A macro and micro view of US Health Care

An issue at the base of the system (me the consumer), and a big, overview of the whole enchilada...

The guy who writes the Health Care blog has written a nice summary of the overarching problems with US health care, you can read it at:
http://abcnews.go.com
Mr. Holt makes an informed case about the problems, and does point out that vested interests will fight any change. The insurance companies, as payers, are the obvious opposition, they benefit in employment and profits from the way things are. The providers (doctors, hospitals) are less obvious. The thinking is that providers get payed no matter who is paying. But Holt points out that there are so many inefficiencies in the system, such that any rational fix will lower payments to the end providers. A majority of doctors see this problem and oppose any fix, but they are not all together on this, witness the Physicians for a National Health Program (www.pnhp.org). Some estimate that 40% of physicians are for a National program, probably to rationalize it and keep more of their power.

Holt's conclusion is that it will take much political will to overcome the opposition, and I think we'll have to wait for 2008 for that to happen.

My trip to my dentist shows a basic problem with the current system in action.

During my last trip for a cleaning I was given an option for a wipe swab in my mouth which would more easily show early signs of oral cancer. Currently, without this option, the doc looks around and tries to see anything unusual. The new option is unproven, but if it works would be a benefit to all...hmm or maybe just to me as the system would possibly lose a full-blown cancer patient - BIG BUCKS!

Now, the hygienist told me if they get enough evidence of success, then the insurers would pay for the procedure. The insurers are not paying for this procedure since evidence is lacking, but why should I pay for research?? Because, if I can afford it, it's to my benefit. But how do I know if it works?? Is $50 cheap enough to make me participate in a study? Not in this case. I have faith in my dentist.

Shouldn't this be the wipe maker's problem? The problem for the maker is they have multiple insurance company payers to deal with, raising costs and squeezing out good but marginal solutions. But is it rational for the maker to ask me and other individuals to pay?? In this crazy market why not?

If we had a single payer system it would be much cleaner, easier and successful for all. A procedure/solution set for all would be defined, and whether the wipe procedure is in or out, and it would only be accepted if proven.

A solution for rational Health Care in the USA

Well, it didn't make the top 25 emailed articles in the past week, or even the top 10 in the Business section of the NY Times (I am a watcher and subscriber), but the Robert Frank article of February 15 entitled "A Health Care Plan So Simple, Even Stephen Colbert Couldn’t Simplify It", http://www.nytimes.com/2007/02/15/business/15scene.html, was a nice, short, thoughtful piece on our Health Care problems. It might be the most detailed proposal out there so far. Our Democratic hopefuls should take a look.

The plan cited is actually from Victor Fuchs, a respected health economist at Stanford University, and Dr. Ezekiel Emanuel, chairman of the department of clinical bioethics at the National Institutes of Health.

The Fuchs/Emanuel Plan outlines a single payer voucher plan that can work. Unlike the President's latest proposal, which is kinda goofy as per the Colbert quote in the article, and it focuses on strengthening the hold of private insurance and taking away the tax exemption that people who pay their insurance premiums though company plans. The latter is a good idea, to continue the dominion of the former is goofy. Why? Because as is we end up spending double what other advanced countries do for administrative costs, and we still have some 45 million uncovered Americans. Under the Fuchs/Emanuel plan, a single payer voucher system would save us $300 Billion per year in administrative costs. It would also:

• cover every American under the age of 65
• allow free choice of health plans
• freedom to purchase services beyond the standard allotment with after-tax dollars
• the private delivery system remains in place
• eliminates the need for Medicaid and other means-tested programs
• would eventually replace Medicare
• managed by a Federal Health Board modeled on the Federal Reserve System
  

This plan make so much sense economically (full coverage and more efficient), maybe not politically, but that's for the politicians to try.

Free Speech and money for war

The President, he respects the Senators (both Democrats and Republicans he noted) who disagree with him but are currently speaking and debating about his Iraq plan and the current situation, describing them as "honorable citizens". He knows they have an opinion, and have a right to express it. Isn't it refreshing to know that he knows the Constitution, which does allow freedom of speech. He also warns them to be aware of your audience as he does when he speaks. Well, when democracy stops at the border, should we shut down our free speech there? So that we don't "embolden" the militants? As the President said himself, sometime after 9/11 in trying to get people back on airplanes, if we don't get back to normal then they've won. Well, this holds for our Constitutional rights as well, if we, and especially our representatives, can't speak freely, then they've won.

The President also has studied the separation of powers between the Congress and the President, most importantly that the Congress has the money to dole out. In his news conference today he lobbied for the money for his plan, strongly playing the wimp card (implying the Democrats are such) by implying that if the Congress does not give him the money for his plan it would endanger our troops. Isn't that his problem for putting them out there before the money is approved?

Ah, it always gets down to the money in politics....

A short summary of the news conference is at: www.upi.com/NewsTrack/Top_News/20070214-112903-2899r/,

rob

Frontrunner picks

In just the recent history of presidential politics, we can see how the Republicans and Democrats differ. Coming from the NY Times, by Marjorie Connelly http://thecaucus.blogs.nytimes.com/2007/02/13/hey-i-know-that-guy/, (loggin needed)

this review of NYTimes/CBS news polls showed that early front runners in the Republican party in 2000 and 1996, George W. Bush and Bob Dole, respectively, were the also the Rep candidate for that year. For Democrats, it was Lieberman in 2000, Jerry Brown in 1992, and Gary Hart in 1998. None of these folks were the Dem candidate for President.

What this might indicate is that for good and bad, the Rep's know who they want early. For Dem's, it takes a process, or is it a village? My pet theory is that Rep's know not only who they want, but what they want and know, based on beliefs, while the Dem's struggle to find the who and the what among many good choices, still searching for answers? I know I am, and will continue to do so...