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Discussing Health Care and Health Insurance

Thursday I wrote about the bureaucratic and cumbersome definitions being used in the text of HR 3200. Having thought about that, I think we would do well as a nation to establish clear definitions of our own for the key points on this issue - doing so would not only make it simpler to discuss what we want or oppose, but might also establish some common ground. To that end, I am presenting what I think are the root questions to this issue.


1. What is Health Care, anyway?

Health Care is one of those things that sounds plain to most people, but which can still trip folks up when they get into specifics. For most people, after all, they can take care of their ordinary health needs and in fact they do not like being told what to do on decisions that they consider personal, like nutrition, exercise, and recreational behavior. How many people have you met who agree that smoking is a bad idea but they do it anyway, that they agree they should lose weight but still have high-fat foods in their diet, for instance? People go a doctor for occasional check-ups or mild illness, when experiencing life events like pregnancy or trying to diet, emergencies like a heart attack, stroke, or for a serious condition like Diabetes or Cancer. So, it seems to me that there are these four categories make up Health Care for most people, and some of these categories will be important to only certain types of people.


2. Is this one debate or two? Is Health Care the same thing as Health Insurance, and if not, why are the two being mixed in this debate?

The Obama Administration speaks of "Health Care Reform" on two fronts; changing insurance rules and changing how medicine is practiced. But the Democrats speak of their plan as one action, as if the same measures which - so they say - will reduce costs will at the same time as improving medical care. Such a bold claim needs to be explained in depth, rather than simply asserted.

3. Does Health Care work well in America?

This is a key question in the debate. The plain fact is, medical care in the U.S. is pretty darn good. If you collapse in the street of any major city in the U.S, you can expect to be in an emergency room within 20 minutes in normal conditions. Diagnosis and treatment of Cancer, Heart Attacks, Trauma, Burns, and many other fields is unsurpassed.


4. Does the present Health Insurance system work well in America?

More than two out of three Americans have insurance coverage that they like. It would seem, then, that there are three areas of contention - how to provide satisfactory medical care for people who cannot find suitable private insurance, how to insure the availability of quality medical care going forward, and how to control rising medical costs. A proper discussion needs to cover this ground with consideration of all major perspectives.


5. Are private insurance companies a good thing or a bad thing?

Private insurance companies are routinely demonized for charging higher and higher premiums from customers, but rejecting valid claims in order to make unfair profits. Certainly there are individual companies which do this, but we should remember that every state has an Insurance Board which governs the conduct of insurance agencies, insurance agents must be licensed and the industry is well regulated. In addition, while many Americans are displeased with their automobile and home insurance, most are happy with their health insurance and do not want major changes.

Insurance was not originally meant to be mandatory. For decades the various forms of insurance, whether Life, Health, Vehicle, Home, Liability or Property, were made available as an option to hedge against catastrophic loss or expenses that could not be met under certain conditions. It should be noted that government requirement that all drivers must be covered by at least liability insurance has neither reduced the frequency of motor vehicle accidents nor the cost of such incidents; the requirement that homes bought on mortgage agreements must carry homeowner's insurance has not reduced the number of claims made on such policies, nor slowed the growth of the cost of that insurance. It is, on the evidence of the history, absurd to imagine that requiring individuals to obtain health insurance or requiring all employers to provide it will in total improve the condition of health of the nation's citizens, nor reduce cost. There is no evidence whatsoever from past experience to justify such a claim.

6. Would the government do a better job than private insurance companies?

Looking at the history of the VA Hospitals, Medicare and Medicaid, it's very hard to imagine how replacing any private insurer with a government program would be an improvement. This is an area where proponents of the new plan need to explain how the waste, errors, and sheer corruption of the past would not simply be repeated on a much larger scale.


I would start a discussion with these six questions. It would be a nice change if even these initial starting points could be addressed.


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Comments (21)

Good idea. We need to get a... (Below threshold)
Madalyn:

Good idea. We need to get a lot of answers before we can make an informed decision, unlike most of our elected officials who vote on issues they have not read nor plan to. They also vote on issues they have no idea what is in it. They are just told by the lobbyist "Vote on such and such" and they do. I was always under the impression they were there to do what we wanted, not someone who has a personal or financial interest in what the outcome will be.

In reviewing HR3200, it bec... (Below threshold)
GarandFan:

In reviewing HR3200, it becomes obvious that the Democrats are more concerned about CONTROL then about 'health care'. They totally ignore tort reform as part of 'reducing health care costs'. You'd think there were a lot of John Edward Jr's in the House and Senate who are afraid of offending the Trial Lawyers Assoc. Instead of responding to specific issues related to health care insurance (preexisting conditions, denial of services, rapid rise in premiums), the liberals want to re-define a system overnight that took over 60 years to develop into it's current form. As Barry says "IT'S AN EMERGENCY!" Well we all saw where that last EMERGENCY! got us. Now these same bastards in Washington want to whine about "Why don't the people trust us?".

DJ,"....but we shoul... (Below threshold)
DaveD:

DJ,
"....but we should remember that every state has an Insurance Board which governs the conduct of insurance agencies, insurance agents must be licensed and the industry is well regulated."

I have learned that it is, in fact, one of the most regulated businesses in our country. I cannot remember where I heard this, but as part of this regulation, insurancs companies are required to maintain a substantial amount of assets to cover catastrophic losses among insurance companies and this is one factor which contributes to large premiums. Do you know if this is true?

Answers:2) It sho... (Below threshold)
jim m:

Answers:

2) It should be two debates, but the administration has conflated health care with health insurance. In socialized medicine they are one and the same. The fact that the Obama administration has cast the discussion in this form is a give away that the intent is to nationalize health care.

3)We have the highest quality health care in the world period. Anyone who would argue otherwise is simply uninformed. Nowhere is there the same availability of technology and health care facilities. Even in remote areas we have facilities that outshine other nations.

4)Yes. But it's a qualified yes. There are gaps. It is a desire to plug the gaps that brings this issue up. Dealing with the health needs of illegal aliens is an issue that needs to be dealt with. Nationalizing health care would be a poor response to hat problem. There are people who cannot afford insurance for various reason. Simpler, smaller programs could be created with far less expense and done so outside the government bureaucracy. Some basic changes in tax laws and laws governing the state by state balkanization of insurance would fix a lot.

5) Absolutely they are good. The fact that people have a choice is good. Let insurance companies compete for business. already, if your employer offers more than one option you can choose what will give you the most satisfaction. In a single payer system there is no incentive to provide better service and no penalty for poor service. They don't have armed security at drivers license testing centers because the experience is so wonderful. It is to keep pissed off citizens in line.

6) Yeah of course it would just like it does package delivery better than UPS and FedEx (both of which are prevented by law from carrying letters), just like Amtrak is better than private passenger rail (oh, wait, there is no private passenger rail anymore the government forced it all out of business. Well, I suppose that should be a lesson learned.)

Going to the emergency room... (Below threshold)
Rance:

Going to the emergency room is to health care, what calling a AAA tow truck is to auto maintenance. The two should not be confused.

Real health care would be getting a physical every year, seeing the dentist at least once a year and preferably twice, getting a colonoscopy every 3-5 years, seeing an opthamologist regularly, etc.

Waiting until your "wheels fall off", and you need to be hauled to the ER, is not real health care.

Rance -You are con... (Below threshold)
jim m:

Rance -

You are confusing taking care of one's health with health care.

What you get when you go to the doctor for an annual physical is health care. What you get when you go to the dentist is health care.

Going to the ER is health care too.

So a year and a half ago when I was vomiting uncontrollably from acute gastroenteritis was not real health care?

Something I could not predict landed me in the hospital and that is my fault? What an arrogant and ignorant statement!

Health care is not like taking your car in for an oil change every 3000 miles.

God forbid anyone in your family should suffer a heart attack or a stoke. I suppose your response would be to blame them for not taking better care of themselves and watch them die on the floor.

People who never smoke get lung cancer too. Bad things just happen. From your statement why should we pay for anything other than the doctor's office visit? Why should we bother having hospitals?

My mother was found to have breast cancer with her routine mammogram. She had surgery to remove the tumors and was recovering. She found herself getting alarmingly short of breath and went to the emergency room where she was diagnosed with pulmonary embolisms, a common occurrence after surgery. I suppose she should have stayed home a died because the wheels were falling ff and that trip should not have been necessary. Besides she's too old and what profit will her continued living provide or society.

Your statement is BS.

"Going to the emergency roo... (Below threshold)
jim m:

"Going to the emergency room is to health care, what calling a AAA tow truck is to auto maintenance. The two should not be confused."

I'll note that in many countries with socialized medicine where you can wait for 2-3 years before finally getting assigned a regular physician, the emergency room is your only choice.

So if what you are really saying is socialized medicine is not health care. I'll buy that.

I can speak a little about ... (Below threshold)
kathie:

I can speak a little about the VA system. My brother who suffered a major stroke in his late 50's, fortunately had been in the Navy for one year sometime in his youth. I became his voice and found an assisted living care home in my home town for him.

Having never purchased medical insurance, fortunately, he was able to use the VA system.

No matter which department he went to the Doctors could pick up his records by using the last four didgets of his social security number. Even though we made an appointment, 15 or 20 other people made an appointment for the same beginning hour. We never went for an appointment when we didn't have to wait for a minimum of 6 hours. I would say the Doctors were very good even excellent, however we never met the same doctor twice. My brother could not speak because of the stroke, so I needed to be there at every turn to explain who is was and what he could do and couldn't do. I think that most of the doctors were visiting Doctors from the many hospitals in the area. Thank goodness, but the people who needed their service were bodies with the last four didgets of a social security number. One nurse never knew what another nurse knew, except what the computer said someone knew.

Fortunately I worked from home and was able to move my schedule around. If I had had a 9 to 5 job I could never have taken care of my brother and his medical needs through a VA system.

The system was impersonal, time consuming, did I say impersonal, expedient, did I say impersonal. I thought many times that maybe I would rather then die then be in this kind of system.

I firmly believe that Americans do not want to be treated as a number instead of a individual who needs care. A government run system is not a system for individuals, but for the collective. It is well worth going to town hall meetings and making sure your voice is heard.

You want a story about gove... (Below threshold)
jim m:

You want a story about government run health care?

I used to work for a medical device company and a few years back Cook County Hospital in Chicago was building a new facility. They desperately needed it as they had not only outgrown the old building, but the old building was ancient and crumbling. It remains the only building I have ever been in in the US where they still employed elevator operators because they had never updated the elevators.

Anyway, with the new hospital it was decided that they would need all new equipment. Not that they would get additional equipment or upgrade equipment that needed it. EVERYTHING would be brand spanking new. No equipment was to be moved from the old hospital.

In order to coordinate this they hired a firm to purchase the equipment. The county paid full list price (which nobody ever paid, but I was told by the purchasing agent to quote them list) plus an additional mark up for the purchasing agent. The new hospital is beautiful. The equipment is excellent. It's certainly new.

The point is they spent untold millions of dollars on equipment that wasn't needed when some of the equipment replaced was only 1 or 2 years old; and they universally overpaid for everything.

I'm so glad that we are going to save money with socialized medicine.

Jim M....saving money is go... (Below threshold)
kathie:

Jim M....saving money is good. But hospitals should be in the business of saving lives. If they are run by corrupt people, those people need to be prosecuted. We don't need to kill people to prove a point. You are from Chicago......I would never have guessed.

jim,There are thos... (Below threshold)
Rance:

jim,

There are those who argue that anyone who is uninsured can always get free health care at the ER.

When they make that claim. They aren't talking about all of health care.

Your mother couldn't have walked, uninsured, into an ER to get her initial mammogram. She couldn't have got her tumor surgery there, either.

This country does have excellent health care for those of us who are insured. For people who aren't not so much.

The point is that when the ... (Below threshold)
jim m:

The point is that when the government runs things there is really no incentive to do anything efficiently. There is no incentive to get the most for the money. If you run over budget you just raise taxes.

In working with the real world, you need to demonstrate a return on investment. Health care organizations may be not for profit, but that doesn't mean they are for running at a loss.

Making a profit in this arena means being able to invest more in the organization. Add additional capacity. Offer new services.

The problem with health care is not quality. There are many places where you can find excellent doctors and services.

The problem is not accessibility. Health care is available everywhere.

The problem is cost and what the government proposes is not an actual reduction in cost but a freezing of payment. So it costs the payer less money. There is nothing in any of this legislation that will reduce cost for the people providing health care services so they can reduce what they charge. On the contrary there is more expensive red tape. There are more oversight committees and government panels.

Want to make drugs cheaper? How about reducing the red tape in getting them approved? Why is it that data must be collected inside he US only? Why does valid data from Canada or Europe not count? Why not have some reciprocity? European nations do.

The same goes or technology. It costs huge money to clear a device for the US market. many devices area cleared for procedures in Europe and the rest of the world but they are not available here because of cost. Reduce the cost to access the market and reduce the cost of health care.

Want to make physician services cheaper? How about doing something to reduce their malpractice insurance by addressing tort reform? Good reform would mean making it easier for justified claims to be paid and false ones to be discouraged. It could be done. Nobody is proposing anything.

I'll note that these two issues are totally off the table. This is not about making health care more affordable it is about controlling the economy and controlling jobs.

Rance - I will agr... (Below threshold)
jim m:

Rance -

I will agree that filling in the gap for the uninsured is a worthy goal.

I will argue that we should not be providing the same health care for people who are here as illegal aliens. Yes compassionate emergency care we should give and already do give. But why should we pay to give them equal care when they are committing a felony?

There are ways to make insurance easier to get. They state by state barriers are one issue. The taxing of health insurance is another. I have a friend who is a consultant. He cannot buy health insurance with pretax dollars like I can. Why?

Reducing the quality of health care in order to create some sort of equal access is not the solution. Reducing the quality so that people die more often from their disease (as they do in Canada and Europe and everywhere else there is socialized medicine) in he name of universal access is not a good answer.

RE: 1)DJ, try this... (Below threshold)
epador:

RE: 1)

DJ, try this separation on for size, no need to re-invent the wheel:

1) Preventive Medicine - immunizations, check-ups, school and annual physicals, cancer screens, counseling regarding life-style, diet, exercise, drug use, sex, to name a few examples. This also includes Public Health efforts for clean air and water, safety in the home and on the road, etc.

2) Occupational Medicine - both preventive and reactive programs for occupational illness and injury - includes but by no means limited to Workman's Comp, Black Lung programs, etc. Also includes screening and managing workers to make certain they can perform their jobs safely - physicals for transportation workers in air, land and sea transport, etc.

3) Military Medicine - all of the kinds described above and below geared for the needs of a robust military program.

4) Acute Care - Hospital, ER, Urgent Care, same day appointments to a Primary Care provider, for unexpected medical problems that require urgent attention. Problems may or may not be life-threatening.

5) SubAcute Care - follow up for Acute Care Problems, or problems that are not urgent but require some attention, and are expected to resolve within 6 months. Includes many elective surgically treated problems as well as medical problems. Includes short -term rehabilitation after injury, illness or surgery.

6) Chronic Disease Management - Treatment and Evaluations for chronic disease that requires more than 6 months treatment. The pharmacy cost for chronic disease management is the often the largest portion of an annual general health care budget.

7) Mental Health - unfortunately artificially carved out in the initial creation of health insurance and thus separated from the rest of the health care system, despite the fact that over 70% of Primary Care visits have a significant mental health issue as part of the complaint.

8) Custodial Medical Care - Skilled Nursing homes, assisted living facilities and home health care/hospice care.

Most people use #4 and 5. If they avoid an ER or Urgent Care and go to a Primary Care provider, the services can be provided relatively cheaply and efficiently. In the current system.

#1 and #2 are expenses that are predictable, and really have no place in a true insurance system for catastrophic illness. In a effort to reduce costs for #4-6, systems have included these to variable degrees, though there is really no evidence published that outside of immunizations and a few pediatric/neonatal/pregnancy interventions, that there are true cost reductions.

Attempting to develop a new payor system as a means of coordinating the various systems listed above (minus #3) is putting the cart before the horse. Mayo Clinic and Kaiser, as examples, have their systems working rather well. They seem to favor most of the new payor system recommendations. They are not positioned, however, to take over care for the entire country.

I think that there are ways of encouraging more coordination of services with private competition being a robust part of the program, and THAT should be part of the effort for "Health Care Reform." As I've endlessly repeated, ensuring a lasting change in health care culture that encourages patient safety is a second goal that reform needs to address. Lastly, as long as the patient has a major disconnect from how and where money is spent for their care, true competition and cost savings will not occur.

The Democrat and White House programs do not address these vital issues.

"The point is that when ... (Below threshold)
JLawson:

"The point is that when the government runs things there is really no incentive to do anything efficiently. There is no incentive to get the most for the money. If you run over budget you just raise taxes.

In working with the real world, you need to demonstrate a return on investment. Health care organizations may be not for profit, but that doesn't mean they are for running at a loss."

A slight correction there, jim m - When government runs things AND THERE'S NO COMPETITION, there's no incentive to do anything efficiently - whether that efficiency in the use of time or money.

Kathie's example mirrors that of a friend of mine who went for VA care in the late '80s. It was good care, but when he went, he knew he'd be there the entire day just to see a doctor, even if he had an appointment.

We need reform - but setting up a monolithic government agency to take over the whole spectrum of health care isn't the way to go. Reform Medicare/Medicaid, implement tort reform - and then we'll see what the situation is. But taking the Medicare/Medicaid model and applying it to the entire spectrum of health care looks to be a real disaster waiting to happen.

Agree with most points, but... (Below threshold)
HSinger:

Agree with most points, but reject lumping Medicare in with VA and Medicaid. Medicare is efficiently administered and effectively the model on which a Single Payer plan might be based, and well it should, while leaving private insurers as an option. Medicaid is state-administered & meager in its provisions while nearly bankrupting hospitals & providers.

The government can't even p... (Below threshold)
Madalyn:

The government can't even put a letter in the correct mail box, how in the heck do you suppose they are going to take care of our health? Get a grip you idiots in Chicago. Your messiah is corrupting our country just like the chicago mob, and he will be impeached or voted out of office (unless of course ACORN, SEIU, etc) buys the same amount of votes for him like they just did. Guess money does talk. Too bad for you the real Messiah will have the final say on where he ends up (you too).

While I would agree that Me... (Below threshold)
epador:

While I would agree that Medicare and Medicaid are separate entities with different problems, Medicare is no shining example.

In my county, trying to find a physician who will take new Medicare patients is night to impossible. The only doc in town who is taking them at this time is not someone I want seeing my father.

The system is going broke despite the fact that the approach to fix it - adding a specific Medicare wage tax years after the program was initiated - has been instituted along with attempts to control costs, only in part because of the addition of Part D (drug) coverage.

You are also leaving out the fact that Medicaid is also bankrupting the States.

Medicare is administered by... (Below threshold)
CJ Newsome:

Medicare is administered by a private insurance company who has entered into contract with the government and is regulated by same. The government dictates coverage, pricing, and availability - only those 65 and older have access. Medicaid is funded by the government and also managed by private companies contracting with the State to administer the program. Medicare and Medicaid covers 40% of the nations populace under these two programs. Unless and until the waste in these "public" programs, not to mention the abuse and fraud, are brought under control and or "reformed" should the government endeavor to push another "public" option on the American people. What "private" company will administer this "HEALTHCARE" - and will it not be the same type of "insurance" as Medicare/Medicaid with all the same problems! Individuals like me who work hard, pay taxes, live from paycheck to paycheck and very rarely move forward to financial "security" have been paying the tab for these programs since their inception. The "entitlement" attitude that the government should take care of the people is entirely and utterly unconstitutional and against all the principles on which this country was founded - the freedom to live our life as we choose and pursue what we individually define as "happiness" - We, as a people, need to awaken and "DECLARE OUR INDEPENDENCE" from a government of oppression, regulation, and taxation without representation. We need to ask - if the "Healthcare Reform" is to stabalize our economy - who will benefit? Certainly not the American People.

Medicare is efficiently adm... (Below threshold)
JLawson:

Medicare is efficiently administered - HSinger.

I disagree. Estimates are that up to a third of the Medicare budget is eaten up by fraud.

Clean Medicare up COMPLETELY - wait five years - THEN talk about expanding it. But the fraud levels in Medicare are terrible.

Most people consider cost t... (Below threshold)
insurance:

Most people consider cost the primary reason for choosing one insurance policy over another. While certainly important, there are additional and by no means less important factors. Among them are some questions to consider.




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