Democrats’ Socialized Health Care Plan Threatening America

Investor’s Business Daily | July 14, 2009

Socialized health-care is being rammed down the throats of the American people. Leftist schemes that have been a dismal failure under communist and socialist countries are now here!

The legislation includes big tax surcharges on the rich, a public plan and fines on employers that fail to provide coverage and individuals that don’t get it. Hoping to regain momentum after several stumbles, top House Democrats insist that they’ll move before the August recess.

The bill’s coverage provisions will cost $1.042 trillion over 10 years, according to a preliminary Congressional Budget Office analysis. Virtually all would come in the last seven years.

With voters’ deficit fears growing almost as fast as America’s red ink, Democrats have scrambled to pay for reform’s huge costs.

Surcharge Howls
The updated House proposal — a joint effort of Ways and Means, Education and Labor, and Energy and Commerce — includes an income tax surcharge. It would impose a tax of 1% of families with incomes between $350,000 and $500,000, and an additional 1.5% for those earning $500,000 to $1 million. It would rise to 5.4% for couples making over $1 million.

The surcharges — on top of expiring Bush tax cuts on the rich — would go higher if cost savings in the bill don’t materialize.

The tax hikes may be the biggest sticking point with Blue Dogs. “No,” replied Rep. Dan Boren, D-Okla., when asked if he could support a surcharge.

Cooper’s aide said his boss “won’t rule anything out, but it’s not his preferred option for achieving budget neutrality.”

Republicans have slammed the surcharge as an attack on small businesses. Minority Whip Eric Cantor, R-Va., used the surcharge to ask Obama to join Republicans “in a pledge not to impose taxes on small-business men and women.”

But Obama praised the House bill, saying it will “begin the process of fixing what’s broken.”


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Fines And Medicare Cuts
The House plan would fine employers who fail to offer health insurance and individuals who fail to get it. Small business in particular opposes an employer mandate.

The legislation also relies heavily on Medicare cuts to finance the program. They include $202 billion by reducing hospital readmissions and tweaking other calculations that would mean hospitals, home health agencies and other providers get less money than under the current system.

. . . more

Comments

  1. RBCinTexas says:

    1. The healthcare bill is over 1000 pages and again not a single member of Congress will have read the thing

    2. The government estimates that it will cost over $1.6 trillion and things always end up to cost at least 5 times more than they estimate

    3. The structure of the bureaucracy that this bill requires will almost guarantee not only the destruction of our healthcare system but will make it almost impossible to get the level of care that we are receiving today

    4. The healthcare system is huge and extremely complicated and yet we have politicians who have no experience in healthcare making rules that will grid lock our healthcare system, drive up costs, create massive fraud and waste and they have done all of this in less than 60 days

    5. This is the same government that has bankrupted everything that they have touched

    6. Fraud, abuse and cronyism is out of control in Washington and is now costing us billions of dollars

    The government is incapable of bring any type of efficiency to anything. When the government gets involved, whatever they are trying to correct has always ended up being much worse than it was before.

    One of the lead architects of this bill is Ted Kennedy who was also one of the lead architects of the 1960s immigration reform at which time he guaranteed the people of the United States that the bill the reform bill would stop illegal immigration and that we would likely see no more than 400,000 illegals yet today even after the amnesty of 1985 we have over 20 million illegals in our country.

    This bill is not only going to destroy our healthcare system it will cost our country millions of jobs, require another massive tax increase and ultimately cause everyone to be part of a single socialized and massively inneficient government machine.

  2. Blog-Editor says:

    This is a classic nightmare government scenario, a boondoggle (term for a scheme that wastes time and money). Just looking at that chart alone shows us the insanity of the plan and what a mess it will make of an already complicated problem. Things are poorly managed now, it will be come an Orwellian/Marxists enslavement machine once the career politicians in Washington implement it. It will make all of us worse off then before and help undermine our world-class medical system. God help us!

  3. Blog-Editor says:

    The non-partisan Congressional Budget Office (CBO) confirms what all of us conservatives suspect, this health-care nightmare plan will not do what it claims and will raise costs to most taxpayers.

    CBO: Health reform bills moving the wrong way
    http://finance.yahoo.com/news/CBO-Health-reform-bills-cnnm-847945793.html?x=0&sec=topStories&pos=main&asset=&ccode=

    The health reform bills released so far would increase government spending on health care without sufficiently reining in health care costs.

    And at least initially they aren’t likely to significantly lower premiums for the majority of Americans with employer-sponsored health insurance.

    That’s the sobering takeaway from testimony Thursday by Congressional Budget Office Director Douglas Elmendorf.

    [...]
    The long-term concern
    The CBO has said numerous times and in numerous ways that the federal budget is on an unsustainable course. The economic crisis has made the debt situation more urgent, but it is not the primary cause.

    “Over the next 50 years, with rising health care costs, the retirement of the baby boom generation, and the permanent extension of the 2001 and 2003 tax cuts, federal debt will climb to more than 400% of the gross domestic product,” Senate Budget Committee Chairman Kent Conrad, D-N.D., noted during Thursday’s hearing.

    But there will be risk to the economy within the next 10 years. The country’s debt is on track to exceed 60% of GDP next year and will top 80% by 2019. And that assumes interest rates stay low.

    Should buyers of U.S. debt grow concerned, however, that the country is not addressing its debt situation adequately they will start demanding higher rates, which would make the country’s debt situation even worse. That’s why fiscal policy experts have been calling on lawmakers to rein in health care costs, find ways to boost tax revenue and cut spending as soon as the economy is in recovery.

  4. Jim Holman says:

    I hear a lot of complaints about the plan, but what I don’t see much about any alternative plans. Over on a related thread Tom C. wrote:

    Where there is no incentive for unhealthy people to limit their medical care they will consume full tilt and the medical providers will be happy to comply – since somebody else is paying. There are two remedies for this: 1) forced rationing of care, and 2) alignment of consumption and payment. I favor a system that emphasizes #2.

    Alignment of consumption and payment — is this not what we already have? Here’s my personal experience:

    I am currently unemployed in a state in which unemployment is over 12 percent. I pay $740 a month for COBRA benefits. That plan comes with a $500 deductible and $5,000 additional maximum out of pocket. Except — many of the copays and the deductible don’t apply to the max out of pocket. The bottom line is that — while unemployed — I could end up paying over $14,000 for health care in a single calendar year. But depending on when health care costs were incurred — split between two calendar years — I could end up paying almost $20,000 in a 12 month period.

    As I read through this blog, I’m reading only with my right eye. Why? Because I’m mostly blind in my left eye because of a cataract. This could easily be fixed in a 30 minute surgery. But between my share of the hospital bill, the surgeon’s bill, and the anesthesiologist’s bill, I would end up paying around $2,000. Currently, I don’t have that kind of money laying around. Jobs being difficult to find, I have no idea when I’ll be able to have the surgery.

    So we hear all of these horror stories about “waiting periods” in Canada. Well, we have waiting periods here, worse than anything in Canada, depending on when you might have the money to afford certain procedures.

    On top of that I have two crippled knees, wear braces on both legs, and take narcotics four times a day. I could get knee replacements — if I had the money — but even then I don’t have the money to go through the rehabilitation period. If I stop looking for work, I don’t get unemployment. When I start working I’ll have to wait until I have enough sick time to get the surgery done, whenever that will be. Again, I’ll take the Canadian waiting period any day over a life of chronic pain for an indefinite amount of time. At this point all I can hope for is that my knees won’t deteriorate to the point where I end up on crutches or in a wheelchair.

    And ironically, I’m fortunate that I have health insurance at all. But the clock keeps ticking, and eventually COBRA will run out. Will I get a job with benefits before that? Who knows?

    This is the system we have today, and I am one of the “poster children” for it. When it comes to health care in the U.S. all of us are only a few steps away from the abyss, some of us closer than others. Aligning consumption with payment? That’s what has happened to me. As health care becomes unaffordable you stop getting health care. Great idea. Been there, done that, got the tshirt.

  5. Scott Jewett says:

    Yes, I believe that socialized healthcare will be another mistake made by our government. Every other nation that has embraced socialized healthcare has been a disaster. I currently don’t have health insurance. Do I like this? No, I do not. Would I like the government to hand me a healthcare package at no cost to me? Sure I would, if I really thought it would work. I don’t have high hopes for this plans success. If you never have a serious illness, and could afford to wait six months to see your doctor, then this plan is for you.

    All a person has to do is look at other nation’s that have socialized healthcare. Let’s use Canada as an example. Do you know how many thousands of Canadian’s die each year because they are placed on waiting lists to see their doctor? There are thousands who visit the U.S. each year and use their own money to seek competent healthcare by our doctors. This to me, is the biggest signal that socialized healthcare does not work.

    Let’s talk about the doctor’s who practice medicine under a socialized healthcare system. They are told by the government what they will make and who they have to see. This takes the excitement out of this profession entirely. If you know that you are at the government’s mercy for your income, you are less likely to be as energetic or interested in the job you do. This also will eventually limit the amount of people who choose medicine as their profession. Hence, the shortage of qualified doctors who are available to see a patient when there is a need. This is the largest single problem with socialized healthcare. This is why there are long waiting lists before you can be seen. This is kind of related to the law of “supply and demand”. If the government regulates the healthcare industry to the point of not having enough doctors’, supply goes down. Unfortunately, the demand would not follow this trend. People get sick, that is the nature of life. So what does this cause? Not enough doctors available to provide healthcare to the many that need it. This also in turn causes the quality of healthcare received, to reduce to unacceptable levels. You can’t blame the few doctors who are left. They have decided to stay in a profession that is fully regulated by our government. You have to respect their choice, they want to help people. But it is impossible for them to tend to every patient as thorough as one would hope.
    My goal here is to put in my “two cents” with the hope that I reach one person and maybe enlighten them to see the inherent problems with socialized healthcare. Our government was not meant to work as the leader of our healthcare or financial system. But this is what is happening. They want to control our banks, our insurance industry, our auto industry, and now our healthcare. What are next, our supermarkets or our clothing stores? Eventually, I see Communism or Socialism in our future. Don’t forget, communism does not work. Russia proved that.

    I know our current financial and healthcare systems have many problems that need fixed. I am not saying that we have a perfect system. I just believe that socializing it is not the answer. I believe that our government’s responsibility lies in punishing the “wrong doers” only. Maybe if corporate execs who take large amounts’ of compensation from struggling industries were punished, than that would begin to repair our faltering economy.

  6. Hey Jim -

    Sorry for all that. You seem to be having a rough time of it. You said,

    So we hear all of these horror stories about “waiting periods” in Canada. Well, we have waiting periods here, worse than anything in Canada, depending on when you might have the money to afford certain procedures.

    I have lived under socialized medicine, and it isn’t just the waiting periods. It is the absolute rationing as well. I watched my wife’s grandfather die because the government health system turned him down for a routine heart procedure.

    You have issues. I understand that. Health care is expensive, and you want help. But what makes you think the government plan would provide it? What happens when the government plan says, “Jim, you aren’t worth it. You are not valuable enough to society to warrant us fixing your eye, or you knees, etc. Sorry – you can’t get the treatment, and even if you have the money, we won’t let you buy the treatment. You just go suffer and eventually die. Health care is for the young and productive who pay taxes – see ya!”

    You sit in your home, in pain and broke, and you ask how much worse can it get? A lot worse. You can be facing euthanasia of infirm infants and old people to reduce the waste of resources on those unworthy of life. You can face a gauntlet of nameless, unaccountable bureaucrats to get routine, simple procedures. It can get much, much worse.

    Don’t like the Pentagon? Don’t like the immigration department? Does the out-of-control nature of the police forces bother you? Don’t like the invasion and erosion of civil liberties under the Patriot Act?

    Then why on Earth would you want to give the same type of people who run those bureaucracies the power of life and death over any sick individual? How long until critics of the regime find themselves denied health care as a way of silencing them.

    Don’t think Obama will do that? Fine, then imagine the next Bush with that kind of power. Shut up, sit down – or I deny your kids needed medical treatment. Criticize me, and a family member suddenly goes to the bottom of the list.

    Come on, Jim. Do you actually think that kind of massive power won’t be abused? Be serious. Next thing you know, you will have SWAT teams closing private clinics because they unfairly compete with the government.

    As for expense – mint more doctors. Way, way more doctors. Why can’t we train doctors on every street corner the way we seem to do lawyers? If necessary, import tens of thousands of doctors from the 3rd world. Competition cuts cost. If you have an MD or PA on every corner, then the prices will drop.

    Government regulations drive up the expenses. The government and the pharmaceutical companies collude to drive up the cost of prescription medicine. The government is a cause of the problem, not the cure.

  7. Jim Holman -

    I’m sorry to hear about all of your health problems.

    But in spite of the emotions invoked by your story and countless others, we have a duty to think clearly about public policy. Economic principles apply, whether we want them to or not.

    Medical insurance costs a lot because, in aggregate, medical procedures are sought without regard to cost (by the 88% of the people in your state who are employed, for example). The costs are spread over those who have insurance, and the total is paid by employers in the great majority of cases, so the individual has little incentive to limit un-necesssary or non-critical spending. That was the explanation for the two towns in Texas with vastly different Medicare spending.

    It is misleading to suggest that government-run medical insurance would “control costs” without mentioning that the cost control is on the aggregate spend, not on the individual procedure. In other words, costs are “controlled” by limiting access, not by improving efficiency.

  8. Jim Holman says:

    George writes: “Health care is expensive, and you want help. But what makes you think the government plan would provide it? What happens when the government plan says, “Jim, you aren’t worth it. You are not valuable enough to society to warrant us fixing your eye.” & etc.

    At this point I don’t know what’s going to come of all the talk of reform. I think there’s no way that we’re going to end up with “socialized medicine,” unless one defines any government involvement as “socialized.”

    The fact is that insurance companies already deny coverage for all sorts of procedures and medications. For example, my insurance plan does not cover “injections.” Yes, that’s right. Any time a physician appears with syringe in hand, that’s not covered. It’s nuts, but that’s the plan. Insurance companies employ legions of people who do nothing but figure out ways to deny coverage for various procedures, even retroactively.

    One huge problem is that health insurance is typically tied to employment. That has two negative consequences. First, your choice of health plan is limited to what the employer offers. That means that if you change jobs sometimes you actually have to get a new doctor. So much for continuity of care and the patient-physician relationship.

    The other consequence is that when you lose your job you either lose your insurance, or end up having to pay large premiums at the very time when you lose your income.

    We need to find a way to decouple health insurance from employment, or at least make sure that people can get coverage while unemployed. We also need to fix the system so that people don’t have to fear going bankrupt from health care expenses. For example, one chain of long-term care facilities around here offers as its only option a health plan with a maximum $25,000 of annual coverage, and the plan doesn’t cover family members.

    Concerning Canada — we hear about the waiting periods and other problems, but in recent years those things have been improved. In 2004 the Canadian government didn’t even have good data on waiting periods. Now they do, and those problems are being improved. Not perfect, but improved. The point is that with some government involvement people can at least petition the government for better service and coverage. Here in the U.S., if your insurance plan denies coverage, to whom do you appeal? To the same people who denied coverage.

    George: “Then why on Earth would you want to give the same type of people who run those bureaucracies the power of life and death over any sick individual? How long until critics of the regime find themselves denied health care as a way of silencing them.”

    We already have government insurance plans, Medicaid and Medicare, and nothing like that is happening. And again, how is giving private corporations, often profit-driven, the power of life and death any better?

    George: “As for expense – mint more doctors.”

    But that doesn’t work. We already have areas of the country with a surplus of physicians, and costs don’t go down. The same with hospitals. Some cities have an excess number of hospital beds, and costs don’t go down.

    Tom C writes: “Medical insurance costs a lot because, in aggregate, medical procedures are sought without regard to cost.”

    That may have been the case at one time, but today most health plans have copays that work against that. E.g., if you have to pay 20 percent of the cost of a $1500 MRI scan, you’re hardly going to get one of those every month.

    Not treating the health care system as a system also drives up health care costs. Many decisions in hospitals are driven by a desire for prestige. Hospitals want to have their own transplant programs, their own MRIs their own CAT scans, etc. They buy this expensive equipment and get into these programs without regard to whether there is already sufficient capacity in the community.

    When I was in the hospital business, I worked at a place with a heart transplant program. Another hospital also wanted a heart transplant program — not because there was a need for additional capacity, but because when patients got transplants at my place they became patients at my hospital. In other words, through not having their own program the cardiologists at the other hospital lost patients, and thus lost revenue. Wanting their own program had nothing to do with providing better or cheaper care. So we ended up with two transplant programs, two transplant coordinators, two sets of nurses and social workers specializing in transplants, etc. etc. The same number of patients was spread out over two programs, thus driving up costs and creating two weaker programs.

  9. #8 Jim

    “…if you have to pay 20 percent of the cost of a $1500 MRI scan, you’re hardly going to get one of those every month.”

    Another way of saying this is:

    “..even if you are not in dire need of an MRI, your fellow insurance policy holders will chip in for 80% of the cost. You will not see the consequence until your employer has to pay higher rates next year. Only a portion of the higher rate will fall on you, so you will not think very hard about not getting that MRI next year.”

    When insurance companies “deny coverage” they are really “controlling costs”. What on earth makes you think that the government can “control costs” without denying coverage?

    So much of this is can be understood by reading a simple textbook on economics.

  10. Jim Holman says:

    Tom C writes: “When insurance companies “deny coverage” they are really “controlling costs”. What on earth makes you think that the government can “control costs” without denying coverage?”

    It’s not magic. It’s simply of matter of traditional process improvement and elimination of non-value-added activities.

    One huge example of non-value-added activity is the current insurance billing and reimbursement system. At the hospital I worked at, back in the 1980s they generated around 3 million billing records per year. My guess is that’s now up around 5 or 6 million per year. Many of these are manually generated. And this is just ONE medium-size hospital. Multiply that by the many thousands of hospitals and clinics around the country and you get some idea of the order of magnitude, and the labor and number of people involved.

    In order to generate those milions of billing records every year, you have to set up between 50 to 80 thousand entries in your hospital’s “charge description master” file. These, of course have to be maintained, and there are people in a hospital who do nothing but that.

    And in order to do any of that you have to have multi-million dollar computer systems to support all of that.

    Then, you actually have to create bills to be sent to the insurance companies. There are Thousands of insurance companies, and for each of those, many different kinds of payment schemes, all driven by contracts. So of course you have many people in a hospital working on these contracts and maintaining the “insurance master” file.

    For each insurance company you can be reimbursed according to a percent of charges, flat rate, per diem, DRG (diagnosis related group) and so on. So hospitals employ vast legions of people who figure all of that stuff out. My first job in a hospital was in the patient account department, and I was one of the many drones who worked on that. Back in 1984 there were 100 people in the patient accounts department; heaven knows how many there are today. Again, that’s what is required for one medium-size hospital.

    But wait! That’s just one side of the transaction. On the other side are the many millions of other people who work in insurance companies processing claims, setting up contracts, etc.

    All of these millions of people, and all of these activities, don’t give a single injection, and don’t administer a single pill. This vast, monumental overhead bureaucracy that has been created, of which I was a part, is totally, 100 percent non-value added. To the extent that we can reduce this, it represents a real savings — money that can be redirected to actual medical care — that does not harm quality of care one whit.

    This is why there is so much interest in a single-payer system, and why the insurance industry executives, with their multi-million dollar salaries and bonuses and golden parachutes, will fight tooth and nail against it.

    You tell Dracula that he’s not going to be able to feed off of you any more, and Dracula won’t like that. To say “we won’t have single payer, we’ll just have the insurance companies compete more against each other” is like saying “we won’t eliminate Dracula, we’ll just encourage Dracula to drink less blood.”

    And this is just one thing. Add to that the vast billions of dollars that can be saved through better contracts and pricing for medical supplies and pharmaceuticals, streamlining of other processes, prohibiting physicians from referring patients to diagnostic centers in which they have a financial interest, better implementation of best practcies, etc., etc., and you begin to see that there is a huge opportunity for savings. In some cases government will be very involved, in some cases not.

    And none of that involves denying anyone any coverage.

  11. #10 Jim

    Apply a reductio ad absurdum to your argument in #10. Everything you assume to be true (excepting leveraged pricing) should apply to car insurance, home insurance, education, automobiles, computers, housing materials, you name it. Why not just have the government take over manufacture and provision of all these? Oh, sorry, I guess they already are taking them over.

    The reason you don’t want the government taking these over is that if you eliminate private enterprise and competition it leads to waste and fraud. If you think that paying insurance executives big salaries costs consumers a lot wait until you start paying the government union “drones” processing claims.

    The reason comptetition is not operating right now for health care is that the third-party-payer phenomenon eliminates the incentives for consumers to exercise purchasing decisions.

    Look, I’m not saying that the system is not broken. It is. I just don’t buy the single-payer cure.

  12. Jim Holman says:

    Tom C writes: “The reason you don’t want the government taking these over is that if you eliminate private enterprise and competition it leads to waste and fraud. If you think that paying insurance executives big salaries costs consumers a lot wait until you start paying the government union “drones” processing claims.”

    Good theory, but in the real world it doesn’t work that way. Take Medicare, for example. Medicare is basically a single payer program for elderly people. But the claims are audited and processed through contracted third-party intermediaries. So you get the simplicity of a single payer system along with competition for who does the actual work of claims processing. However you want to calculate it, Medicare overhead costs are lower than those of commercial insurance companies.

    Just as important — and this is rarely mentioned — Medicare, or any single payer system — is easier and cheaper for hospitals to work with. One system, one set of rules, one contract. All of that translates into an economy of scale and simplicity of process, inasmuch as anything in the medical world can be simple.

    Medicare also was a leader in cost control. In 1984 Medicare developed the system of DRG (diagnosis related group) reimbursement in which inpatient stays were reimbursed according to a fixed schedule based on the type of case, rather than as a percent of charges. This has been widely implemented throughout the world of commercial insurance.

    No system is perfect, but as far as I can tell, in the real world, single payer works about as well as anything can.

  13. #12 Jim

    OK, I concede the point for the sake of argument. Billing might be more efficient under a single-payer system.

    But, so what? What about the delivery of medical services, which is what we are really talking about. The myriad decisions regarding which procedures are provided for which people at what price will now be determined by government decision makers rather than market forces. It is not plausible that the savings from billing and other paperwork will be so massive as to make up for the inefficiences that will inevitably follow from a non-market based system.

    You have had several people, on this thread and the last, testify to their experiences regarding socialized medical services as compared to the (admittedly flawed) American system. Maybe they have some real world experience and their advice is worth heeding.

  14. Jim Holman says:

    Tom writes: “What about the delivery of medical services, which is what we are really talking about. The myriad decisions regarding which procedures are provided for which people at what price will now be determined by government decision makers rather than market forces.”

    I would find your argument more persuasive if there were evidence that government health programs are consistently less rational and workable than private insurance. In my observation, with few exceptions, the evidence is largely to the contrary.

    And getting worse all the time. There are countless horror stories of commercial insurance refusing to pay for (refusing to authorize) medically warranted treatments and diagnostic tests. On top of that is the practice of rescinding medical coverage after the fact, based on the pretext of some trivial but unreported condition, when it turns out that the patient develops an unexpected disease.

    And this is on top of the practice of not covering anyone with preexisting conditions, sometimes almost to the point that one has to have virtually perfect health in order to get private insurance. And that’s on top of the practice of companies offering employees insurance plans that are so marginal that they barely qualify as “insurance.” A friend recently told me about an employer’s plan with a high deductible and low annual benefit such that the plan provided a benefit only if one’s health care expenses were between $1000 and $5000 per year. Less than that or more than that and the “insurance” essentially vanished (but, of course, not the payment of premiums).

    Government programs are not perfect; no program is. But private insurance is increasingly unreliable and unobtainable even as premiums rise almost as fast as the compensation of health insurance executives.

  15. #14 Jim

    Re-reading your posts here I get the overwhelming feeling that you have a big emotional investment in this topic, which is understandable given your medical needs. But emotions aften cloud clear thinking.

    You and others are being sold a bill of goods (and services, I guess). There is simply no way that insurance coverage can be expanded, no one denied any services, and costs lowered, without drastically curtailing current treatment options and quality. Robert Samuelson, a fairly dipasionate writer on these topics puts it thusly:

    If you listen to President Obama, his “reform” will satisfy almost everyone. It will insure the uninsured, control runaway health spending, subdue future budget deficits, preserve choice for patients and improve quality of care. These claims are self-serving exaggerations and political fantasies. They have destroyed what should be a serious national discussion of health care.

    The whole article is worth a read: http://www.washingtonpost.com/wp-dyn/content/article/2009/07/26/AR2009072602188.html

    Really, though, you give the game away when you say “But private insurance is increasingly unreliable and unobtainable even as premiums rise almost as fast as the compensation of health insurance executives.” You are smart enough to know that executive salaries account for only a tiny fraction of medical insurance costs. But said executives make great villains if your aim is larger control of the economy and other people’s lives.

  16. Jim Holman says:

    Tom writes: “Re-reading your posts here I get the overwhelming feeling that you have a big emotional investment in this topic, which is understandable given your medical needs. But emotions often cloud clear thinking.”

    Also I worked in the business for 21 years, including the patient account/insurance/reimbursement end, and also was involved in some significant cost-cutting and improvement projects. This gives me a kind of “insider” perspective, as well as a firm belief that it is possible to do better.

    Tom: “The whole article is worth a read.”

    Thanks, I did read. I was struck by this sentence: ” . . . the administration can’t logically argue that much health care is wasteful and also that the uninsured will automatically benefit from more of it.”

    I’m not trying to defend any particular plan or administration here, but I don’t think the above is inconsistent. Uninsured (or poorly insured) people often don’t seek medical care in the early stages of a disease, when it could be of great benefit to them — e.g., diabetes and high blood pressure. Then they suffer from a heart attack or stroke or some other complication that could have been prevented with an occasional lab test and a doctor visit and pills that are so cheap that we could give them away. That doesn’t contradict the fact that there is a lot of waste in the current system.

    Concerning my emotions — what has happened with me is simply that the story that I have heard about with other people has in a small way become my story. Frankly, I’m doing much better than many other people, but my own experience brought home the reality of all of these other experiences in a very personal way. It’s me today, and (God forbid) you tomorrow, and we have to find a better way. Not a perfect way, but a better way.

    Tom: “You and others are being sold a bill of goods (and services, I guess). There is simply no way that insurance coverage can be expanded, no one denied any services, and costs lowered, without drastically curtailing current treatment options and quality.”

    In one sense I agree with you. We can’t do that overnight. In my experience with process improvement and cost-savings, what I saw is that improvements need to be incremental, and you can’t immediately do all that you might want to do. No one is that smart, and no one can possibly foresee all the problems that the reforms themselves might cause. And in that regard I also am disturbed by some of the reports of the “reforms” that are being discussed. Doing too little is a risk, but doing too much too quickly is a greater risk.

    This is one reason why I liked the idea of the “public option.” It would permit small-scale improvements and experiments along with the existing system. It would provide another option along with the existing system. As problems developed they could be addressed. If the new option stressed the system, the system could be given time to adjust.

    That said, I think “that insurance coverage can be expanded, no one denied any services, and costs lowered, without drastically curtailing current treatment options and quality,” but it might take 15 or 20 years to do that with cautious, modest, incremental reforms.

    Let me put it this way: reforming the health system is like putting man on Mars. It won’t happen successfully next year, but it might happen 20 years from now.

    Tom: “You are smart enough to know that executive salaries account for only a tiny fraction of medical insurance costs. But said executives make great villains if your aim is larger control of the economy and other people’s lives.”

    True, the executive salaries, bonuses, and golden parachutes are not the problem. But they are a symbol of the problem. That a handful of people can get phenomenally rich from funds that should be used for the health of others is a shame and a scandal.

    But not all executives are like that. For some years the director of the large hospital I worked at had a very modest salary in comparison with the obscene compensation of insurance executives. He loved people and he loved to see people saved from death, loved to see people restored to health. His wife was a nurse practitioner who worked with low-income pregnant women. He got a decent salary, but for him it wasn’t about the money but about helping people. I had the great pleasure of getting to know him, and to this day I have tremendous respect for him. Too bad there are not more like him.