Common Sense & An Open Mind

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    "You must lay aside all prejudice on both sides, and neither believe nor reject anything, because any other persons, or description of persons, have rejected or believed it. Your own reason is the only oracle given you by heaven, and you are answerable, not for the rightness, but uprightness of the decision." T. Jefferson

Quick…change something!

Posted by Free to Think on March 25, 2010

I’d like to address a reply that I received regarding my last post, because I think a lot of people probably have similar thoughts.  I’ll break his comments down into two parts.

Comparative health

‘Bryan’ wrote: “You said you agreed with the statement by Dick Armey who said the president’s plan will “destroy the most creative, innovative health care system in the world.” As a biological engineer, I can certainly agree that we have some of the most innovative medicine in the world, but this is different from a health care system. From a results standpoint I’d say our health care system is rather ineffective. We pay more money on health care per capita than just about everyone, and to what ends? Are we more healthy than other modern countries? If one compares the standard metrics of life expectancy, disease morbidity, etc., it doesn’t seem so.”

Americans ask a lot of their health care system. We want knee replacement surgery so we can still play golf, we want to be treated for infertility, sexual dysfunction, acne and other quality of life problems. We want no stone left unturned when faced with life-threatening illnesses. We want to keep our elderly loved ones cared for and comfortable as long as possible. We want insurance to pay for it and we don’t want to think about what it costs. I’m not making a judgment call on this, I’m just pointing out the facts.

It’s tough for statistics to compare ‘quality of life’ health between countries. And statistics can be slippery. Life expectancy is also affected by personal choice, which is not a factor in health care quality.  Obesity rates in the US are among the highest in developed countries, which can lead to many health problems and early death. In addition, if you remove the homicide rate and motor vehicle death rate from life expectancy statistics, US citizens have a longer life expectancy than any other country on earth.  For more on this read this very informative article.

Another example of misleading statistics is our high infant mortality rate. But when you do the research, you find that the vast majority of American babies that die are very premature. And most of the time premature birth fit into two categories:

1) babies of unhealthy women in poverty (obese, cigarette smokers, no prenatal care.) In its infinite wisdom, the Medicaid program often does not cover prenatal screening.

2) Besides that, it is primarily high-risk pregnancies that end in premature birth. The US is a leader in fertility treatment. According to a 2006 Institute of Medicine report, the numbers of women using assistive reproductive technology doubled from 1996 to 2002. Women who may not be able to get pregnant at all in other countries, such as older women and women suffering from complications like endometriosis, do conceive here. But their pregnancies are much more likely to end in pre-term deliveries.

I just read an interesting article that speaks of another quandary. Amanda Bennett writes about her husband’s last 24 months of life fighting cancer. After kidney surgery bought him 5 years of healthy remission, his cancer metastasized. When asked what to do, of course they chose action. The insurance company and her family paid over $410,000 for drugs and treatments for those final two years, with no definitive proof as to whether any of it actually prolonged his life. In retrospect she agonizes over that cost, especially considering his suffering at the end. Yes, this ratchets up the price of insurance for us all, but there is no easy answer here. Who’s to say where we draw the line? Obama has not, and of course cannot, offer his opinion on tough choices like this.

Government fixing health care

Bryan also writes, “Personally I think this is more a state’s issue than it is a federal one. If it does pass, I expect there to be a lot of fat in it. However, I think it’s true to say our current health care system is very very broken. Reform needs to happen…somehow.”

Firstly, yes you are correct. As defined by the 10th amendment, powers not granted to the national government nor prohibited to the states by the Constitution of the United States are reserved to the states or the people. Health care is not within the jurisdiction of the federal government. But constitutional restraints haven’t stopped them before. As I mentioned in my last post, I believe it’s now up to the states to defend their rights.

I happened to see a quote today by Albert Einstein. He said that “insanity was doing the same thing over and over again and expecting different results.”

I thought this was a perfect summation of the situation at hand. I agree with Bryan that the health care system is flawed. But from a purely logical standpoint, it makes no sense to believe that handing it over to the government will do anything but create more problems. The government’s track record definitively demonstrates that they cannot solve economic or societal problems. The issues with health care are business problems, and politicians are lousy businessmen. Medicare is broke. So is Medicaid and the Post Office. Social Security, which was supposed to be self-supporting, perpetually sustainable program, has become a giant ponzi scheme. The military is known for spending thousands of dollars for a single screwdriver. As a matter of fact, I challenge anyone to point to a single government-run business that’s managed efficiently and economically. We’re talking about the same people who didn’t know that the lending policies they were endorsing would lead to the housing bubble.

Yet some Americans continue to have blind faith that the government has the answer now. Many of us have been convinced that we have to do “something…somehow.” So we have just passed a 2,700 page law that takes control of the lives of Americans in a completely unprecedented manner. There was no time for Congress to read or review the 11th hour changes that were made to the bill, let alone get public opinion. No one is quite sure what’s in it, how much it will cost or how anyone will be affected.

A smiling House Speaker Nancy Pelosi explains to us, “We have to pass the bill so that you can find out what is in it, away from the fog of controversy.” To me this is scarier than anything I ever read by Orwell.

The bill passed by a slim 219-212 only after months of arm-twisting and insertions of pork-barrel bribes to Democratic dissenters. Contentious debate continues among the people.

Is it safe to say that we rushed into this in a less than responsible manner? What was the mad urgency to pass the bill before Obama sprinted off to Asia? “This is what change looks like,” the White House website jubilantly declared when the bill finally passed this week. Oh I see. Pushing this bill into law proves that Obama lived up to his campaign slogan. That certainly trumps widespread support or time for adequate debate. To be fair, all Obama did promise was change, not necessarily positive or conscientious change.

An interview with Obama demonstrates how frustratingly difficult it is to get straight answers from the President. Obama alleges that Congressmen who don’t vote for his bill are satisfied with the status quo and don’t want change. But he knows that Republican and even some Democratic members of Congress are advocating free market solutions, which Obama doesn’t want to even consider. What I think we need to see is Obama explaining why his strategy will work better than theirs with specific and concrete details. But as this interview illustrates, he himself is not clear on everything that’s in this new law. But you can read about some of the terrifying implications here.

I should also point out that the socialized programs of other industrialized nations offer good care but are currently bankrupting their countries. They too are seeking to alleviate strangling health care costs.

What must be addressed

The problem is, no matter who puts the bandaid on the wound, the infection will continue to worsen until the cause of the ailment is treated (an appropriate analogy, eh?). Why will astronomical prices go down just because the “government” (i.e. the taxpayer) is footing the bill? The answer is: it won’t.

So why DO Americans spend more per capita on healthcare than the rest of the world?

As I’ve talked about in earlier posts, the way the system works now, there is no incentive to lower costs.

The best analogy I’ve seen was in a 20/20 television segment comparing health care to food. If we all bought food insurance to pay for our food, then went shopping with our insurance card and our $20 co-pay, would anyone bother to check the prices? No, we’d simply buy the fancy prepared meals and the filet mignon. We’d buy a little extra to be on the safe side even if it meant throwing out what we didn’t use. Why not? The effect would be that food costs per capita would go up.

When we go to the doctor for a routine problem and he orders a battery of tests, we don’t ask what those tests cost. Often the doctor himself doesn’t know, nor does he care. Ordering a CAT scan, or physical therapy for an injury, or an appointment with a specialist to confirm that it’s nothing serious, costs him nothing. In our litigious society, doctors want to take no changes, even when they know that extra treatments are probably unnecessary. One lawsuit could ruin their practice. You may say that this keeps doctors on their toes and very thorough, but studies show that more tests and procedures don’t necessarily equate to healthier patients.

We as patients are happy to go along. Why not? We’re not paying for it. But ah, we are. When the insurance company pays the bill, their costs go up. They pass those costs back on to the consumer, most likely your employer. When disgruntled patients sue their doctors, the insurance companies foot that bill too, and raise the doctors’ insurance rates. The doctors are forced to charge more, which once again escalates costs of consumer insurance.

When I was a kid and my dad was a self-employed house-painter, he could afford to buy health insurance for his family. It didn’t cover a lot of things, including routine doctor’s visits, but he could afford it. He wrote a check to the doctor when I had chicken pox, but knew that if I needed surgery he was covered.  He knew just what Dr. Jones costs for an office visit compared with Dr. Smith.

Those days are gone, and the reasons are long and disputable. We can’t say that our free market system is broken, because we really don’t have much of a free market system. Only 35% of total health care expenditures today are paid for by private health insurance.  Medicare and Medicaid spending grew by 7.2% and 6.4% in 2007 alone. That to me doesn’t illustrate the ability to control costs. What will change now? Solutions that the Obama administration has been silent on: tort reform to control lawsuits and easing regulations to allow more competition within the insurance industry.

The point is: whether it’s our employer or our government who insures us, the basic cost of health care won’t change without the root problems being alleviated. As the track record shows, costs always RISE when the government is in charge.

Car insurers aren’t affected by the same types of government regulations and don’t compete with government entitlement programs.  Ads for cheap car insurance are ubiquitous. If you have a clean driving record and just want basic catastrophic coverage, it doesn’t cost much. If you smash your fender, however the bill is on you.

Regarding health care, the awful truth is that we can’t afford to give everyone everything they want all the time. You won’t hear Obama say that either.

As I’ve talked about in another post, if I wanted to open Joe’s Discount Health, there would be too many federal regulations standing in my way. Now there will be even more. There is no option for families to choose a high deductible, catastrophic plan that’s more affordable. Doctors don’t compete for prices, nor do hospitals offer competitive prices for diagnostic tests. There is no insurance discount for healthy people. A family can’t choose to save money by going to a large clinic and paying out of pocket to see whichever doctor is on call. These are solutions that have not been discussed by the current administration.

My final point: forthrightness and transparency are already out the window before our new healthcare program even begins. The cost for this new program is probably going to be twice what the American public has been told. As Michael Cannon says, “If someone sold you a house, or a car, or a mutual fund this way, we would put them in jail.”

For more detailed information on all these issues, please refer to my earlier posts.

I’d be very interested to hear anyone’s thoughts.

One Response to “Quick…change something!”

  1. Eric said

    I recently left my full-time job and had to get short-term individual health insurance. I had an option between getting this insurance in Connecticut or Massachusetts as I have a residence in each of these states. In Massachusetts, the cheapest monthly plan available for a 25 year old male in good health is approximately $250/mo. Similar plans in Connecticut cost around $75/mo, 75% cheaper. The reason? According to the sales rep I spoke to (and common sense), it’s the Massachusetts Health Care Reform Law. Anyone who thinks legislation will lower costs is ignoring the evidence.

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