Sunday, August 23, 2009

Doctor Dalai's Do-It-Yourself Healthcare Plan

"Free people can treat each other justly, but they can't make life fair. To get rid of the unfairness among individuals, you have to exercise power over them. The more fairness you want, the more power you need. Thus, all dreams of fairness become dreams of tyranny in the end."

Andrew Klavan

"If the government controls your health care, it controls your LIFE."

Doctor Dalai

I'm clearly not a fan of the healthcare bill being rammed through Congress. I think it is a thinly-veiled attempt to take over a significant chunk of the US economy, one that is critical to our very health and our lives in general. This is being done in the name of "insuring the embarrasing 47 million uninsured" or "trimming our horrible healthcare costs" or some similar, high-minded excuse.

What it truly hopes to accomplish, and I am totally convinced of this, is to send us down the path toward a European-style Socialist government, with more and more citizens dependent upon the State. This is the sort of thing those on the Left drool over, although they become angry and indignant when you point it out. If you troll on liberal blogs and websites, the main topic these days is how important it is to have a single payer Government system, like Canada or England or Australia, or Denmark, or. . . The proponents cite statistics showing better outcomes in various metrics with such a system, the detractors cite other stats showing worse results. I'm finding the data hard to reconcile, but I think it is obvious that such plans have much longer waiting times for just about everything, the level of care is no better, and often worse, and the cost in terms of taxation is horrendous.

An interesting aside about cost. In many articles about the British National Health Service (NHS), expat Americans go on and on about how there is no bill presented to them. The implication is that they see the care as "free," totally ignoring the huge amount of tax revenue that supports the system. I wonder if we Americans are the only people who anxiously await our income-tax refund check, thinking of it as free money from the government, and not wanting to realize that it is simply our own money that was loaned to Uncle Sam at no interest whatsoever.

I do not believe in complete governmental withdrawl from our lives. The government exists to regulate, but it does NOT exist to provide. I do not agree with a complete laissez-faire approach, nor do I think the goverment should be involved much beyond guiding people to do what they are supposed to do. The Bernie Madoff scandal shows us that letting the free-market run without control will lead to the greedy and unscrupulous taking advantage of the, well, greedy, as well as the innocents. Alan Greenspan, the supposed genius of the Fed, couldn't grasp this simple premise that any five-year-old understands from playground interactions. But, the recent home-loan bubble tells us nicely what happens when the government dictates who should be allowed to have what, and the subsequent crash again demonstrates what happens when regulations are inadequate. I guess I neither a fan of government or of human nature.

I've attempted to read through H.R. 3200, ‘‘America’s Affordable Health Choices Act of 2009," but the damn thing is 1015 pages long, and written in inscrutible legalese designed specifically to make governmental documents as obtuse as possible. The Official Summary notes key provisions of:
It's rather hard to find these individual pieces in the bill, and there is a lot more in the 1015 pages than meets the eye of this summary, which is, of course, quite favorable and reasonable-sounding. The public-option is heavily touted:

One of the many choices of health insurance within the health insurance Exchange is a public health insurance option. It will be a new choice in many areas of our country dominated by just one or two private insurers today. The public option will operate on a level playing field. It will be subject to the same market reforms and consumer protections as other private plans in the Exchange and it will be self‐sustaining – financed only by its premiums. . .

Innovation and delivery reform through the public health insurance option. The public health insurance option will be empowered to implement innovative delivery reform initiatives so that it is a nimble purchaser of health care and gets more value for each health care dollar. It will expand upon the experiments put forth in Medicare and be provided the flexibility to implement value‐based purchasing, accountable care organizations, medical homes, and bundled payments. These features will ensure the public option is a leader in efficient delivery of quality care, spurring competition with private plans.

Oh, but the competition will be healthy, just like Fed-Ex and UPS survive when up against the US Postal Service, according to an unfortunate analogy presented by Mr. Obama himself.

It occurs to me that we should discuss just what we want or don't want in a healthcare plan, i.e., let's look at some of the pieces that may or may not exist in the House bill. I'm going to present these as options one could include if assembling a piece of legislation Lego-style. I wonder if this is the way Congress goes about it. . .

  1. Universal Coverage. We truly don't know how many uninsured there are in the United States. Estimates vary from 10 million to 52 million, with 47 million being the most commonly cited figure. But, these numbers do include people that can afford insurance, but don't want to buy it, illegal aliens, and so on. So, your first choice is this: Do we want to cover absolutely everyone? Do we do so in the name of the value of each individual life? If so, how do we reconcile abortion (and I'm reluctantly pro-choice, by the way.) How do we pay for this? Should we simply tax everyone? The "rich" only? Do we hit business owners harder than individuals? Should we alternatively just declare that anyone can walk into any doctor's office, clinic, or hospital and get care? If they cannot pay, the health care system eats it (which is pretty much what happens now in a lot of areas.) Does the healthcare provider (or the government payor, or the insurance company forced to cover) have the right to investigate the patient claiming poverty to see if their plea is legitimate? Can the funding entity refuse a freebie to someone driving up in an Escalade and chatting away on a Blackberry? Would there be jail-time for someone trying to game the system?
  2. Extent of Coverage. Do we wish to pay for any and all treatment? Yes, it is clear that if a young person develops cancer or other serious disease, a full court press is necessary and desireable. But, are we to cover liver-transplants for a drunk picked up off the street? And of course, there is the question of care in the last days of life. Nasty as it may sound, do we ultimately want "death boards" to limit futile expenditures? Do we give 99-year-olds pacemakers and artificial hips? Are we willing to pay the price to do so?
  3. Catastrophic Coverage. An unfortunate number of Americans are bankrupted by a severe illness or accident. Should there be a major-medical/catastrophic illness policy for all? How much should be covered? What should be covered?
  4. Insurance Reform. Should we require the insurance companies to cover everyone, in particular, those with pre-existing conditions? Should coverage be portable? Should it be tied to the job or the individual? Should insurance execs make millions while refusing to pay for care in certain instances?
  5. Preventative Care. Ironically, the more preventative care we introduce, the longer people live, and the more healthcare will cost. Do we choose to do this anyway? Will there be penalties for those who continue to smoke, drink, and overeat? How will the government/insurance company find out about your indiscretions? Will they have access to your credit-card bill and grocery-discount card to oversee your purchases?
  6. Medical Decisions. A big part of HR 3200, not mentioned in the summary, is something called COMPARATIVE EFFECTIVENESS RESEARCH, establishing a Center which will "conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically." This gives the government a path to controling healthcare decisions. Do we trust the government (or insurance companies) to do this? Will we allow the "Center" or its equivalent to override the judgement of the individual physician?
  7. Profit. It can be argued that healthcare is so important that profit should be eliminated, with the removal of any financial incentive, fee-for-service, etc. Do you agree with this?
  8. Tort-Reform. HR 3200 has absolutely no mention of tort-reform. We all know that a tremendous amount of expense comes from CYA tests, scans, and so forth. But the lawyer-dominated government, from the President on down, shun tort-reform, on the premise that someone horribly harmed by a bad outcome should be able to recover hundreds of millions of dollars in compensation. Which do you want?
  9. In-Office Imaging. The loopholes in Stark II allow for in-office imaging. The clinicians who own imaging equipment utilize scanning at 2-8 times the rate of those who don't. They claim added convenience to their patients. Do we wish to pay for this or not?

I've certainly left out a lot of possibilities, but you get the idea. These are very hard choices, which are being made in the intelligence vacuum of Washington, without our input. To me, the fact that tort-reform is not included in this bill tells us that the goals are far more political than generous and magnanamous. Well, I'll take back that last clause: Mr. Obama and Congress are planning to be very generous with other people's money.

Having a child with a chronic illness, who will be uninsurable once out from under my coverage, seeing the waste in the system daily as a physician, I understand very well the need for reform. But this bill, and the current drive to ram it through come Hell or high water, will not fix the problems. It will not cover all of the uninsured, it doesn't address tort-reform, but it certainly does attempt to insinuate the government further into the healthcare system, in ways obvious and not so obvious. This is a giant stride toward socializing the nation, and making us dependent on the State for our very lives.

Certainly, there are problems to be solved, very, very serious problems. But the best approach is for government to regulate, not provide. The insurance companies have to be brought in line. They need to make a profit to survive, but they cannot be allowed to just do their own thing. To throw in an entity that makes no profit might sound good to those who hate capitalism and fair competition. But you must realize that profit, properly regulated, is a far better motivator than any other. If you think otherwise, I'll invite you to visit your local Post Office or DMV.

Make your choices, and tell Congress what you really want to see in healthcare reform. Otherwise, we'll get what they really want. I, for one, don't want to see that happen.


Anonymous said...

If you really think the government should only regulate and not provide, you also need to be firmly against all of these things (and probably more):

Police Departments
Fire Departments
Public Roads
Municipal Water and Sewer Systems
Municipal Garbage Systems
Public Schools (including state universities)
The Military
Foreign Aid
Public Parks
National Science Foundation
National Institutes of Health
Public Museums

Most people think that the government should regulate some things and provide some things, so you might not really mean that the government should only regulate.

Anonymous said...

The FEDERAL gov't should be limited to provide only those things specified in the constitution. Public defense, i.e. the military and NASA clearly fall into that category. Police and fire and water are local municipalities /city/state entities and not federal. I do not think the Federal gov't should not be providing funding for museums. Again many of those are local and not federal.
Please understand the difference between the intent of the constitution to limit the powers of the federal gov't vs. all the remaining items delegated to the state. Take out the constitution and read it. it's all there.