Americans Back Universal Health Care
by RonChusidSurprise, surprise. Ask the voters and they prefer universal health care over paying more out of their own pockets for health care. AP reports on this report from a Congressional committee:
The federal government should guarantee that all Americans have basic health insurance coverage, says a committee set up by Congress to find out what people want when it comes to health care.
“Assuring health care is a shared social responsibility,” says the interim report of the Citizens’ Health Care Working Group, a 14-member committee that went to 50 communities and heard from 23,000 people.
The committee describes its recommendations as a framework. The recommendations don’t say who would pay for universal health coverage or how much it would cost. The concept of government-guaranteed coverage runs counter to the Bush administration’s position that consumers should bear more responsibility for their initial medical expenses.
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It’s really going to look nice when people are dying in the streets because they can’t afford health care while the doctors drive around in their Lexus and Mercedes automobiles and vacation in the south of France. Then, the greed and corruption of the American free enterprize system will be revealed for all the world to see. Then only rich republicans can afford health care.
Jim,
Mischaraterizing the problem as you do is not very helpful in solving the problem. The high costs of health care are not caused by doctors. Much of the cost comes from new technology, and from the unhealthy American life style/diet. While looking for villians is not the best approach to solve the problem, I’d look far closer at the insurance industry and HMO’s than at doctors.
Playing class warfare in this manner is not very helpful either. It just reinforces out of date sterotypes about liberals.
Jim,
One of the reasons Ron posts on this subject and has the background to respond comes from being a doctor who has been in practice for many years.
I probably have him beat by a few. I’ve been in nursing for 30. I can’t disagree with you more. Too many doctors work hours that are unhealthy and lead to burnout.
The reasons for the cost of health care are complex and identifiable. There are some doctors who defraud both the insurance companies and Medicare. It is probably no more of an effect on the cost of health care than the infamous trial lawyers and malpractice insurance costs.
Other reasons are contributing far more to the problem.
Many of the people dying from lack of health care actually do so in a hospital. Whatever untreated diagnosis that finally brought them to the ER, got them admitted on self pay basis – which means more unreimbursed care for the facility. That has closed down quite a few facilities in areas where more and more people had no insurance.
I’m glad to see this initial start on the idea has gone this far. There is a lot more information to be gathered and analysed before realistic and effective plans can be developed. That needs to be done and other temporary soulutions developed for the interim.
Putting the federal government in charge of anything a recipe for disaster. Look at the mess FEMA and Homeland Security made in the aftermath of Katrina.
I do not see how the Federal Government can provide universal health care efficiently when you look at the state of the VA health care system right now. The VA is under funded and understaffed. Veterans have to wait months to see a physician in some cases.
If the federal government takes over health care, it will have the efficiency of the US Post Office with the compassion of the IRS.
The blame for high cost of health care is due to several things: excessive medical malpractice litigation, the medical insurance industry, the cost of prescription drugs, and new medical technologies.
Universal health care does not mean placing the government in charge of health care. It’s more a matter of increased government involvement in financing of health care, which the government does more efficiently. Medicare provides care at a much lower price than private insurance companies and at the same time generallly places less restrictions than private plans do. One of the reasons for the findings of this report is the failure of the private insurance system, which is rapidly deteriorating.
There are also plans such as Kerry’s which provide incentives but still maintain the private insurance system. (Technically this wouldn’t be universal, although his plan greatly increased the number of insured).
Interesting that you blame the high cost of healht care on malpractice litigation first. True this is a factor, but a very small factor. It just happens to be the factor Republicans talk about the most.
The results of putting government in charge of anything depends largely upon who is charge of the government. The Bush Adminsitration is extremely incompetent, leading to the problems with Katrina and Homeland Security. On the other hand FEMA was an effective agency under Clinton.
Gary,
The problem with the government not working right now is that people who don’t believe in government have been in charge of it for so long.
The incompetence of the political appointees, who don’t have the best experience or knowledge for their positions, have cost us some of the best and brightest civil servants we had.
I’m a critical care nurse. In the unit I worked for 6 years, and in Home care before that, increasing numbers of privately insured patients ended up hospitalized because they had to wait too long for an appointment. The VA problems are due to underfunding by the GOP Congress. Nice way to honor our vets. You can’t completely compare it to the rest of the health care system because, like the IHS, it is essentially socialized medicine. I think they are excellent examples that socialized medicine would not work for this country. Universal health insurance is not socialized medicine.
A far bigger share of the cost of health care is the accounting nightmare of the multi payor system. This does not mean the 1500 insurance companies. It means the completly different private and government payors:
Medicare
Medicaid
VA
Workers Comp
Private Health insurance companies
Energy Employees Occupational Illness Compensation
Charity
Self pay
Indian Health service
PHS
Military
If employers paid a specified sum per employee – like the Medicare tax, everyone paid something in taxes – linked to their income level and we added all the other federal and state dollars for the first six payors, we could disperse it the same way Medicare does – a sort of voucher system.
Another piece that has languished for over a decade is the electronic personal health record (PHR) Having the individuals full health history readily accessible, complete and accurate would save millions of hours of physician and nursing time to collect and recollect the same information. It would also do away with unnecessary testing, treatment, the complications of those plus the problems of treatment delay because the diagnosis was delayed. If Bush would fully fund that, it could start reducing costs much more quickly than anything else.
The end costs of treating the uninsured and underinsured who ‘delay gratification’ of going to a doctor (or because their insurance doesnt cover the cost of the visit, they can’t get an appointment) when the symptoms first start are far in excess of the cost of initial treatment. Eg: guy with 5 kids can’t afford his BP meds one month, he has a stroke. Over the next 5-10 years he becomes diabetic, develops heart disease, has a leg amputated, has open heart surgery, develops renal failure. True situation. It is the usual scenario for someone who doesnt take care of themselves. This guy was trying and might have delayed or greatly minimized any of those complications.
The medical malpractice contribution to the whole bill?
0.4%. There is a decimal point in front of the 4. If we instituted the PHR, that would probably go down with it.
Interesting that people STILL think the USPS is so inefficient. I even heard an Air America host diss them.
Every study of the USPS compared to other countries postal services and the companies they compete with has shown it is extremely efficient. We not only get more for our buck, they make far fewer errors and do less damage to the contents of packages. 14 years in Alaska – excellent service. They don’t leave valuable shipments at your door. You take the notice to a very convenient local PO and pick it up.
Some people think this is because they are subsidized by tax money. Not true, the USPS is so much a system on it’s own, the employees have their own medical insurance. And it significantly underinsures them.
Pharmaceutical profits and unnecessary drug treatment is absolutely a significant problem. One that the GOP is not going to fix.
The VA is actually ahead of many others in terms of computerized records.
This leads to interesting results. Some surverys of medical care list the VA as being among the best health care providers. I’ve seen liberal blogs, such as Washington Monthly, grab on to this as evidence that government health care is better than private.
The problem is that anyone who has experience with the VA knows this is not true, so this argument is not helping sell the case. The problem is that many methods of rating health care do not really represent the true quality. Most likely their computerization gives the VA an edge in presenting the data to make themselves look good.
Here’s a real world example that shows how this could happen. One HMO, which I only have a handful of patients in, pays a quality incentive for meeting certain criteria, such as performing certain tests on certain types of patients at a certain frequency. However you have to have a minimum number of patients enrolled in order to qualify to receive the payments. The catch is that in order to receive credit for doing the tests you have to go to their web site and inform them of all the tests you do. Otherwise they try to extract the data from billing information, but their numbers are way off.
In my case I don’t have enough patients to qualify for the incentive payments, so I’m not going to waste my time sending them the info on the testing I do. On the other hand, people who have lots of members have a financial incentive and therefore will send the data. Therefore all their quality measures are recording is who sees their incentive program as worth the time to be involved with.
Its easy to imagine those with better computer systems being able to more easily accumulate the necessary data and interface it with the HMO’s data collection system. I think this is how the VA comes out looking good. They do a better job of getting the information out.
Another factor is that VA doctors are not necessarily the ones providing the care. I have lots of patients who see me, and also see a VA doctor once a year to get their meds thru the VA. I might see a diabetic many times a year to achieve tight control while if they were only going to the VA their sugars would be out of control. They go to the VA with good numbers and evidence of good care. However I’m not submitting this to anyone the way the VA is. They benefit from the care provided outside of their system.
“Pharmaceutical profits and unnecessary drug treatment is absolutely a significant problem.”
While there are definately people receiving meds they don’t need, this isn’t the real probelm. There are also far less people receiving some meds they should. The problem is that they are receiving more expensive meds than is needed as the drug companies push more expensive medications when an older generic will often be sufficient.
There are many problems with the whole drug system and I sort of meant to lump them all into ‘significant’. In that it’s another area of unnecessary cost and treatment, such as when there is a misdiagnosis.
As far as how much it contributes to the overall excess cost of health care in America, it has to be enough to be worth addressing. That doesn’t even take into consideration the personal cost to patients who undergo the hassles of adverse drug effects and delay in proper treatment.
As better studies of neutriceuticals are building, more emphasis on those options should also be cheaper.
Is the problem with new expensive medications over older generics also a physician awareness issue? Our pharmacy pushed this constantly, both for inpatients and writing prescriptions at discharge. Our cardiologists were pretty good at trying the older stuff first and only going to newer drugs if they actually worked better.
“Is the problem with new expensive medications over older generics also a physician awareness issue?”
Yes, that is certainly a part. The drug companies spend a fortune marketing new drugs. Sometimes hospitals or insurance companies will send out pharmacists to counter promote generics but this is minimal compared to drug company marketing.
Sometimes it is easier to place someone on a new brand name drug. I can simply grab some samples to use until I find the correct dose for the patient. In the short run patients are happier if I can start them with samples, but most understand when I explain that if I do that they will get a much more expensive medication. Only after an explanation are they satisfied with filling prescriptions for the generic if they realize this will cost them much less in the long run. (Of course there are is a distinct minority who insist that generic medications aren’t any good.)