Let’s Do The Easy Health Care Reform
Jan 22nd, 2010 | 81 responses
With the GOP win in Massachusetts there has been a lot of talk about what to do with health care reform. Some on the left pushing for immediate action while others call for stopping all reform now. What I can’t understand is why we can’t at least do stage one of the process.
There are a number of aspects to health care reform that are, as far as I know, quite non controversial.
- Preventing companies from denying coverage due to pre-existing conditions
- Requiring that all plans provide preventative care, like annual physicals, at little or no cost
- Preventing companies from dropping coverage due to a serious illnesses
- Preventing companies from making large rate hikes due to serious illnesses
- Eliminating lifetime caps on coverage
This is just a short list, I’m sure there are other aspects to reform that are also fairly non controversial. So why can’t we agree to pass this part of reform now, allow it to go into effect and see what improvements it makes ?
We could then continue to discuss larger scale issues like providing subsidies to help lower income people obtain coverage, allowing the formation of cooperatives to buy group coverage, possible public options, etc.
But in the meantime it is quite possible that the above reforms could help millions of people.
Yet nobody seems to be willing to do it. The only logical reason for this seems to be that the left doesn’t want to give up an issue and the right doesn’t want to give Obama any sort of victory.
To me this seems like a no brainer.
81 Responses to “Let’s Do The Easy Health Care Reform”
Dr. I'm surprised you're taking this position. You do know about the exponential function, right? The doubling time is 70/x where x is the % increase (the derivation of that approximation is available if you want to check my math). When health insurance goes up 7% a year (which it does), it doubles in 10 years (it doubled in the last 9). Because it's exponential, it is 4 times what it was 20 years ago and in another ten (or less) it will be 8 times, then 16. I assure you, this country will crumble and fall long before we can afford 10 times what we're paying now.
Current family plans average $13,000 a year. Median income is $42,000. NO ONE making $42,000 a year can afford $26,000 in health insurance. Yet that's what they'll owe in less than a decade. Median income hasn't risen significantly in 30 years. Private health insurance cost will cripple us long before the Medicare fund is even depleted, let alone resulting in the kind of crippling debt from, say, tax cuts for the rich and 2 wars.
So why didn't the schmucks just pass a bill when they had the chance? Answer, they need a spine transplant, which I am sure would be covered by their Cadilac HC plan (deductible premiums which would not to be taxed, as non-union member plans are slated to be). Try listening to some Docs., they see a major illness in the current and the pipe dream HC plans.
I agree dduck. I'm fed up with the spineless Dems. As for listening to the docs, no one is listening to anyone but their own echo. We have a global laboratory of health care schemes. We can see what works and what doesn't. We choose the most expensive for the worst outcomes. Great.
But I don't expect doctors to propose ANY ways to control costs unless the cost control comes out of someone else's pocket.
But I don't expect doctors to propose ANY ways to control costs unless the cost control comes out of someone else's pocket.'
With that attitude there is no hope but a Tower of Babel. Come on, we sent a man to the moon.
I favor major tort reform to lower costs, portability which allows you to 'carry' your policy with you when you leave an employer (not just COBRA) at the same group rates, easing regulations to allow the design of insurance plans with selective coverage of different conditions, the capacity to offer plans across state lines (with caution) off the top of my head. Saving resulting from these actions can be applied over time to covering more of the uninsured.
I havent read all of all of the Republican proposals, but I'm quite confident in predicting that you haven't read all of the Democratic ones. At least the former are available on the internet and not locked in Pelosi and Reid's office safes.
Now I anticipate that you are going to say none of the above is 'significant' but they go a heck of a lot farther than a bill that never gets signed into law.
Yes, I favor the same position on waterboarding as 58% of the American people so that proves I must be out on the fringe somewhere. I agree, that's hilarious.
Now I have to get some work done so I might not be back to face your Cotton Matheresque response until much later. Have a good evening GreenDreams.
Tort reform – worthless. In fact, if the 7/8 of injured parties who DON'T sue, did, even with caps it would be MUCH more expensive than it is now. But ok. 0.5% is the cost of malpractice. Not very helpful, but thanks for the big idea. Aetna loves you.
Nothing stops insurers from offering portability today! What is it with you guys implying that REGULATION rather than GREED keeps insurers from giving you a sweet deal? But, hmmmm. Deregulate. Thanks. Aetna loves you.
In fact, I understand both the GOP and the Dem proposals. I don't like any of them as much as I'd like simple, everyone's covered, Medicare for all. Or single payer, just like civilized countries.
I don't care how many people are as immoral as you, DaMav. This is a different topic and I'll not go there but to say that your viewpoint is not important to me. I know where you stand.
I don't like the malpractice system. I'd like to eliminate it completely. I've been on a jury in a malpractice case and thought the people bringing the lawsuit had no case. The insurance company doctors representing the doctor settled, unfortunately. I just know that even if we do it, the savings that conservatives claim for it just won't materialize.
But…those expenses are beyond the ability of those with incomes below the median to afford. Those bills mean that other things would have to be sacrificed.
As I've pointed out before, the moon wasn't lobbying against it. Those who benefit handsomely from the current scheme don't want their golden egg laying duck, I mean goose, cooked.
The plans aren't for everyone. For the people who can afford to save up (HSA's would be nice, at least with current tax laws), it would save them, and ultimately everyone else, money. As things currently stand, only about 10% of the population controls their own insurance situation, with the rest, either the government, or their employer, chooses it.
Do you have any idea how much health care costs? Do you have any idea how much one night in my hospital costs? I'll tell you. One night in our SICU (surgical intensive care unit) costs $5,000. That's a bed and a nurse, by the way. No medications and no treatments.
How much does one bottle of IV Ig cost? $12,000. One of my patients received eight of them over the course of less than two weeks. That's only ONE of her medications.
We have a patient on my unit that has been here since May. She's essentially lived in this hospital, for all intents and purposes, for the last two years. At a grand total of more than $5,000 a night. Why don't you do the math?
Demographically, we are going to see a boom in the number of people needing the kind of specialized care that my hospital gives. The Baby Boomers have barely reached their 60's. Just wait until they're in their 80's and 90's–and nearly all on Medicare. It is going to CRUSH us, if we don't get this under control.
How much money did you pay in Medicare taxes last year? I would guess my husband's contribution to be around $2,000. His employer would have matched that. And he is fairly well paid. He worked a whole year and will have failed to pay enough into the system to pay for a single night in an ICU. He and I together will not contribute enough to pay for a single bottle of that IV Ig.
People, GET REAL. THIS is reality.
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Thank you, doctor, for your comments. Most of the people who oppose this d@mn bill DO understand many of your concerns. That is why they so vehemently oppose the Dem plan. It is not rocket science; it is political gamesmanship, social engineering and a blatent power grab by the government..
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The liberals like to demean tort reform, yet MANY doctors (I know a few) here in Illinois have moved their practices due to high malpractice insurance and Illinois' poor record on rewards. How do you think fewer doctors affect the cost of health care???
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CyKick, it's not a matter of opinion. It's a matter of fact. The cost of litigation by patients and insurance to pay for it, combined, costs around 1/2 % . Highest estimate I've seen is CBO's at 2%.
So first, we're playing with chicken feed. Debate it to death, but even if half of claims were fraud, which I doubt, you're only talking .25% to 1% benefit by eliminating ALL fraud. Your insurance will increase that much, as will total health care cost, in A MONTH.
And second, you're playing with fire. That CBO report? It confirms what Harvard found, which is that very few people injured and justified in seeking compensation actually sue. CBO says 1.5%. Harvard said 1/8 th . If a fraction more of those harmed were compensated, it would be far, far more expensive than it is today.
So slim pickings for potential cost savings, and not worth the time to debate it, with much larger ticket items to consider.
And frankly, we should be grateful the cost is as low as it is, since many who could seek damages, actually don't.
As for “too few doctors” there are many causes of that, and one major one is how few slots there are at med school, and how exclusive and expensive it is. more of my rant on that, here. Some good points by DLS too.
http://themoderatevoice.com/59990/getting-to-th…
Vera,
So what? Hospital care is expensive. What exactly would you like to do about it? Let's tell the hospital they can only charge $2000 for a bed in the SICU. That would help, wouldn't it?
Well maybe not, since the only way they could charge $2000 and make money is to either,
1. Have crappier rooms
2. Have fewer nurses
3. Pay the nurses less
Depending on the amount of reduction, they might do all three. Which of the three do you prefer?
It's silly to talk about the cost of healthcare. It simply costs what it costs. Anything the government does to regulate pricing will result in one of three things…poorer quality, less innovation, or rationing.
This is just simple economics.
If you want to reduce costs, the best way is to eliminate the employer based tax reduction. This would lead employers to stop providing health care and make the costs more transparent to the user. This, in turn, would get people more focused on cost and put more pressure on prices in a productive way. A better solution would be to ban employer based health care but in my view, this is Unconstitutional.
Parenthetically, what do you think the government is going to do to slow the growth of costs?
Green,
What's your definition of affordable. I have a wife and 3 kids. I just went on the Aetna website and found a policy with a 3k deductible that has dental and is 8k a year for all five of us. Do you think that's affordable or not? I could drop the dental and save 1k.
That seem pretty reasonable to me but maybe I've got it wrong.
As to your comment about single payor, if Medicare's the model, we could take the $35 trillion or so unfunded liability and make it $100 trillion or better. Sounds like a good plan to me : ).
Those who benefit handsomely from the current scheme don't want their golden egg laying duck,”
Some of those benefiting might benefit with more potential patients and those needing drugs.
AS a first step on the journey to “meaningful” health care, a bi-partisan plan to cover laid-off, fired and in- between jobs people. The former employees would pay some of the former premium and use we could use job stimulus money (yes it's your tax bucks) to subsidize. This would be beyond the Cobra plans, if it is better, than the state plan. Get 10 volunteers from each party to hammer it out, and take joint credit (they also get lapel pins of a golden duck.)
No, they couldn't have passed a bill with no Republican support. By the time they could have passed a bill that would have pleased Joe Lieberman (IRL), they would have Republican support. Senator Lieberman made that quite clear over and over again.
Multiple states have passed laws that meet the Republican ideas of tort reform. It hasn't done what you are claiming it will do in any of them. In addition, what I stated was that it would not reduce health care expense to the extent claimed by Republicans. Given what has happened in the states where it exists I have no reason to doubt the accuracy of that statement. As I have also stated, it's just the Republican version I dislike. It doesn't go far enough and takes the wrong approach. I think that malpractice and other types of lawsuits that involve highly technical issues don't belong in the standard court systems and we should develop a kind of arbitration system with panels that are trained to understand the issues that will come before them. This would include malpractice and lawsuits that require an understanding of other highly scientific and technical issues such as patent infringement and engineering questions concerning product liability.
I calls dem the way I sees em.
The reasons hospital care is so expensive is multifaceted, but here are some:
because those with insurance pay a premium to make up for the people who don't have any insurance.
because no one person is really paying the bills, either the insurance company or the government is picking up the tab, and who cares about cost if you're not the one paying the bill.
because too many people either will not or can not choose to let a loved one go without exhausting all medical options–which are fantastically expensive.
Your argument is a straw man. We have to both inject more money into the system, and better control where it's spent. If you think costs both end and begin in those three pathetically simple tropes you listed, you are sadly mistaken.
Living wills and advance directives–you know, “death panels”–are a good place to start. Most dying people don't even know what hospice is, most people don't ever get counselling on how to die with some dignity. Yes, of course I am talking about end of life care, but that's where my experience lies.
In short, we have to start telling people NO. You can't have that fantastically expensive operation, you can't gorge yourself on the health care menu. The dying don't get to suck away so many dollars that the living can't get adequate care.
I'm talking about the surgeons and specialists legally making obscene amounts of money off of medicare. I know that this is a long thread, but check on the exchange around danurbachmd. The AMA is a huge player in this game, and they have the most to lose if reform starts getting meaningful. Properly done, more people, at more average wages, could be hired to do a better job at lower overall costs. There's no way to justify someone getting $70,000/month to work part time and not see it as part of the problem. VeratheGun explains the rest.
Oddly enough, I believe that if one state could break its chains from the two-party system long enough to kick the current set of medical specialists and lawyers to curb, they could solve a lot of these problems without any changes to federal law.
VeratheGun explains the rest.”
Although, that was not my point, it is valid. I'm saying, covering more folks that lose jobs, would help the problem by covering those that hospitals now must subsidize with your money, and yes for a while, those you mentioned would also benefit, so they probably would not oppose Cobra+, a bi-partisanship dynamite charge to break the log jam.
Vera,
Who is this we who is going to tell people no exactly? If I want to buy insurance or spend my money for that expensive operation, why can't I?
You call my argument a straw man and then use an example that has nothing to do with the cost of hospital care. I have nothing against hospice as an option. I oppose it as a requirement for people who have the means to do something else.
If you are saying, that people who receive health care for free should not ultimately have access to every procedure at any cost and any time, we agree. If you are saying the same should apply to all, I could not disagree more. A person should be able to spend their money however they want.
My emphasis is on reducing costs, not increasing the money. Both allow more people to be covered, but only cost reduction is sustainable. If we can cut down the cost of a surgeon to a few hundred dollars, instead of a few thousand for major operations, we're not hurting the entire medical system, just the surgeon. Likewise, most medical drug costs can be reduced by selecting cheaper drugs that do the same thing, or by negotiating the price. Also, the current process for getting a new drug to market is insanely expensive, and the drug companies like it that way, because it reduces competition. Medical care does not have to be as expensive as it is now, nor do we have to sacrifice quality to expand coverage. There's a lot of waste involved in current system, but those that get the extra don't want it made any more efficient.
In short, if the AMA, the ABA, pharmaceuticals, or insurance companies like the plan, we need to start over.
Thanks for the editing advice.
I'm a psychiatrist, which technically isn't primary care, but effectively is, at least for some of us. I did a lot of primary care, as I was often the only medical person regularly seen by the patient, or their other docs failed to diagnose or attend to basic medical issues, probably bc of patient overload. Also spent a lot of time on basic medical education. By “go-to physician”, I mean that many medical professionals went to me for their own care, which is one of the better ways to judge quality of care.
Probably could have made more, but liked to keep my practice small enough to practice care that met my own standards, e.g. returning calls same day, usually within a few hours; or seeing people same or next day if they had urgent problems. As a solo practitioner, it wasn't possible for me to accept insurance, but I kept my rates low, and did 10% of my work pro-bono.
I had other sources of income, so I had the luxury to give high-quality care at a reasonable price, something most MD's could not afford.
Your point is well taken. Obviously, we should be willing to sacrifice for our health, but clearly some things are non-sacrifice-able, e.g. food and shelter.
I think there are a few coherent possible solutions to the mess, but there is no solution that won't upset a lot of people. The issue has become exceedingly complex, and it isn't fiscally feasible to provide every person in this country with the highest level of care possible, something Americans have been exceedingly reluctant to accept. If you find a way to provide basic care for everyone, then there will be many little susies who can't get their heart-lung transplant, or grannies who can't get their valve replacement or cancer patients who can't get aggressive treatment until their dying breath, etc…It's already a reality that health care is rationed, so do we want to do it helter-skelter, or in a more controlled way?
What bothers me the most is that Americans seem to have lost the will to make the hard but necessary choices. I think our political parties are no longer serving the country well, but have devolved into acting mostly in their own interests. I know this is the nature of politics to some degree, but it seems much worse than previously.
GreenDreams, if you read all of my comments, you would realize that I am in no way against people being compensated for malpractice; I would just like to see it less arbitrary. In my years of practicing, being sued was never my greatest fear; it was of making a mistake that would seriously harm one of my patients. If I had ever seriously harmed a patient, I would have wished and counseled patients (or families) to make a claim. It would have helped me with my pain and guilt over causing harm to someone who had entrusted their health to me. That's what the malpractice insurance is for. On the other hand, claims without merit are generally traumatic to the practitioner. Two physicians I know have stopped practicing medicine altogether after suits which they won or were dropped, as a direct consequence of the suits. These were both mid-career MDs with busy practices, who were good and caring physicians, but were so traumatized by the dramatic but baseless allegations that they were unable to continue with their work in medicine. Physicians are selected to be resilient, optimistic and persistent. They have often invested most of their lives working to be MDs. When a group of people like this start dropping out mid-career, something is seriously wrong. The loss to society in terms of their skills and the lost investment in their training is also substantial.
Maybe the person who said we need legal reform, not tort reform was right. Obviously law is not my field. I'd be a little surprised to see either, given that the majority of our legislators are lawyers.
Ironically, the needs of physicians are most closely aligned with those of patients. We want and (most of us) need to practice good medicine. We hate it when we cannot.
I'm not an apologist for the field of medicine or even MD's in general (if you're curious, I'd be happy to give you examples) and certainly not for large corporations.
Thanks for your thoughtful reply. I generally have a favorable view of doctors, as well as lawyers. I work closely with both.
I have a wary and negative view of those who use red herrings to sidetrack an important discussion. I'm not accusing you of that. Rather, I see those who want to derail any reform at all, using “tort reform” as a red herring to sidetrack us into demonizing lawyers and patients.
My point is that this is not just small potatoes, it's less than peanuts, less than chicken feed. We have some huge and difficult decisions to make if we are to rein in health care costs. Tort reform is a distraction. Best case scenario is that we would spend a year enacting it and it would save the equivalent of 1-2 MONTHS of cost increases in health care. (malpractice is .5 % of health care, which is rising 7 % a year). Furthermore, the publicity from the battle might very well bring out of the woodwork, many injured patients and their families who chose not to sue. It might just cost more. MUCH more.
I would propose setting aside at once any issue that cannot guarantee a savings of at least 5%. Remember, that's still less than a year's increase at the current rate.
Best case scenario is that we would spend a year enacting it and it would save the equivalent of 1-2 MONTHS of cost increases
GreenDreams, you keep saying that. Have you actually read any of the counterarguments? Do you remember them well enough to repeat them?
Yes, DJ, I've read them, but I don't believe them. There is serious research in this area and what I've seen from those who want to demonize victims and their lawyers doesn't hold water. The most common argument is that “defensive medicine” makes doctors order unnecessary tests to shield themselves from “malpractice.” I say Bull. I've been there. I'll bet you have too. A loved one is sick, really sick and you and the doctor and the patient ALL want to do the MAX. What arrogance to malign doctors and imply that they're covering their asses instead of doing the best for their patients.
But come on, all-knowing not-really-a-doctor J, give me a percentage savings you think is achievable by ignoring ALL malpractice. What's your fantasy bottom line?
By the way, this crap really angers me right now, as my wife is in surgery as I type this. The cynical garbage that her doctors are running up the bill to keep me or her from suing them is just unadulterated crap! Go peddle it to Rush.