Monday, August 3, 2009

Monday Answers--Health Care

Today I'll be posting the first of my answers as explained here. I don't know that I will always do this weekly, but if you ever leave a question in my comments, I do read them all, and I do try to answer them!

Today's topic is universal health care, aka single-payer health care, aka socialized medicine.

Well, here's a doozie: What's your take on the potential for universal
healthcare? It's been on my mind a lot. Always interested in hearing more
thoughts and opinions.

There is a bill currently facing our congress which has lots of people screaming about socialized medicine and loss of patient rights and all kinds of other things...I will start off by saying that I have not read the bill. I would like to actually (in spite of it being over 1000 pages)--I'd like to see what is really in it--but I have not read it yet. So, the best I can do today is answer with my thoughts about the concept in general, and then my feelings on what I do know of the bill.

Point #1--I think that socialized medicine is a whopping lot better than the capitalistic system we have right now. If you didn't read it when I linked it last fall, I would encourage you to read the post my husband made here. He lived in Norway for two years, and has some personal experience with socialised medicine. Or maybe go read the post my cousin wrote here. He lived in Switzerland for several years as a child and then in Germany for two more as an adult. Both of them heartily favor socialised medicine because they have seen how well it works. The WHO statistics seem to point quite clearly to socialized systems as the best if you look at their chart of the world's healthiest countries. Yes, it is true that the system will run into problems if it is underfunded (as it is in Canada, Ireland or the UK--the places where most of the horror stories come from), but, if it's properly funded, then you'll probably end up with something like France (#1) or the Scandinavian countries...
Yes, I did say 'probably'...this is because I realize that we have a very big country, and there is a lot of diversity in terms of proximity to care providers, health education, and other things which might affect the fair rationing of care. A socialized system--one which provides free care to everyone--will have to insist on a certain amount of taking turns, and it's true that sometimes people will have to wait for things like surgeries that (in fairness) shouldn't wait. So I think that a dual system makes sense: have a public option available to everyone--for free of course, but still have a few private options available. The private sector--as with education--would cost more, but if you had the money you could get things faster and/or get things which were not deemed 'necessary' but which you wanted (say, for example, an extra ultrasound, a vasectomy, or most cosmetic procedures). Honestly, I think some sort of combination like that probably makes the most sense.

Point #2--My understanding of the current bill is that it's not socialized medicine at all. It is actually an attempt to reform a capitalistic system. I don't know that I think it's ideal, but reform definitely seems in order, and I think this sortof plan is likely to go over with the American people much better than a truly social one.

  • In my understanding, the bills calls for making efforts to cut waste by demanding that medical practice be evidence-based (rather than marketing-based). Well hallelujah! Unfortunately the research isn't always clear--sometimes one study directly contradicts another--so determining which evidence to use as basis for medical practice may be complicated...but I think that the bill is making a push in the right direction at least.
  • The bill will determine the value of the doctors' time, which will probably cut the incomes of many of them (what's not to love about that?! I would like to see people enter medicine because they want to help others, not because they want to get rich). I recently heard the complaint that this is "putting a value on humans" but we've been doing that for years with minimum wage...I think it's a healthy change.
  • The bill will offer an alternative to private insurance, so that everyone will be able to get some kind of insurance that they can afford, whether it's private insurance for the richer, public insurance for the middle class, or publicly-funded insurance (medicaid) for the impoverished. It would force insurance companies to change their policies so that they couldn't drop someone just because they got cancer and suddenly became expensive. In other words, it would provide insurance to everyone (but everyone would have their choice of insurances), as opposed to the social model of scrapping insurance and just giving everybody free care when they walk in the hospital doors.
  • The government will push hard(er)--require?--people to get preventative medical care, including vaccines. (Um, they kinda 'require' vaccines already and if you don't believe in them it's pretty simple to get an exemption...) Although I expect more people would probably go in for routine check-ups, I don't see this making a difference in our right to make choices about our care, so again, I don't see a problem.
  • One complaint I've heard is in regard to the rationing of care is that the elderly or those who have chronic/fatal conditions would likely be pushed to the end of the list for certain surgeries and treatments. It's a matter of doing the liver transplant for the guy who's 46 instead of for the guy who's 86, (regardless of how long they've been waiting or why they need it), because the former is likely to get more good out of it. On the one hand I can appreciate that that sounds a bit heartless, on the other hand I look at how many people are currently unable to get the treatments and surgeries that they need, and I think that if we're not going to be able to save everybody, it does make sense to try to save the ones who have the greatest life expectancy first.

A few other things that I think need to happen--and I don't know if they are in the bill or not (mostly I think not):

  • It needs to be a whole lot harder to sue doctors for malpractice. Yes, it needs to be possible, but it needs to be harder. There should be more mediation and arbitration required before litigation is possible. With that in place, malpractice insurance prices should come down, and thus doctors fees should be able to come down.
  • Costs should be the same for everybody. In other words, there should not be a pre-negotiated preferred rate for insurance companies but another (higher) one for people who pay out of pocket. There should not be preferred and non-preferred providers (with different rates of coverage). I suppose it's fine if one doctor wants to charge a little more than another, but I'd like to see it more like grocery stores...milk may cost more at one place than at another, but it's not much more, and the prices are public knowledge.
  • It should be illegal to advertise for pharmaceuticals of any kind, or to anyone. In other words, when the drugs are released, doctors should receive information (brochures perhaps) detailing the contents, purpose, and side-effects of the drug. The doctors can then choose to add it to their repetoire or not. Meanwhile, there would be no drug lunches, no free palm-pilots given to doctors to encourage them to prescribe one thing over another, and none of those horrible ads which stealthily proclaim "this drug may change your life, (and it may kill you)...ask your doctor about it today!"
  • The whole drug testing/approval process needs to be longer. In the rush to get new things on the market, the FDA has streamlined things so much that in my opinion most things are insufficiently tested before being released to the public (I think the frequency of drug-recalls for serious injuries and deaths validates this view). Anyway, I think a good option would be to do the testing as they currently do, and then release the drug as a "phase B testing" option, where patients (with their doctors) could choose it with the understanding that it had been through initial testing but was still considered experimental. It would be an informed consent sort of thing. New drugs would have to be in this phase for a minimum of 2 years (or x number of people trying it) before they could have final approval and be released for general usage. I think this would cut back on a lot of the lawsuits by helping protect and inform the population about things that have only had minimal testing, while still allowing them access to new formulas as soon as possible.

A final thought:
If you are scared about the idea of the government having control in our health care, I would ask you to think about the other things they control in this country: roads, the postal service, schools...I'm not saying that all those things are perfect, but would you really rather pay for private courier service when the post office provides free mail delivery (usually to your door) 6 days a week? Go ahead and complain about 40-something cent stamps, but remember what you'll pay to send the same thing via FedEx or UPS. Nationalizing a system can save costs and improve service (in my humble opinion), and I think that socialized medicine--or yes, that bill that's in the house right now--may have flaws, but it's a darn sight better than what we have right now.

(Feel free to leave more questions...I'll get to them in coming weeks!)


Janeen said...

I really do not think it is as simplistic and you are posting. As for mentioning countries that have socialized medicine already, my understanding is that they are not countries like the US, in other words, they are somewhat used to have some of the freedoms limited. I have concerns about the government getting as much control as it would through the healthcare. The government was not meant to get this much control, that was the whole point of the constitution. I have only read a summary and I would have to read the bill but it does appear that there may also be some financial information going to the government for this. My other concerns is that this is going through too fast and being signed on too quickly by those who have not read the whole thing.

Now, I'm in South Korea at the moment and, to be honest, I don't know exactly what sort of system of medical care there is. I think it is some form of national care though because I think we can get on the insurance through DH's employment. But I'm not positive about this. Thing is is that medical care, even with NO insurance is not as expensive. There are also quite a few other things that are quite different here but it would take too long to go through them all.

I have my concerns, especially in regard to the amount of government control and what this will mean.

Benson & Sarah Garner said...

I agree with the above poster - it's no where near as simple as you make it sound. Especially this bill... there are MANY elements of the bill that are hidden in the 1000 plus pages that I think would make the majority of people who LOVE the idea of socialized healthcare back away from it in this form.

Roads, postal service and schools, in my opionion, are very poor examples of government run "success". Government run programs are simply used more because they are "free" (hello taxpayers!).

It is one thing to have socialized healthcare avaialable - but to make it the only option? The bill includes legislation that will in just a few years lead to the destruction of the private markets leaving government run healthcare the only option for all citizens... that is not right and straight up un-American.

The constitution was founded on beliefs of freedom... taking away my choice to choose what doctors I want to see and how I pay for my healthcare? That is NOT freedom.

Marly said...

See, my biggest problem is that the existing government health insurances aren't run well. I was on medicaid. Its not that great. My friend is currently on medicaid. They won't cover her new prescription for glasses and she is going to have to get some teeth pulled because they won't cover the work she needs done.

I think they need to fix the current programs before they go adding something new. I also think now is not the best time. They are throwing money at all sorts of things. We are in so deep its not even funny.

I also agree with the previous poster that these things are going in too fast. Some senators have actually said "we can't read the bill, that would take days" Umm, isn't that the idea? Aren't they supposed to be watching out for us not just signing something because someone said it was a good idea.

I just really don't think that in our countries current economic place now is the right time for this.

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