Monday, August 24, 2009
Thoughts on Healthcare
Julie Falk, August 2009
To say that Americans disagree over the proposed change over to government-run health insurance is like saying NBC likes Obama. If I show up at a town meeting and voice my concerns, I may be called a “tool of the Republican right” or accused of being a Nazi puppet of the insurance companies, all because I’m not sure I want the government in control of my health care.
So I’m writing this out to show that I am thinking, I am educated, I am weighing carefully the sides in this debate.
The questions seem to me to be these:
1. Do we want to trade this imperfect system for a different imperfect system?
2. How dependent do we want to be on the government? Because, if this socialized government-controlled system is brought into existence, we will all be at the mercy of the government – whoever happens to be in power at the time, whatever set of beliefs and POVS the current administration may happen to have, this will direct how health care is doled out.
OH, and the declaration of the Obama that no one will be forced into this system, that people who now have private insurance they like may keep it, is no assurance whatsoever. If private insurance companies have to compete with tax-supported government systems, you know what will ultimately win out. If companies have the choice of paying high private insurance premiums for their employees and paying additional “penalty” taxes (Example: Pg 149 or HR3200, lines 16-24 ANY Employer w/ payroll 400k & above who does not provide public option pays 8% tax on all payroll) , OR getting on board the Washington insurance plan, eventually, even if they don’t want to, they will be forced by economics into the government system. With freefalling membership, private insurers will sputter and die. Note: if you read page 16 of the current healthcare proposal, HR 3200, it states, “Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law. Interpretation: No new private policies can be written after the government health care option is available. If you leave your company, if you go to work for yourself, you will have nowhere to turn but the public option.
Conclusion: Sooner or later, we will ALL be in the government system.
So, let us analyze.
Question 1: Do we want the current system in which a few people get everything medically they want and need, the vast majority of people get what they need and a few things they want, and a few don’t even get what they need. OR do we want a system in which the government approves or disapproves treatments, determines how much tax we will pay to support this, and for which there is no alternative?
There are some very serious problems with the current system.
Private insurers are in control of what people can have and can’t have. They have to approve surgeries and rehab, prescriptions and treatments, doctors, when, where, and how often. They can easily deny treatment to their patients just by denying that anything is wrong with them, or they can be selective about who and what they will insure. I will even go so far as to say private insurance companies have been responsible for illness and death by denying their members treatment. If you don’t believe it, just check the court cases.
In 1976 my father was diagnosed with Cruz felt-Jacob disease. We tried to take care of him, but after two years we were forced to find an institution were he could get twenty-four hour care. No hospital, no nursing home would take him, so we ended up putting him in the state hospital. Because the state hospital is a place where the mentally ill are hospitalized, BCBS denied payment, claiming my father was mentally ill and mental illness wasn’t covered. By the time he died in 1979, my stepmother was faced with bills totaling $30 thousand dollars. She ended up taking BCBS to court, where it was proved that my father had a disease, not a mental illness, and BC finally paid.
In January of 1992 my hands began to swell and hurt. The diagnosis was carpal tunnel. The doctor tried anti-inflammatory drugs, cortisone shots, splints; nothing helped. My hands became so weak I couldn’t even cut my meat or stir dough. Nerve damage began to occur, and in April and May I finally ended up having surgery for carpal tunnel release in both hands. Afterwards my doctor said I had the condition because I had “rheumatoid of the tendons” whatever that is. He prescribed rehab therapy for my hands. Blue Cross Blue Shield denied payment for the therapy because my condition was “chronic” and they don’t cover chronic conditions. About five years later, after I went back to teaching, my shoulder tendon swelled, due, I suppose, to writing and erasing the chalkboard. I was having a hard time raising my arm. My family physician prescribed physical therapy, but BCBS refused to pay for it, claiming that my shoulder condition was caused by the chronic condition. My doctor disagreed with this and wrote a letter saying this was not a result of the tendon condition but from my profession, but unless I took them to court over it, BC was continuing to deny payment. Meanwhile, the therapy was successful and I regained use of my arm. The condition did not reoccur. We ended up having to pay for the 12 therapy sessions out of pocket, about $1200.
If private insurance companies get forced out of business, they have done it to themselves. I have no sympathy for them.
So, as you can see, we are at the mercy of private insurance every bit as much as we would be at the mercy of the government, so what’s the difference? The difference they say is with private insurance companies you can switch if you don’t like the way your private insurance company is treating you.
Really? What if you have a chronic condition? What if no insurance company will take you on because of a pre-existing condition? Then where is your choice?
Blue Cross Blue Shield claims they will not turn down anyone because of a pre-existing condition, but their premiums are based on your health. If you look like you will cost them some money down the road, they will charge you accordingly and beyond what anyone who is not a millionaire can afford, so the result is, in essence, the same as turning you down. Example: our friends, retired dairy farmers, have had to sell off their farm piece by piece just to be able to pay their $24K a year BCBS insurance premiums. Why so much? Donna needs joint replacement and therapy. She has had numerous surgeries. She has become expensive to insure, so the BCBS has raised their premiums to the level that, if this couple didn’t have that property to sell, they would not be able to afford insurance at all. They can’t switch to another insurance company because no one will accept them because of Donna’s history.
The private insurance system we have now used to work a lot better when there wasn’t so much that could be done for people who were seriously ill. Example: In the past you got cancer and doctors could try a couple of things to save you, but you would probably die. Now there are almost endless possible treatments, many of them with a good chance of success, but also very expensive, so as our healthcare costs go up, our health insurance premiums go up and up and still more UP to the point where fewer people can afford it.
Several studies estimate the number of uninsured Americans. According to the U.S. Census Bureau, nearly 46 million Americans, or 18 percent of the population under the age of 65, were without health insurance in 2007, their latest data available. (DeNavas-Walt, C.B. Proctor, and J. Smith. Income, Poverty, and Health Insurance Coverage in the United States: 2007. U.S. Census Bureau., August 2008.) (Keep in mind, this includes people who were without insurance for just a short time. But also keep in mind that this has gone up since 2007)
Companies that insure their employees are struggling to maintain the quality of coverage they have provided in the past. NONE of them want to pay for shoddy, cheap coverage; but as the economy maintains its downward clockwise swirl, these businesses are in a battle to survive. It is understandable that they seek less expensive coverage, especially if it’s that or go belly up, because telling your employees that they have no job is considerably worse than telling them they have less health insurance. Will employee coverage from the government be less expensive for them? Most likely yes, at first.
It is true that people with Medicare and Medicaid wait until they have an emergency situation before they seek medical treatment, because the ER is covered and their doctor isn’t. The government says we need to institute this new system so people who now go to the ER for treatment will not have to wait to go to the doctor for check ups. Then if something is seriously wrong, it can be caught early on, and ultimately this illness will cost much less to treat, therefore saving the system money. If they really believe that, then just start paying for doctor appointments for your people on Medicare and Medicaid. But overhauling the entire system just to change that is like buying a car when all you need is new tires.
Okay, so that’s just scratching the surface about what is wrong with our present system of healthcare insurance.
What will be the drawbacks to a government run system? We don’t know yet, for sure.
We don’t have to go far to see what a government-run healthcare system looks like.
Michiganders cross the border to go into Canada and buy their prescriptions, because government cost controls keep drugs cheaper over there. However, as a result of this, the reward for developing new, safe drugs is practically non-existent, and Canada’s pharmaceutical companies don’t bother. Canadians who need top quality care and cutting edge technology and drugs come to the states. When they are told that they have to wait two months for an MRI scan to determine why they are getting severe headaches, Canadians with money come to the states and pay out of pocket to get their MRI in a week. Can our government guarantee that this won’t happen to us here, if we go with government run healthcare? NO.
BTW, some people may say that I have been told lies and exaggerations about the Canadian health care system by people against public healthcare, but what I’m saying comes from people I know who used to live in Canada, including a Canadian doctor, and I’ve been hearing this for many years – pre-Hillary Clinton years. Canadians may or may not get specialist care in a timely fashion.
Canada also has a doctor shortage. But so do we.
What does Canada say?
“The incoming president of the Canadian Medical Association says this country's health-care system is sick and doctors need to develop a plan to cure it. Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country - who will gather in Saskatoon on Sunday for their annual meeting - recognize that changes must be made. ‘We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize,’ Doing said in an interview with The Canadian Press. ‘We know that there must be change,’ she said. ‘We're all running flat out, we're all just trying to stay ahead of the immediate day-to-day demands.’ ” By Jennifer Graham (CP) Overhauling health-care system tops agenda at annual meeting of Canada's doctors The Canadian Press online – Aug 15, 2009
So Canada’s system does have problems. Imagine that.
Israel provides another example of national health care. Israel, which has had a hybrid public/private system since 1994, covers its entire population through four private companies, which are heavily regulated by the government and subsidized by taxpayer funds. Israel’s system is sometimes held up as a shining example of an effective socialized program. But upon doing a little research, I find they have – problems. No kidding?
Their biggest problem is their health fund keeps going broke.
“There were inadequate provisions for three areas of inflation: an aging population, an increase in technology and a total increase in population. The Minister of Finance basically kept the lid on and did not provide adequate funding to do this, so every year there’s a crisis. Two of the sick funds are almost bankrupt because of this.” Shimon Glick, M.D., is Professor of Internal Medicine and Chairman of the Division of Medicine at Ben Gurion University Faculty of Health Sciences in Beer Sheva, Israel. He is National Ombudsman for Israel’s Ministry of Health. (date unknown)
“Still, the health insurance system suffered from a series of severe problems - mostly budgetary - that heavily influenced and weakened its ability to function as a national health care system, leading to protracted conflicts and frequent crises in the past decade and a half. The continual improvement of medical procedures, which are consequently more expensive, has accelerated these budgetary problems.” Israel Ministry of Foreign Affairs, website, 2002
The government in Israel needed more money but politicians had promised constituents not to raise taxes, so they resolved the problem by allowing the fund groups to charge a small fee for doctor visits and so forth. So the cost goes up when you actually are sick.
They have plenty of doctors. Too many, in fact. This is because in the late 80s, early 90s, many Russian Jews immigrated to Israel who happened to be doctors, so there is nothing in the system that has caused them to have lots of doctors, it’s just a one-time thing. As a matter of fact, Israeli doctors earn very little money: about $70-80 thousand a year. Compare that to American doctors who earn an average of $190 thousand a year according to NBC news. I’m surprised some of those Russian Israeli doctors don’t high-tail it to America. I don’t think our doctors would tolerate that.
For some, the answer is to demand that the government fix it. Let’s give the responsibility of providing healthcare to Washington, because they will be fair. They will provide for everyone, not just people who have jobs, not just productive members of society, but the poor and the disabled. They tax everyone, and when everyone is paying into the system, we will have the money to pay for all this.
England’s health care system isn’t being held up as a shining example by anyone, despite the fact that Obama’s stepmother says it saved her life.
Question 2: Do we want to give over control of healthcare to the government?
Where do we get the money to pay for all the people who don’t have insurance? How can we control costs of expensive treatments? We will have fund crises, just like Israel. The government will take the easy way and repeatedly raise taxes to keep it afloat, just like they do for everything else, and we will have no choice but to pay for it. Is there anyone who doesn’t think this will happen? I’m absolutely certain of it.
Many doctors won’t take Medicaid patients now because the government doesn’t pay them what they get for other patients. This shows that the government is already making costs lower by simply refusing to give doctors and hospitals what they need to cover services at the present level. Hospitals will respond by giving less time to patients, rushing them through the system, not being careful, because they will no longer have the leisure to be careful. They will need to treat more patients to make up the difference.
As the government struggles to control costs, will they become selective about who gets what? Death panels, no, but what if they determine that “We have enough money to pay for this many heart transplants this year. Sorry, but the list for this year is full. You need a transplant ASAP, so we will put your name at the top of the list - for next year.” “ Your grandmother needs a hip replacement, however she is eighty-two years old, and it’s just not financially prudent to spend that much money on someone who could die next year. But we will make her comfortable.” Would they do this?
Do I trust the US government to run the health system?
When attempting to determine how someone will act in the future, I have a tendency to look at past behavior. I scrutinize the last time the government did something similar, and by similar I mean took over something that people used to do for themselves. It was in 1935 when Social Security was instituted by Roosevelt. The idea was that there would always be more people paying into the system than those actually receiving payments because A) the population continues to grow, and B) Some people will die before reaching retirement, not collecting what they contributed – my father for instance, who died at age 62.
(If all the money Dad put into the social security system had been placed into a retirement account instead, his widow and children -aka me- would have received a lot more inheritance. As it was, we got nothing, except for the small payments of $188 a month I received to help me go to college when he was ill and couldn’t work.)
Anyway, that was a great idea, right? Retired people had lost their savings for their old age in the crash of ’29. Payroll taxes for Social Security were 2%. Within a few years, benefits were expanded to cover dependants. In 1950 payroll taxes were increased to 3%. Benefits were expanded to cover disability. In 1956, taxes increased to 4%, in 1961 to 6%, and early retirement for men was permitted. In 1972 payroll taxes were increased to 9.2%, The self-employed, who could previously opt out, were now required to pay, and so on and so forth, growing like the Blob, until 1993 when someone went, “Uh, oh….”
“In 1996 The Social Security Trustees' Report stated that the Social Security system would start to run deficits in 2012, and the trust funds would be exhausted by 2029. All members of the Advisory Panel agreed that some or all of Social Security's funds should be invested in the private sector. To keep the unchanged system actuarially sound, payroll taxes would have to be increased 50%, to 18% of payroll, or benefits would have to be slashed by 30%.” http://socialsecurityreform.org/history/index.cfm
And now that whole system stands on the brink of collapse because the government got people depending on it for their retirement, so many people didn’t save for their old age; they figured the government would take care of them. Now my generation is approaching that time when we should be able to collect what we have paid into the system for many years. Apparently it will not be there. Or at least not the amount we were anticipating. People are living longer and reproducing less. And as the economy shrinks, there is less money going into the box. Who could have foreseen this?
Apparently not the politicians who instituted it.
Let me give you a smaller, less dramatic example of how the government runs things.
Last year the government announced that all broadcasting would be changing over from analog to high definition (HD) in February. Everyone who applied would receive a $40 coupon for up to two converter boxes, so they wouldn’t have to buy an HD television to receive the new digital signals.
Tim and I believed this. We applied for and received the coupons for the converter boxes. We hooked up our converter boxes to our analog televisions. Results? Only two stations came in, 7 and 11, with 50 sometimes, sorta. The HD signal wasn’t strong enough for us to get other channels out here in the country, where, by the way, we don’t get a wireless internet signal, either. We were advised to get a newer stronger antennae. More money for dubious results. Anyway, we ended up having to pay for Dish network to get TV, something we really can’t afford. We are considering just going without TV.
This is not the best example, because I can understand why the government did this; it just didn’t work out for us very well. BUT I also feel we were mislead into how simple and painless this transition would be. Were we mislead? Maybe, but I think it more likely that no one in the sprawling government bureaucracy had any idea that there would be loose ends to their neat little transition package. Or, if they did, it was unimportant. To them.
How long will it be before government health care begins to show the same lack of vision?
So, with this history, why would I want the government to be in control of my health care? Why would I want to depend upon some committee to decide if I need something or not? Okay, to that I can answer myself: right now the insurance companies are making the decision as to what treatment I can receive and here we are full circle back to the first half of this essay. Here we are screwed either way.
Another concern… this may seem like a long shot, but not really. What if the government collapses? Becoming more and more dependant on the government is a dangerous thing for a free people to do.
Okay. I can answer that one, I think. The people will revert to co-op insurance, and private companies will spring up like weeds in July, and we’re back to where we started, except the government will still find a way to collect the taxes.
How is the government going to handle all the people who will scam the national healthcare system? And at what cost? How many more bureaus and boards and court costs?
Administrative organization – I can’t assume this will be done correctly or streamlined because the US government hasn’t a clue how to do that in other government run systems. I expect it will be a mess of unbelievable proportions. UNLESS they put someone in charge who has no political agenda and doesn’t worry about pleasing everyone.
So do we really need to completely change the system, or are we throwing out the baby with the bathwater? What if we tried smaller changes first, such as replacing HMOs with MSAs (Medical Savings Accounts) and shifting to a preventative mode of health care.
And another thing: Why hasn’t the government taken a look at torte reform? Persons opposed to a national health care plan say that costs could be brought down significantly by making it harder to sue a doctor –Obama is accused of protecting trial lawyers’ biggest source of money because he gets big juicy contributions from trial lawyers, so the Democrats won’t move against them and their biggest source of big money. I believe it.
Doctor’s are human. They will make mistakes, but the legal system is just out of control. Others (particularly trial lawyers) say that people who are victims of malpractice need a voice – a way to pay for the results of a doctor’s mistake. That may be so. But that doctor isn’t going to give up his home on the lake. He’s going to raise what he charges so he can pay for malpractice insurance. So we all pay when a doctor makes a mistake and the “unlucky” patient rakes in the windfall.
So after taking a look at the issue, this is how I see it. Do we want state-of-the-art great hospitals at a cost that is prohibitive to some, or care that’s more mediocre, but everyone gets it, eventually? Apparently no nation has figured out a way to do both.
Having done some research and thought this through a little more objectively, I find I am still nervous about the idea of going to national health care, but not as worried as I was before. There’s plenty of stuff to complain about, no matter which way we swing. Costs are going to be high, service is going to be less than perfect, people are going to fall through the cracks, there will be abuses of the system. But as far as a putting a government-run health system into place, we are at the end of the line of nations that have chosen to go this direction. Most people in other nations seem to be mostly satisfied. Life goes on - the world does not crack. We will trade high insurance premiums for high taxes.
But think carefully and think hard. Because once we cross that line into government health care, it’s unlikely there will be any way to go back. After the government gets control, it doesn’t like to give it up.