of his or her relevant health information, and bills are paid automatically.
Life would be soooo much easier for everyone.

Unfortunately, those with less money rely even more heavily on fast foods because they are so cheap. And buying food in bulk requires more up-front money, which would be an issue for many during hard economic times. Of course, poor people could always just borrow some grocery money from corporate CEOs, who it appears will continue to be paid tens of millions regardless of whether their company thrives or goes under.

 

[psy]

If one was to think short term then McDs everyday seems like a good idea. I was hoping the average American wasn't that mathematically challenged.

 

[Miami_med]

The problem is that the government is trying to "fix" healthcare in the first place. I'm not sure that anyone could genuinely take what is done in Taiwan (a small country now the property of China with a largely wealthy population) and extrapolate that to the US, with 300 million people and a land mass that encompasses half of a continent. Secondly, forcing everyone to carry around a card with a bunch of personal information at all times is just a little bit scary, and efficient healthcare isn't really worth to me what abuses that would probably render after the next "crisis."

 

[psy]

The same security issue can be said for your driver license, credit cards, and social security card if you carry them in your wallet. The security risk is also high. The card that would carry your personal info should be encrypted and password protected. By having easy access to your medical records, it would greatly reduce the need to do redundant testings. Recently I helped an elderly gentleman to the ER where they ran numerous tests before transferring him to another hospital. There, he had to undergo the same series of blood draws, urine sampling, etc... because the data from the previous hospital was not available. I think the benefits outweigh the potential risks.

 

[Josh L.Ac.]

I doubt the Taiwanese consider themselves the property of China despite the mainland's posturing.

 

[NonTradMed]

The problem is that the government is trying to "fix" healthcare in the first place. I'm not sure that anyone could genuinely take what is done in Taiwan (a small country now the property of China with a largely wealthy population) and extrapolate that to the US, with 300 million people and a land mass that encompasses half of a continent. Secondly, forcing everyone to carry around a card with a bunch of personal information at all times is just a little bit scary, and efficient healthcare isn't really worth to me what abuses that would probably render after the next "crisis."

While I agree that having a nation wide program would be harder to implement on a large country like the US and probably impractical, I like the idea of encouraging nonprofit insurance companies. Also, the idea of getting everyone covered under some sort of health insurance would solve some of the issues we face in this country.

Health insurance, by it's very nature, only works if a suitable number of healthy people are covered along with sick people. If insurance companies are allowed to select their clientele, in theory, they would focus on getting only the healthy individuals and refuse the sick ones. Hence sicker individuals would be forced to rely on the gov't for their health care. The result is we pay twice for healthcare. Once for our own health care, second time for the sick individuals who can't find any coverage and depend on tax money to provide care. By making it harder for insurance companies to discriminate against sick individuals, society pays only once for healthcare (i.e via their insurance company). Although, given the large size of our country, the heterogeneity of the population, and how unhealthy we all are, I think the system would still utilize a lot of money.

Problems, problems....




Btw, I don't think Taiwan considers itself the property of China (although there is so much cross-strait business going on that this could change...).

 

[Dirt]

The idea of "for profit" health insurance is fundamentally flawed in that their reason for existence, to pay medical bills, is at odds with their goal, increasing profit.

Sure a gov't involvement in health insurance mucks things up, but the alternative is a massive portion of the population who cannot afford health insurance or the care they need. In this scenario, either the gov't is going to pay the bill anyway, or these people will just die. For those of you who feel that they are getting what they deserved, I hope they die on your front lawn you selfish bastards.

The idea of "for profit" drug companies is not nearly as flawed as health insurance because without profit there would be no incentive to create new drugs and do research. There was a different thread discussing private vs. government funding and each has their problems and their benefits, the consesus seemed to be that together they do alright. The biggest problem with drug companies, as I see it, is marketing as a significant percentage of the cost of drugs is tied in to marketing. I would be in favor of limiting pharma marketing and offering tax breaks to money reinvested to R&D, allowing for "for profit" drug companies to remain. Obviously medicare needs to be able to negotiate drug prices as well.

 

[Miami_med]

While I agree that having a nation wide program would be harder to implement on a large country like the US and probably impractical, I like the idea of encouraging nonprofit insurance companies. Also, the idea of getting everyone covered under some sort of health insurance would solve some of the issues we face in this country.

Health insurance, by it's very nature, only works if a suitable number of healthy people are covered along with sick people. If insurance companies are allowed to select their clientele, in theory, they would focus on getting only the healthy individuals and refuse the sick ones. Hence sicker individuals would be forced to rely on the gov't for their health care. The result is we pay twice for healthcare. Once for our own health care, second time for the sick individuals who can't find any coverage and depend on tax money to provide care. By making it harder for insurance companies to discriminate against sick individuals, society pays only once for healthcare (i.e via their insurance company). Although, given the large size of our country, the heterogeneity of the population, and how unhealthy we all are, I think the system would still utilize a lot of money.

Problems, problems....




Btw, I don't think Taiwan considers itself the property of China (although there is so much cross-strait business going on that this could change...).

This is the 800 pound gorilla in the room. It's very easy to sell the idea of universal health insurance to everyone when we say that the government or the insurance companies pay for it. It's entirely different when people figure out that it still means that THEY have to pay for it. Health insurance in its purest form is a risk pool, in which people of similar risk (or people of different risks at rates proportional to their risk) throw all of their money into one pool, and distribute it to those who need it. The rates are set based on the expected amount of expenditure within the group, thereby shielding every individual from the full brunt of the cost in the case of a crisis in exchange for a set and predictable payment.

The current system of health insurance however doesn't make sense under that ideaology. By "forcing" people to take people with pre-existing conditions at artificially low rates, it necessarily pushes up the price of insurance on anyone else. Just like there are more poor people than rich people, which causes people to want to pass along the cost of running the country to the rich; there are more healthy people than sick people, and a national concensus on funding within the context of understanding how funding actually occurs would probably stick it to the sick people.

You see, the average person doesn't understand that the money used by the government or the private insurance company still comes from him. That's why everyone wants to work it that way. The average person who supports state backed health insurance is usually thinking, "gee, I don't like sick people not wanting to go to the doctor, the government should fix it." They then expect other people to fund the government. I don't usually see huge amounts of medical charity funding coming from the same people carrying signs about covering all of the children.

The real problem is NOT a lack of access to health insurance. The real problem is that healthcare costs too much. The cost of healthcare should be stuck based on market forces somewhere around the average of what people can afford to pay according to their individual values, and that valuation should set the price of health insurance at a place that virtually all productive members of society can afford. The rise in medical spending (and consequently insurance premiums) is the direct result of funding flowing in from the government in the form of Medicare and Medicaid and the subsequent setting of a legal "standard" based on what could be provided with the limitless funding of the early days of these entities. Healthcare costs less in other countries NOT because the government runs health insurance or provides universal coverage. It costs less because they provide less. The relative valuation of the difference in what we provide is a topic for a different post.

 

[docB]

You see, the average person doesn't understand that the money used by the government or the private insurance company still comes from him. That's why everyone wants to work it that way. The average person who supports state backed health insurance is usually thinking, "gee, I don't like sick people not wanting to go to the doctor, the government should fix it." They then expect other people to fund the government. I don't usually see huge amounts of medical charity funding coming from the same people carrying signs about covering all of the children.

Good points. I think we're seeing a change on this though. People are starting to understand that they pay for the entitlements the government doles out. That is why we're seeing so much appeal to class envy in the election. People are being told that only the rich will be punished. Only those making more than $XXX per year will have to pay. They are being actively sold the idea that someone else will fund the government.

 

[edmadison]

So many good things in Miami_med's last post. I'd like to build on a few of them. First of all, calling our system of health insurance "insurance" is crazy. It's not insurance. It's prepaid health care. This may seem like semantics, but it is a critical distinction. People buy insurance to protect against a hazard. That's the way health insurance used to be. But starting in the 70s and really jelling in the 80s is this idea that health insurance should cover everything, not just large hazards.

First, it started with mandated coverage of pregnancy and delivery. Sure this sounded great, who can argue with prenatal care. It's good for society. That's how it was sold to the single or old people who subsidize it. Of course over the following decades, the state legislatures went crazy. Now insurance plans are required to cover all sorts of stuff, depending on the strength of the various lobbies: Chiropractic, massage, acupuncture, biofeedback, nutrition.... The list goes on and on and on. Each one certainly has some merit (except chiro, of course ). But the net effect is your are required to take all of these luxury options that you may or not want. It's akin to requiring everyone's employer to buy them a new Cadillac with all the options. It doesn't matter if you just want a 20 year-old yugo for less money. Thus, many employers have opted out of the system.

If you really want to fix the system, go back to catastrophic coverage only and make all primary care cash only. Have insurance with 500 or 1000 deductibles. Of course the preventative med people with have a cow about this. I don't think you could ever sell such a system, but it could give everyone a 5000/yr raise because the employer won't have to pay anymore.

I would, however, quibble with the notion that healthcare is too expensive. I would counter that some health care is too expensive and add that how prices of various goods and services are determined, along with the willingness of the government to pay for them is irrational. A 15 minute procedure by derm, IR, or ENT can earn that doc as much as a PCP can make in an half day. Insurance will not argue about paying thousands of dollars for a CABG, but will nickle and dime a PCP over whether an encounter is a 13 or a 14. This is insane. The subspecialists don't care, however because they are living large. Well, when the government starts moving toward a socialized system, we PCPs aren't going to have anything to loose and will sell them out in a hearbeat. I wonder if Ortho will be as popular when they're on the government dole for 135,000/year.

Ed

 

[Dirt]

The 800 pound gorilla in the room here is the fact that you would send millions of people to their proverbial and actual deaths to save yourself some money and send them a message that they need to be more responsible for their own health care.

Someone made this argument in the SP forum that the problem it is that entitlement programs do not promote the message of personal responsibility adequately. This is the case and is something that needs to change. Society does need to teach people that they do pay for their health care in one way or another, and to be more responsible.

The other approach is that people should learn personal responsibility the hard way through suffering and death. If McCain has his way this may just happen. The problems with this are twofold. First of all, people rarely learn things "the hard way" any better than they do through getting welfare. "The hard way" breeds contempt and hatred not learning and responsibility (beating your kids teaches them how to beat their kids more than it teaches them respect), you would essentially create class warfare. Secondly, the "learning period" would be chaotic with massive amounts of uninsured (is McCain planning on repealing EMTALA???) and a severe hit to both public health and the private health of millions, not to mention the lives and well beings of doctors who would see fewer and fewer patients who could pay for their services.

So the options are, continue on with an imperfect, albeit manageable system, and work to try to improve it, or pull the rug out from under society and see who get's lucky. And by get's lucky I mean survives.

I guess I could always buy a funeral home.

 

[Miami_med]

The 800 pound gorilla in the room here is the fact that you would send millions of people to their proverbial and actual deaths to save yourself some money and send them a message that they need to be more responsible for their own health care.

Someone made this argument in the SP forum that the problem it is that entitlement programs do not promote the message of personal responsibility adequately. This is the case and is something that needs to change. Society does need to teach people that they do pay for their health care in one way or another, and to be more responsible.

The other approach is that people should learn personal responsibility the hard way through suffering and death. If McCain has his way this may just happen. The problems with this are twofold. First of all, people rarely learn things "the hard way" any better than they do through getting welfare. "The hard way" breeds contempt and hatred not learning and responsibility (beating your kids teaches them how to beat their kids more than it teaches them respect), you would essentially create class warfare. Secondly, the "learning period" would be chaotic with massive amounts of uninsured (is McCain planning on repealing EMTALA???) and a severe hit to both public health and the private health of millions, not to mention the lives and well beings of doctors who would see fewer and fewer patients who could pay for their services.

So the options are, continue on with an imperfect, albeit manageable system, and work to try to improve it, or pull the rug out from under society and see who get's lucky. And by get's lucky I mean survives.

I guess I could always buy a funeral home.

The thing is, that there wasn't massive rampant death due to inability to access healthcare before the government started paying for the majority of healthcare. This is really just a scare tactic that clearly didn't happen before the mid-1960s and the implementation of Medicare. People were largely NOT dying in the street before EMTALA in the mid 1980s. They are not dying in the street now either.

The issue is not about teaching anyone a lesson. The issue is about not creating massive inefficient beauracracies to redistribute wealth within the healthcare sector. The issue is not giving false definitions to words and ideas to convince people of something that they may not really want. The idea that some people may actually face the real consequences of their actions is a side effect. The next generation will take it more seriously. We can try to shield everyone from every bad move forever. The result is a world that looks more and more like the one now, where society and the economy slowly melt down in response. Atleast we can all sink together.

By the way, about class warfare. I will say as someone who really hate both candidates in this election, Obama's commercial where he talks about insuring everyone followed by the play that he will raise taxes "only" on those making >$250k/year is the single most blatant play to class warfare I have ever seen in a political campaign.