More on health care reform

[twirlgrrl]

http://www.cnn.com/2009/POLITICS/08/17/potter.health.insurance/index.html

Excerpt:

I explained during the press conference with Rep. Slaughter how the industry funnels millions of its policyholders' premiums to big public relations firms that provide talking points to conservative talk show hosts, business groups and politicians. I also described how the PR firms set up front groups, again using your premium dollars and mine, to scare people away from reform.

What I'm trying to do as I write and speak out against the insurance industry I was a part of for nearly two decades is to inform Americans that when they hear isolated stories of long waiting times to see doctors in Canada and allegations that care in other systems is rationed by "government bureaucrats," someone associated with the insurance industry wrote the original script.

Comments

[gen-here.livejournal.com]

I'm sorry... I call bullshit. I'm sure there's a lot of that, but there are actual people that share their stories about having to wait long, long, long times for care in Canada - not paid by anyone. I remember babyslime saying stuff about waits for MRIs for herself and care for T. My BIL is from BC and he had to wait over 6 months for an MRI and an additional 9-12 for the surgery to fix his shoulder. That's just 2 families - and they're the only 2 Canadian families I know.

I'm not standing up in defense of the current system - it's broken. No doubting that. But the proposed solution in the Senate right now is NOT good! There needs to be a middle ground. The Senate plan right now is great if you don't need anything more than to have a doctor on file to see for a yearly physical. But unless something is done to limit the abuse of the system (call an ambulance to go to the ER for narcotics - and then call that ambulance to take you to another ER if you're denied? Comatose 98 year old whose family insists on every possible intervention to keep them alive - not to be confused with active 98 year old who personally chooses to have medical care?) There are TONS of ways that the system can be helped without giving total control over to the government!

[twirlgrrl.livejournal.com]

Sorry I took so long to respond to this!

Yes, there are definitely areas of certain countries--most notably Canada, and most notably BC--where the wait for an elective test for a non-urgent, non-life-threatening condition can be long. As I understand it, each province in Canada manages their own health care system, and BC in particular has funding and care access issues, in part because of their rural population and a shortage of physicians which makes wait times and travel distances longer than elsewhere.

My mom lives close to the Canadian border, and she hears stories of people who come to the US for tests that have been delayed in Canada, if they can afford it. She also hears stories of people who pose as Canadian citizens so they can get free care and medicine over the border, as well as people who go into Canada specifically to buy prescription drugs at Canadian prices. I don't know if she actually knows any of the people in the stories or not.

So yeah, there are problems of various kinds in various systems all over the world. No denying it. But here, people who are uninsured or underinsured might wait FOREVER for that shoulder MRI, because it won't be paid for at all. At least in BC you can have the MRI eventually and you won't have to pay for it. And in some countries, you don't have to wait at all. And in some other countries, if you can afford private insurance you may have to wait less time than if you're on the public plan. There are all sorts of ways of doing this. I personally don't believe that leaving it all up to private industry, to for-profit companies, is a good idea.

I think of the currently proposed solution, with both public and private health care coverage, IS a middle ground. It's not a proposal to give total control to the government. I'm not sure why you feel that the current proposal is only good if you only need a primary care doctor on file--please explain if you like, I'm just not getting that part!

The two examples of abuses of the system you give are interesting in their disparity; the first one is one of those outlier examples that I doubt is a big drain on the system, but I agree that overuse of emergency rooms is a problem--primarily because uninsured people who have nowhere else to turn.

(sorry, had to cut this due to length)

[twirlgrrl.livejournal.com]

(part two)

The second example is a great debate-starter in the area of those really big issues, including end-of-life care (also known now as "death panels"), advance directives (now known as "death books"), evaluating the benefit and value of health care costs (also known as "rationing")--all of these things are incredibly complex and fascinating to discuss. Unfortunately the current political discourse is, um, lacking in these areas. But I ask you, if these kinds of costs are to be reduced, if these 'abuses' are to be limited, who is to make the decisions in this regard? I mean, obviously, it should be medical ethicists and physicians, not CEOs of large corporations and not politicians. But who should be paying them to have these discussions and to guide the decisions? And who should enforce the reimbursement rules that are put into effect? Because right now, reimbursement rates and rules for seniors and the disabled are under governmental jurisdiction in the form of Medicare. Medicare rules determine how much will be paid for any particular patient's diagnosis, and Medicare also determines which level of care is appropriate depending on the patient's condition--acute hospital, skilled nursing facility, home care, hospice. That is not to say that Medicare officials are making individual decisions for people's care. No, those decisions are made by the physicians, the patients and their families, the social workers and utilization review specialists in the hospital and elsewhere. Yes, finances are part of these decisions, because Medicare only pays so much. And I don't believe that anyone is proposing any big changes to how this system works. I believe the proposal is for expanded availability of a Medicare-like program to other segments of society, to compete with private insurance companies, which spend 30-40% of their dollars on administrative costs as opposed to Medicare's 4%.

I'm sorry to blah blah blah on you like this... I get all excited and try to fit everything in when having this discussion. I'd love to hear your thoughts, particularly on end-of-life care decisions for Medicare patients as per your example--how do you think costs should be controlled in the 98-year-old's care, and who should make those decisions?