Sunday, June 07, 2009

Health Care. Or Not.

Earlier this morning Mike posted a letter to the editor written by a doctor (one assumes a doctor of medicine, rather than of philosophy) which very nicely addressed the dual issues of shared responsibility and avoidance of scare tactics in addressing the problem of health care reform.

Health care is something you tend to think about most in two parts of your life: first, when you have small children who always need some sort of maintenance; second, when you get older and find that all your constituent parts don't work quite as well - individually or together - as they once did. I look at what my children go through in getting care for my grandchildren, and what we (well, my sister, actually, as she's doing most of the work) are going through in arranging quality care for our father, who remains unable to do much for himself after his stroke earlier this year.

Health care reform, real health care reform, in this country requires, as the good doctor said in his letter Mike shared with us, shared responsibility. This means:

1. Taking responsibility for living in a healthy way so that you don't need more than basic health care most of the time. That means eating right, not doing anything stupid like smoking or taking drugs, getting the right amount of exercise, not engaging in activities you know are likely to cause injury (sorry about that, all you extreme sports people and dumbasses who refuse to wear motorcycle helmets because it limits your freedom to incur deadly brain injury), and seeking medical help when a problem first starts, rather than waiting until you have one foot in the grave and the other one on a banana peel, when your problem will be more difficult (and expensive) to solve.

2. Finding lawyers who care more about justice than about the size of their fees; who don't encourage their clients to file enormous medical malpractice suits grossly out of proportion to the injury suffered; and finding judges and juries willing to stand up and say such suits are fundamentally stupid. Somebody's paying those gigantic settlements, lawyers' fees, and court costs. Surprise! - it's us.

3. Working with the pharmaceutical industry to find ways of keeping the price of prescription medicines down. The outrageous cost of drugs is driven partly by research and development costs, partly by advertising (how many Viagra, Cialis, Levitor, and other drug ads do you see in magazines and on prime-time TV each day?), partly by an opaque pricing structure, and partly because of the enormous cost of insurance against the inevitable lawsuits.

4. Getting people on all sides of the argument to stop demonizing the options recommended by other sides, and whining shrilly about the negatives of any solution but their own. Nobody's interests are served without a clear, thoughtful analysis of the pros and cons of each proposed solution. Example: what does "socialized medicine" actually mean in the context of the debate? Why is a "single payer" plan any different in end result from the patchwork system we have now? And don't just say that it's because "government bureaucrats are making decisions about my health care." Oddly enough, bureaucrats are making those decisions's just that they work for a profit-driven health care industry, and not for "The Government."

Health care in this country is the best in the world...if you can afford it. The problem is that there are too many people who have an economic interest in the issue: doctors who endure a very long and expensive course of training and certification and then - understandably - want to be paid appropriately (and avoid the threat of catastrophic malpractice suits); insurance companies and medical care networks who want to maximize earnings while minimizing costs; lawyers who stand to make millions of dollars by successfully prosecuting malpractice lawsuits (often of questionable merit); and average folks who have a hard time balancing the competing needs to eat, live indoors, and pay for medical care.

I don't know what the ultimate solution is, although I strongly suspect that it's some version of a government-funded single-payer insurance system. Every possible approach to the problem has good and bad points ... the issue for us should be to stop endlessly harping on the bad points and demonizing those who support positions we don't, and start working together to create a system that keeps people healthy.
I suspect the doctors and lawyers will continue to earn their livings regardless of the outcome.

And I also suspect that my grandchildren will still be listening to the same noisy debate when I am old and decrepit. Or older and more decrepit than I am now.

Have a good day. Be safe and live healthy.

More thoughts tomorrow.



Melissa B. said...

5. Doing something about the ignoramuses like one of my students who piped up the other day: "Well, if they want affordable health care, why don't they get a better job?" How do you answer that without making the dumb kid cry?

BTW, don't forget: Please come on over and check out my Silly Sunday Sweepstakes!

Mike said...

Wow. When you said felt a post coming on, you meant it. It would be interesting to send this in to the letters to the editor and see how it gets cut down.

SusieQ said...

Before we leap into a national health care plan of any kind, I want answers. I want to know the pros and cons of various plans. I am concerned that Congress will go ahead and push a national health care plan onto the public without first explaining why their plan is superior to any others. We have a right to know.

I want to know how the government plans to pay for a national health care plan. I want to know why the government has not been taxing this fringe benefit (health insurance) all along. It is a form of compensation and should have been taxed all along.

I want to know what percent of our health care dollars is spent on liability insurance for the health care providers. I personally know of one doctor who had to close her practice because she could no longer afford the liability insurance she needed. That is not due to greedy insurance companies that provide this type of insurance. That is due to greedy lawyers and a court system that forces medical providers to pay big time in malpractice suits, because they know the money is there to be had through the insurance companies.

I want to know just how well Medicare, which is run by the government, is doing these days. I have heard that it is in trouble financially. I have heard that some doctors are refusing to take Medicare patients because the government is too slow to pay its bills.

There are horror stories coming out of Britain about health care rationing. We need to find out if these stories are true and why if so. We surely do not want the same thing to happen here. Last time I checked, Australia was not experiencing this kind of rationing. But will they in the future? How about Canada? What is happening there? These are legitimate questions. I want answers.

Yes, we should all strive to live responsibly when it comes to our health. This should be encouraged. (So maybe the government should pay my fitness center fees if it wants me to be healthy.) But, please, I do not want the government invading my privacy and looking over my shoulder to make sure I eat my broccoli and get my eight hours of sleep each night.

There must be ways we can deal with the rising cost of health care without placing at risk our freedom to make certain choices for ourselves.

The Mistress of the Dark said...

I wonder how someone that makes less than 20,000 a year would feel about a national health care plan. Someone who can only afford a high deductible plan of her own that is almost pointless in helping curb medical costs. I wonder how all those people that work in jobs that don't offer health care and THEY ARE OUT there would feel about national health care.

I recall why I never bothered before, because HEALTH CARE COSTS TOO DAMN MUCH MONEY for someone thats in the lower class bracket and what you can afford makes you wonder why you are paying for it in the first place.

Leslie David said...

Any of us (including all of our elected officials) who were in the miliary have had single payer health insurance. We didn't pay anything, and while occasionally I read about some major screwup (which occurred at DeWitt on Ft. Belvoir) the overall care was pretty good.

Bilbo said...

Melissa - good comment! And I did enter the S3 this week!

Mike - if past experience is any indicator, it would be cut to ribbons and end up saying the exact opposite of what I started with.

SusieQ - we're saying the same thing...except that I still don't see the difference between the big, bad, government looking over my shoulder and a big, bad, cost-minimizing-and-profit-obsessed HMO looking over my shoulder. I think it has more to do with one's philosophy of the role of government than with the consideration of all possible approaches to health care.

Andrea - yep.

Leslie - I think you just helped underscore what I was trying to say. Thanks. And thanks for the dances, too.

SusieQ said...

Bilbo, here is one reason I am cautious about government becoming a health insurer.

An opinion piece from the Wall Street Journal Online - What will happen if government competes with private health insurance companies