Commentary by Ron Beasley
The New York Times reports, correctly, that there is little hope for "bipartisan" health care reform. There may be a few who oppose a public plan for ideological reasons but the reality is the Republicans don't want to give the Democrats a victory on this because they know it will be popular. In spite of the ads they may run they know that public health care is popular in Canada, Great Britain, France, Spain and everywhere else. It is the third rail of politics in Canada and Europe and even the conservatives in those countries know not to touch it. We saw what happened when George W. Bush tried to mess with Social Security, the third rail of American politics.
We hear that a government run health plan will result in health care rationing. That's true but what they fail to mention is that we have that now. The reason the that the anti government plan marketing is not having any impact is that both those that have health insurance and those who don't know that we already have rationing. I have had two friends and one relative who have probably died before they should have because of rationing. Yes, they all had insurance but physician requests for diagnostic tests were rejected by private insurance companies until it was too late.
And there is another form of rationing � the preexisting condition of being between 55 and 65 years old. I will return to this later.
And then we have Medicare. Medicare will approve about anything and health care providers know that. See what a Texas town can teach us about health care in the New Yorker. To make matters worse these procedures are often not even in the best interest of the patient. I will give you a personal example.
My 86 year old mother is in really good health but had started to be short of breath. They ran some diagnostic tests and discovered she had a bad heart valve. She was referred to a cardiologist who was ready to split her chest open and replace the valve. I asked him several questions:
She is in relatively good health now � following the surgery will she ever recover to be as good as she was before? The answer was probably not!
I told the doctor that I heard that being on a heart lung machine can have a negative impact on memory and asked him if that was true. The answer was yes, especially in older people.
The next question was what will happen if the valve is not replaced? The answer was the shortness of breath may gradually get worse.
I asked him if it were his mother would he suggest the surgery? The answer was NO!
The bottom line is they were going to perform a procedure that would cost 50 thousand plus dollars that would have left my mother worse off after the surgery because Medicare would pay for it.
At 63 years of age I cannot get health insurance at any price. I am denied procedures that could keep me alive for another 20 or 30 years while Medicare pays for procedures that add little or even have negative impacts on the health of the patient. That's rationing and foolish.
There is health care rationing now and there will be rationing in any new system. Society simply can't afford to give everyone the care they might desire. So what is required is intelligent rationing. Will it be perfect? The answer is no but it needs to be better than what we have now. That means that any government health plan needs to do a better job of of deciding which procedures are truly worth while. I would still feel better about a plan where profit was the major driving force even though it might not be perfect.
So very clear, isn't it? Rationing is what insurance companies eat for breakfast. It's what drug companies do when they refuse to allow better prices for their biggest customer of all, Uncle Sugar, through Medicare. And brokers for banks and investment businesses salivate at the mention of fat sums accruing in medical and/or health savings accounts made necessary as their cousins in insurance push growing numbers of people into high-deductible policies because they simply can no longer afford an old-fashioned, easy to use insurance plan.
ReplyDeleteI'm not surprised when I hear politicians and other shills for the insurance, drug and financial industries spread that kind of foolishness, but when journalism leaves such low hanging fruit unpicked I wonder about their common sense. I suppose too many advertising dollars are at stake.
I know Maggie Mahar should be on her way to another Pulitzer because she's bird-dogging the issue with the tenacity of a snapping turtle. Check out her blog, Health Beat. And track some of the stuff as The Health Care Blog for a while. I've been following this issue for months and am very excited about what's about to happen.
Comparative effectiveness data and giving Med Pac some teeth are already in the works, with or without the approval of the Congressional sausage grinder, and the next several years I think CMS will emerge as the gorilla it should have been since the Sixties when Medicare came into esxistence.
It has been a while since I mentioned this so forgive me if you have read it before.
ReplyDeleteDuring my time as a health coach for WellPoint I realized that approximately 50% of my patients were not taking all of their prescribed meds because they could not afford them. These were people who were employed and had "good" health insurance. Around 50%!
When my father and aunt were diagnosed with cancer the next words out of the doctors' mouths were "What kind of insurance do you have?" After hearing their answers they were both told to "go home and put your affairs in order." My father had really crappy insurance and my aunt (still on the family farm) had none.
I say we go to the French model.
I need to correct something in my comment. Maggie Mahar may be on her way to a Pulitzer, but not "another" one. I was thinking of Paul Starr's "The Social Transformation of American Medicine" (1982). I think of Mahar's book as a sequel and update of the same line of thought, supported by a hundred pages of bibliography and end-notes.
ReplyDeleteMaggie Mahar's book "Bull: a History of the Boom and Bust, 1982-2004" (which I have not read) received many good marks, including Warren Buffet's recommendation that it be read by investors at Berkshire Hathaway. "Money Driven Medicine" is in the same league, I'm sure.
Incidentally, I get books via abebooks.com (American Book Exchange) which is a database of thousands of booksellers. This is my go-to place for any book, especially out of print or hard to find items. I got both of these books very economically. "Money Driven Medicine" was available from a few places for a dollar, so I got several copies to give away.
We're all going to be in for a rough future. Check out this blog... it's worth reading. All about the health care crisis... from a nursing and therapy perspective.
ReplyDeletehttp://www.alliedtravelcareers.com/blog/