August 31st, 2009 by MotherJonesRN in Better Health Network, Opinion
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I hate it when I can’t get into conversations that are happening on my own blog. My job at UGH (undisclosed government hospital) has a way of getting in the way of my real life. Jeanne T. has asked a lot of valid questions about healthcare reform. She also asked me to answer some of her questions. Here we go:
Have you read HR: 3200?
I have not read all of H.R. 3200 – America’s Affordable Health Choices Act of 2009. Reading War and Peace is more entertaining than reading a congressional bill, so I only got through about 150 pages of text before my brain cells started imploding. However, I did learn a few things about the proposed legislation. No one is going to kill your grandma or reduce Medicare benefits. This new legislation will save money by cutting billions of dollars in overpayments to insurance companies and eliminating waste, fraud, and abuse. Maybe that’s why the insurance industry is spending billions of dollars to defeat this bill.
Question: Do you currently have money taken out of your paycheck
for Social Security?
Do you believe that you will receive Social Security assistance when you pass the age of 65, 70?
What is the reason that you and I will not receive Social Security checks?
Answer: Do I have money taken out of my check for Social Security? Is the Pope Catholic? The good people at UGH take money out of my check every two weeks for Social Security, and I know that I’ll never see that money again.
I’m a nurse for life, which means I’m not going to retire. In other words, I’m going to die with my Nurse Mates on. Unfortunately, I believe that my peers are going to receive meager monthly social security checks after they retire. I know where you are heading with this question. “If the government can’t run the Social Security Administration, what makes you think that they can run a public health care system?” It’s all President Franklin Roosevelt’s fault. The social security system is the ultimate Ponzi scheme, and Roosevelt set it up as a safety net to help out old folks just before they died. The average life expectancy back when Social Security was set up was around 60 years old. President Roosevelt got messed up because he thought he we would always have more money coming in than going out. He didn’t know that our life expectancy was going to go up, and he had no idea that future administrations were going to tack on more entitlement programs. Now Roosevelt’s Ponzi scheme is out of control, not so much because of government mismanagement, but because we aren’t dying off quick enough to make the system work. Hey, wait a minute. Maybe we need to rethink those death panels. Just sayin’.
Question: Can the US government run a public health insurance agency?
Answer: Yes, I believe our government can do whatever we have the will to do. We put a man on the moon didn’t we? If those blood sucking, profit driven, insurance companies who make their money by keeping us away from healthcare providers can run insurance companies, why can the US government? Uncle Sam wants to keep us around until we’re too old to work so we can keep paying into the social security system. See above.
Question: How do you feel about politicians writing healthcare reform versus healthcare professionals?
Answer: I think that healthcare providers are in a better position to understand the lingo and the fine details that go into healthcare bills, but that doesn’t necessarily make them more trustworthy when they champion causes. The letters “MD” does not mean anything if the person lacks integrity. In my opinion, Dr Howard Dean is a man of great integrity. By the way, there are three nurses in Congress: Eddie Bernice Johnson (D-TX), Carolyn McCarthy (D-NY), and Lois Capps (D- CA). I’ve had the honor of meeting each one of these fine ladies. They rock! Johnson and Capps support public option healthcare reform. McCarthy’s website reports that she supports H.R. 3200 – America’s Affordable Health Choices Act of 2009.
That’s it for part one. I’ll write part two later. Like I said, working at UGH has a way of getting in the way of my personal life. It’s been nice talking to you. Keep the conversation going while I’m working this weekend at UGH.
*This blog post was originally published at Nurse Ratched's Place*
August 24th, 2009 by EvanFalchukJD in Better Health Network, Health Policy
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There has been a lot of talk about the way in which a public health insurer would compete against private ones. As the President put it recently:
People say, well, how can a private company compete against the government? And my answer is that if the private insurance companies are providing a good bargain, and if the public option has to be self-sustaining — meaning taxpayers aren’t subsidizing it, but it has to run on charging premiums and providing good services and a good network of doctors, just like any other private insurer would do — then I think private insurers should be able to compete. They do it all the time.
He makes a good point. But we don’t have to talk about this in theory – we can look at existing state insurance programs to see how they operate.
In states prone to natural disasters like hurricanes, the market for private insurance has become increasingly uncompetitive. Several state governments have responded by setting up public insurance programs to sell coverage to property owners in their states. They operate something like private insurance companies – collecting premiums, maintaining reserves, and, importantly, buying reinsurance in the event of a catastrophe that exceeds what they can pay for themselves.
The New York Times reports that a number of the state insurers are thinking of doing something that a private insurer would likely never do: dropping their reinsurance coverage. It could save hundreds of millions of dollars a year. But it would expose them to billions of dollars in risk – that they likely would be unable to pay. The Times calls it “running naked through storm risks.”
Why can they do this?
I suspect that in the event of a bad hurricane that depleted their reserves, these insurers believe they can turn to the state or federal government to cover their losses. They are acting as if they already have a sort of “free” reinsurance from the government. Or, to use a modern expression, they are assuming they will get a bail out if something bad happens.
What it means is that these companies aren’t running anything like a private insurer. By not accounting for the cost of a catastrophe, they aren’t dealing with the real insurance risk they are taking. As long as a disaster doesn’t happen they save money. But when (not if) a major hurricane hits, they will be swept away in the storm, leaving the state and federal government – and the rest of us – with the bill.
“It’s typical of governments today to not be willing to make the hard decisions that are necessary to face up to the true risks and the true costs of the policies that they’ve undertaken,” said Robert Hartwig, president of the Insurance Information Institute, an industry group.
The Times says there are some efforts underway to formalize this sort of “implicit guarantee” from the government. That might be a step in the right direction if it forces everyone to grapple with the extent of this risk.
But what we see with these kinds of insurers is one of the important ways in which public insurers really aren’t the same as private ones.
*This blog post was originally published at See First Blog*
August 16th, 2009 by Happy Hospitalist in Better Health Network, Humor
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A humorous slam at private insurance companies. I read the whole article and wonder how much better life would be, not only for doctors but for patients as well if their third party paid a reasonable bundled fee, with profit potential, and let the patients and the doctors and the hospitals figure out how to divvy up the money. This humor is a take on private insurance companies, but it might as well be the government behind the Medicare National Bank. Neither has been able to control the cost of delivering health care to the masses. The only way to do that is to stop paying for it.
So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company’s list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company’s claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company’s crack cost-review and retroactive cancellation and denial squads, my insurance company’s executives and board of directors, my insurance company’s profit requirements, the shareholders, my employer, and my doctor.
via Surgeonsblog
*This blog post was originally published at A Happy Hospitalist*
August 8th, 2009 by DrRich in Health Policy, Humor, Quackery Exposed
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It is quite popular among certain medical bloggers, who count themselves as scientifically sophisticated, to disparage so-called “alternative medicine.”
Indeed, there are entire websites devoted to demonstrating (in homage to Penn and Teller) that various forms of alternative medicine – such as homeopathy, therapeutic touch, the medical application of crystals, Reiki, naturopathy, water therapy, bio-photons, mindfulness training, energy healing and a host of others – are completely devoid of any scientific merit whatsoever; are pablum for the uneducated masses; are, in short, irreducibly and unredeemably woo.
These same medical authors are scandalized into virtual apoplexy by the fact that the NIH has funded an entire section to “study” alternative medicine, and worse, that most respected university medical centers in the land now seem to have embraced alternative medicine, and have established well-funded and heavily-marketed “Centers for Integrative Medicine” (or other similarly-named op-centers for pushing medically suspect alternative “services”).*
Until quite recently, DrRich counted himself among the stalwarts of scientific strict constructionism. He was truly dismayed that the NIH and some of our most well-regarded academic centers (under the guise of wanting to conduct objective “studies” of alternative medicine) have lent an aura of respectability and legitimacy to numerous bizarre ideas and fraudulent claims masquerading as legitimate medical practices. To DrRich, such developments were yet another clear and unmistakable sign of the End Times.
Furthermore, DrRich (a well-known paranoid when it comes to covert rationing) saw a more sinister advantage to the official and well-publicized support that government-funded institutions were giving to the alternative medicine movement. Namely, fostering a widespread impression among the unwashed rabble that alternative medicine is at least somewhat legitimate (and plenty respectable) will further the cause of covert rationing. That is, the more people who can be enticed to seek their diagnoses and their cures from the alternative medicine universe, where they are often spending their own money, the less money these people will soak up from the real healthcare system. With luck, real diagnoses can be delayed and real therapy put off until it’s far too late to achieve a useful outcome by more traditional (and far more expensive) medical means.
So, for several years alternative medicine was seen by DrRich pretty much as it is seen by all of the anti-woo crowd – as an unvarnished evil.
But in recent days the scales have fallen from DrRich’s eyes. He now realizes he was sadly mistaken. Rather than a term of opprobrium, “alternative medicine” may actually be our most direct road to salvation. Indeed, DrRich thinks that far from damning alternative medicine, we should be blessing it, nurturing it, worrying over it, in the precise manner that a mountaineer trapped in a deadly blizzard would worry over the last embers of his dying campfire.
What turned the tide for DrRich was a recent report, issued by the U.S. Centers for Disease Control and Prevention, estimating that in 2007, Americans spent a whopping $34 billion on alternative medicine. Even more remarkably, a goodly chunk of this money was paid by Americans themselves, out of their own pockets.
The implications of this report should be highly encouraging to those of us who lament the impending creation of a monolithic government-controlled healthcare system, and who have been struggling to imagine ways of circumventing the legions of stone-witted, soul-eating bureaucrats now being prepared (Sauron-like) to descend upon us all, doctor and patient alike.
This is why DrRich has urged primary care physicians to break the bonds of servitude while they still can, strike out on their own, and set up practices in which they are paid directly by their patients. Such arrangements are the only practical means by which individual doctors and patients can immediately restore the broken doctor-patient relationship, and place themselves within a protective enclosure impervious to the slavering soul-eaters.
One reason so few primary care doctors have taken this route (choosing instead to retire, to change careers and become deep-sea fishermen, or simply to give up and become abject minions of the forces of evil) is that they do not believe patients will actually pay them out of their own pockets.
Well, ladies and gentlemen, this new report from the CDCP demonstrates once and for all that Americans will, indeed, pay billions of dollars from their own pockets for their own healthcare – even the varieties of healthcare whose only possible benefits are mediated by the placebo effect. DrRich believes that many of the people buying homeopathic remedies are doing so less because they believe homeopathy works, and more because they feel abandoned by the healthcare system and by their own doctors, and realize they have to do SOMETHING. The CDCP report, in DrRich’s estimation, reflects the magnitude of the American public’s pent-up demand for doctors whose chief concern is for them, and not for the demands of third party payers.
Perhaps more importantly, this new report implies that it will be somewhat more difficult than DrRich previously believed for the government to outlaw private-sector healthcare activities. Creating a monolithic government-controlled healthcare system would naturally require the authorities to make it illegal for Americans to spend their own money on their own healthcare, thus rendering direct-pay medical practices illegal, and putting the final stake into the heart of the doctor-patient relationship. But the rousing success of the alternative medicine universe will make such laws difficult to enact.
To see why, consider just how encouraging this new CDCP report must be to the third-party payers. Thanks in no small part to the efforts of the government (and the academy) to legitimize alternative medicine, Americans are spending $34 billion a year on woo. This amount indicates tremendous savings for the traditional healthcare system. The actual amount saved, of course, is impossible to measure, but has to be far greater than just $34 billion. Some substantial proportion of patients spending money on alternative medicine, had they chosen traditional medical care instead, might have consumed expensive diagnostic tests, surgery, expensive prescription drugs, and other legitimate medical services. Furthermore, those legitimate medical services (as legitimate medical services are wont to do) often would have generated even more expenditures – by extending the survival of patients with chronic diseases, by identifying the need for even more diagnostic and therapeutic services, and by causing side effects requiring expensive remedies. (While alternative medicine is famous for being useless, it is also most often pretty harmless, and tends to produce relatively few serious side effects – except, of course, for causing a delay in making actual diagnoses and administering useful therapy, but that’s a good thing if you’re a payer.) So the amount of money the payers actually save thanks to alternative medicine must be some multiplier of the amount spent on the alternative medicine itself.
What this means is payers (which under a government system means the government) will be loathe to do anything that might discourage the success and growth of alternative medicine, and this fact alone may stop them from making it illegal for Americans to pay for their own healthcare.
Still, we musn’t be too sanguine about these prospects. Under a government-controlled system, the imperative to control every aspect of healthcare (in the name of fairness) will be very, very strong. It is easy to envision the feds declaring several varieties of alternative medicine to be covered services, so people wouldn’t have to buy alternative medicine themselves.
But alternative medicine (bless it) will be impervious to government control. Practitioners of alternative medicine aren’t doing what they are doing in order to be subject to federal regulation and bureaucratic meddling. If the feds declare, say, homeopathy and therapeutic touch to be legitimate, covered services under the universal health plan, why, the alternative medicine gurus will simply come up with entirely new forms of alternative medicine specifically to remain outside the universal plan. (New varieties of alternative medicine already appear with dizzying speed, and can be invented at will. No bureaucracy could ever hope to keep up.)
Therefore, as long as the central authorities depend on alternative medicine as a robust avenue for covertly rationing healthcare, the purveyors of woo will always be able to flourish outside the real healthcare system. And this, DrRich believes, represents the ultimate value of woo, and establishes why we should all be encouraging and nurturing woo instead of disparaging it.
DrRich has speculated before on various black market approaches to healthcare which could be attempted by American doctors (and investors) should restrictive, government-controlled healthcare become a reality. Some of these were: medical speakeasies; floating off-shore medical centers on old aircraft carriers; medical centers just south of the border (the establishment of which, at last, would stimulate the feds to seal the borders against illegal passage once and for all); and combination medical center/casinos on the sovereign land of Native American reservations.
But now, thanks to the success of alternative medicine, there is a direct and straightforward path for American primary care physicians to practice a form of now-long-gone “traditional” American medicine, replete with a robust doctor-patient relationship, right out in the open. Simply declare this kind of practice to be a new variety of alternative medicine. Likely, you will need to come up with a new name for it (such as “Therapeutic Allopathy,” or “Reciprocal Duty Therapeutics”), and perhaps invent some new terminology to describe what you’re doing. But what you’re actually doing will be so fundamentally different from what PCPs will be doing under government-controlled healthcare as to be unrecognizable, and nobody will be able to argue it’s not alternative medicine. In fact, it will seem nearly as wierd as Reiki.
Alternative medicine, in other words, will provide American doctors who want to practice the kind of medicine they should be and want to be practicing with the cover they need to do so. And this is why we must support medical woo, and celebrate its continued growth and success.
* A list of these academic medical institutions now sporting Centers of Woo is maintained by Orac, and can be found here. The length of Orac’s cavalcade of woo, and the famous names appearing on it, is truly stunning. The sinking feeling one gets from looking at Orac’s list can only be surpassed by actually clicking on a few of the links he provides, and sampling some of the actual woo-sites offered by these prestigious academic centers, which read like excerpts of some of the more unguarded moments from Oprah, or even the Huffington post.
*This blog post was originally published at The Covert Rationing Blog*
August 1st, 2009 by KerriSparling in Better Health Network, Health Policy, Opinion
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Two weeks ago, I was in Washington, DC with the Better Health team, listening to people talk about voting down government health care.
Last week, I was in Chicago at BlogHer, part of a lunch meeting with Valerie Jarrett, Senior Advisor to the President and Assistant to the President for Intergovernmental Relations and Public Liaison, listening to women at BlogHer talk about passing the government health care bill.
And I have now just entered the land of confusion.
Valerie Jarrett spoke with a room full of bloggers about health care, but she also listened. She listened while women told their personal stories and she seemed to understand that health care situations aren’t as simple to solve as we’d like them to be. Women candidly told their stories and a few tears even slipped out. But she listened intently. And she said she wanted to give a voice to those who might not speak up for themselves.
“Often the people who need it the most don’t speak up because they don’t feel like they have a voice. Give the grass roots a voice, empower them, work together informing people within their communities. You can work to help them get their voice, get info that they don’t have.”
This lady is important. Her cell phone rang several times during our lunch (it could have been THE PRESIDENT, for crying out loud) and she had her assistant take the call so she could focus on us. She handed out her card and scheduled phone calls between some bloggers and her staff to help with the specific health issues that these bloggers were dealing with. Sure, for them it was a matter of being in the right time at the right place, but she really listened. I’ve never sat in a room before with a member of high political influence who paid attention to the people more than the information on her cell phone or in her planner. (Maybe that means I’ve been in the room with the wrong politicians?)
It was a remarkable experience, and the room was electric with hope.
And now I’m even more confused about this health care issue. I want insurance coverage, I want good coverage, but I don’t want to be excluded due to my pre-existing condition. I can’t find a happy mental medium with this, but I know there has to be a way for people like me to find health coverage despite diabetes.
With that thought, I’m off to the Joslin Clinic in Boston, with my pregnant best friend in tow, to immerse myself in the best that health care has to offer. And I hope that whatever decision made by our government leaves me with access to the people I need to help manage my care.
*This blog post was originally published at Six Until Me.*
