(1 and 3) Scrapping Medicare and Medicaid and starting over would require a 1,000 page bill you say you're against. Scrapping Medicare and Medicaid would make access worse, not better. Impractical - good luck finding a politician willing to scrap Medicare and Medicaid. Non-starter that would wind up, again, doing NOTHING.
(2) We already have a two-tiered system. Poor folk and even lower middle class folk without insurance never get healthcare until they show up at the ER, get a bandaid slapped on, and a swift kick in the butt back out the door. Then, twenty years after untreated chronic hypertension and hyperlipidemia, they get on Medicare and require a $100,000 bypass surgery for coronary blockage. Not exactly saving us money or increasing access either, is it?
(3) The issues must be dealt with together. You can't increase regulation of insurance companies without also increasing the pool, because insurance premiums would sky-rocket. You can't increase the pool without mandating coverage, because there will always be a few who "hold out" to let all the rest of us pick up the tab. Trying to pass things piecemeal could wind up making the problem worse rather than better. Healthcare reform is a complicated topic. That's why it requires a sizeable bill. Opposing healthcare reform based on spending is ludicrous on the face of it. If we DON"T reform, healthcare spending is going to break our government.
(4) This is exactly what Pres. Obama has agreed to consider.
(5) Most people identified as smokers do pay higher premiums already, at least if they are buying insurance independently. Some people overweight can't help it - it's called genetics. How do you encourage personal responsibility with reference to health? Mandate insurance coverage so people have to pay something for their healthcare and it has value to them. The opposite is to let people think healthcare is free because they don't have to have coverage, so they do whatever they please. Further, reform of the system to focus more on primary care instead of treating it like a joke in our nation's medical schools and hospitals would go a long way toward encouraging better prevention. It would be great if people could be counseled about risk factors. Primary care doctors do not have the time nor the incentive to do so. Focusing on and funding the primary care "medical home" model would allow people to have access to ancillary primary care personal, NPs, nutritionists, etc, who can take the time to counsel them about basic prevention. This can free primary care MDs/DOs up to serve as executive managers of patients' overall health. Ideally, the primary care physician would be a fully-informed coordinator seeking specific consults. As opposed to the status quo, where a patient sees five different specialists taking the patient in five different directions and the primary care doc has no clue what is going on. The specialists don't know what the other specialists are doing either. That equals duplication, unnecessary treatments, mismanagement, etc.
Completely agree with you. Wish more people would think the way you do.
Perhaps you are a concrete thinker and cannot see implications or correlations. Perhaps you have neither thought about, researched, nor taken the time to self educate on these things. Perhaps comprehension is a problem. I don't know, but it's not the diagnostic validity of these tests that is in question -- it's the cost efficacy at current pricing levels. Look it up.
In the words of Ebenezer, I believe I'll retire to bedlam.
Honey, don't worry - You don't need a mammogram. It will be much CHEAPER to let you get breast cancer first and then undergo a mastectomy and radiation (even though it really won't be cheaper). Plus, we wouldn't want you to miss all that fun of a late diagnosis and all the extra goodies for showing up late to the party. People who believe that belong in Arkham.
Oh yeah, the problem must be the cost point. There are two variables in this equation -- you can either increase the efficacy or decrease the cost in order to create a positive effect on the outcome being measured. What you cannot do, however, is boost the payments for the measures that are already shown to be poor from a cost effectiveness vantage....... then there is the whole "compared to what" argument, whereby decreases in the reimbursement for any given intervention raises its relative value for the purpose of assigning cost efficacy utility... but let's keep this to simple "common sense" and "compassion" and not let those pesky little things like facts... or math... or those silly numbers get in the way of a good statist push......
)So, even when we have historic precedent, ideologs still rule the day, because there is so much confounding information that we can't prove, or even objectively measure, which theory is correct.
