Health Care Reform: A Professional’s Perspective
I am a pharmacist, and I am writing to weigh in on the health care debate. I am reminded daily of how our health care system is broken. There is no lack of personal anecdotes regarding health care in America, so I will not repeat any. However, people generally seem to agree that our system needs fixing. Those who say we already have the best health care system in the world usually forget to add “if you can afford it.” To me that implies a broken system. Fixing it will take years, but we need to start now, and we need a government funded public option to help do it.
The free market has failed us in health care, and a public option would spur much needed competition in our system. In 2006, Merck’s cholesterol drug Zocor went generic. Merck essentially bribed United Health, the nation’s largest insurer, to charge the lowest copay for the brand name drug, while charging the highest possible copay for the generic alternative. The best part of this story is that Merck cut a deal with a generics company, and Merck actually manufactured the generic version and used the generics company to distribute it. I defy you to find a better example of market failure.
Much in this debate has been said about patient choice and rationing of care. I will interject here to say that the phrase “rationing of care” is pretty ugly and emotionally charged. Perhaps a better term for some situations is “cost-control.” At any rate, the notion that patients should be able to choose their caregivers and their form of treatment is certainly an ideal for which we should strive. As it is now, only those fortunate enough to be able to pay for their care 100% out of pocket are the ones with true freedom of choice. Those saying that a government funded public option would lead to rationing of care are ignorant at best, and dishonest at worst. If you rely on an insurance company – or the government – to pay for your care, you are already subject to rationing and/or cost-control measures, and any appearance of free choice is an illusion.
I see examples of this every day at work. If your doctor writes you a prescription that your insurer deems too expensive and refuses to pay, your health care has been rationed. This happens several times a day. Often times the insurer will recommend an alternative medication, and just as often the alternative is something that should be suitable for the patient, and is less expensive, but is not what the doctor ordered. This is what I would call cost-control. It is different from rationing, in that care is not absolutely denied, and it is something from which a public option would not be immune. However, the practice of rationing or cutting costs in order to profit is exclusive to private insurers.
We must accept that cost-control will occur, but how would a government funded plan do so equitably? For prescription drugs, Arkansas Medicaid contracts with EBRx, a company that runs two committees comprised of Arkansas doctors and pharmacists. These committees analyze safety and efficacy data from clinical trials to determine which medications will be on Medicaid’s Preferred Drug List (PDL). The committees’ meetings are open to the public and comments from the public are welcomed. Through the process the panels evaluate which drugs are most effective and reserve them on the PDL. If all drugs under consideration are found to be equally effective to treat a particular disease, then the least expensive ones are placed on the PDL. It’s natural not to want bureaucrats and politicians deciding who and what is covered. That is why a strong government funded public option should have a system like Arkansas Medicaid’s in which costs are kept as low as possible while still having health care professionals call the shots.
I have some other thoughts on how to help control costs for a public option. First of all, the government must be allowed to negotiate drug prices with pharmaceutical companies. Second, many of the chronic diseases we all currently pay for (diabetes, hypertension, hyperlipidemia) could be prevented through education on proper nutrition and healthy lifestyles. One of President Obama’s principles for health care reform includes nutrition counseling. This is great, and I find it hard to argue with the idea that preventing illness in the first place will save everybody money on emergency room visits and treatments later.
My hope is that my voice will help the case for a strong government funded public option. There are many opportunities to save money with a public option, but from my perspective that is not the real issue. Even though good disease prevention measures and increased competition among insurers could do that, for me reform is really all about making sure every citizen has access to quality health care.
Mike Clark, Pharm.D.
Fayetteville
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yrfuneralmytrial
August 26, 2009
Excellent post. Thanks.
Me
August 26, 2009
Isn’t Medicaid going bankrupt? Just like social security? And isn’t our 10 year deficit now over 9 trillion… which is about twice what our entire national debt was 2 years ago? Also, you say the public option adds the necessary competition to unfair insurance companies, but isn’t it also unfair to add a competitor that writes the rules and just prints money when it needs more? How many people out there realize that private citizens without benefits can get health insurance for reasonable rates (I have a friend that just got it for $95 a month for a decent policy and that is less than what I pay with employer contributions)? How many people out there realize that many of these uninsured people are uninsured because they chose not to pay?
Another local resident
August 26, 2009
$95 a month? What is his deductible? $5000? That’s hardly “good” health insurance.
This whole damn country needs to grow up and start treating one another differently, and that’s what this debate is really about. Are we really so dispassionate that the only health care system we can accept involves profit-motivated beaurocrats? Where is the compassion-motivated system?
Do you health care?
Mullva
August 26, 2009
Nice concise article with good points.
Thanks for the basic approach to define the very broad terms into everyday occurances.
It is nice to see and educated post instead of a screaming rant by an ill equipped screaming lunatic at a town hall meeting!
burgerboy
August 26, 2009
Profit-motive is important because PROFIT is why companies produce new and exciting drugs, treatments, etc. Like it or not, the bottom line matters just as much as any desire to help someone.
In order for our care to remain and increase in excellence, there has to be a way for people to make a damned good living doing it.
People don’t spend their entire youth in Medical School simply because they want to help people. They do it because they want to help people, and because they know at some point it will pay off handily.
I would prefer a free-market system continue in some shape or form. I’d be all for health-care savings accounts administered by the government. The more competition that can be built into it, the better.
There are several reasons that health insurance is so damned expensive.
You have doctors saddled with their own huge insurance policies because of all the lawsuits they are subjected to. Because of this possibility, they tend to run unnecessary tests because they don’t want to get sued. Cap punitive damages in lawsuits. Allow lawsuits for gross negligence only. ****ing lawyers ruin everything they touch. THOSE are some greedy bastards.
Get the lobbyists out of Washington. Stop having policy made by people who are being bribed with campaign funds.
Given the examples we have around the world, I believe equal healthcare for all means we’ll all have mediocre healthcare. I want better than that, and I’m willing to pay for it.
In my experience, people who insist that we all have equal everything generally are people with lower than average work ethic and/or intelligence.
Hard work needs to be incentivized in every way possible. We have too many people taking free-rides in this country already.
Of course I’m likely talking to the generation who idolizes Che Guevara, who was willing to commit mass-murder in the name of “equality” so ideas like that go over like a **** sandwich.
Brian
August 26, 2009
Very informative post. Glad to see there are still some people that truly care about people less fortunate than themselves.
jesse
August 26, 2009
I agree with “Another local resident.” So many arguments against moving toward universal healthcare seem motivated by individual and corporate self-centeredness. Not the best attitude for America’s long-term well-being literally or figuratively.
Me
August 26, 2009
@burgerboy Great points. Of course we all would love to live in a world where everything is given to us on a silver plate, but unfortunately, that is not life. People who say life is not fair are correct; in America we are given much more than we truly deserve! I am compassionate, but I’m not an idiot. This is like the “teach a man to fish vs. giving them a fish” arguement; there is no way to sustain a society that doesn’t incentivise hard work and just gives to everyone. We give billions in aid to Africa but it doesn’t help them because farmers can’t make a living competing with government rations given out for free. Their economies are in decline becuase of our “compassion.”
@another local resident – Her deductible is $1,000. That might not sound great, but she is in her 20s and is healthy so she really needs the insurance in case of something big (like if she stole a trike and broke her leg riding it :)).
Also, I have another friend that doesn’t have insurance. I hate that he doesn’t have it, but the issue isn’t really that he can’t afford it. The issue is that he eats out every day, drinks at the bar almost every day, and generally just doesn’t spend his money wisely. He hasn’t fixed a simple problem on his car for years but sure has partied enough during that time. Should my tax dollars go towards his healthcare?
Me
August 26, 2009
Besides, regardless of the compassion arguement, can we really afford a non-profit government option? Why can’t we find sustainable funding for social security and medicare/medicaid first? Do you guys realize what a $9 trillion deficit over 10 years means?! The fact of the matter is that healthcare is very expensive and if we just print the money for it, our dollar will be like monopoly money in no time.
David Franks
August 26, 2009
I’d be more convinced by the argument that profit is important for continuing research if the pharmaceutical companies didn’t spend so much money advertising their already-overprescribed products. Never mind the resulting muddying of the doctor-patient dialogue (for those who actually get to talk to a doctor): clearly there is plenty of profit.
As for insurance, as long as those who profit from the product are not those who use the product, there will be a conflict of interest in the insurance industry. Here are a couple of insurance-related measures that would help the health-care system without going all commie:
1. Make a portion of each premium payment a purchase of stock in the insurance company. Let the stockholders/policyholders decide whether their dividends should be in cash or a better product. This would turn insurance companies, at least in part, into benefit associations, a time-honored system for solving problems. It would make insurance companies less like banks and more like credit unions, which tend to keep people more in touch with their money. (I know a lot of people who love their credit unions. I don’t know anybody who loves their bank.)
2. Create a set of standards for a public health-care insurance policy– health maintenance, lifestyle counseling, pre-existing condition coverage, limitation of exclusions from stated coverage, price or whatever– and leave it to the private insurance companies to offer it based on public demand. The pool of uninsured and underinsured would be a good source of business even at a discount: it is large enough to have actuarial viability, and it tends to be relatively healthy. Either the demand for coverage is overstated, or insurance companies would be crazy to pass up a good source of business. Either way, let the market decide.
Nobody who wants a public option wants everybody to have mediocre health care. But those who cannot acquire or keep their coverage, mediocre care is better than none.
Eisenvater
August 26, 2009
@Dr. Clark: Thanks for your clear, concise insights.
@Me: “… many of these uninsured people are uninsured because they chose not to pay…” That statement is just plain offensive. I see your irresponsible party-boy friend and raise you a couple of dozen friends and co-workers who can’t afford the premiums, even if they’re available to them in the first place: people who stay in school because that’s the only way to keep affordable health insurance; people who use the free clinic because their pre-existing conditions make it impossible to find an insurer.
@burgerboy: “Given the examples we have around the world, I believe equal healthcare for all means we’ll all have mediocre healthcare.” I see this argument/belief a lot and it’s usually based on anecdotal evidence, not on a solid comparison of how the different approaches work. If the health care systems are so mediocre, how come all industrialized nations have them in place, some of them for over a century? Why are infant mortality rates higher and life expectancy is lower in the U.S.? And while we’re on anecdotes, I’ve lived in two of those countries. The quality of health care was the same. The only difference I’ve experienced are high bills and fear of losing insurance here. Both were never an issue in Germany and Britain.
Why is it so difficult to accept that good health is both a human right and an economic factor? Even those of y’all who lack compassion for your 50 million uninsured fellow citizens should be able to see that sick people can’t contribute (as much) to the economy. About 20 000 Americans die every year because they can’t get the treatment they need. What’s the economic value of those lives?
Me
August 26, 2009
@ Eisenvater – My comment may be offensive, but it is completely true. I said “many of these uninsured people are uninsured because they chose not to pay” and I completely stand by that statement. Of course I didn’t say “every uninsured person” I said “many.” Are you saying that there aren’t “many people” that lack insurance but have internet, cell phone, ipod, bar money, etc.? I’m not griping about those peopole; they are entitled to that choice. If you aren’t one of those people then you should not take offense to the statement.
Me
August 26, 2009
@Eisenvater – You ask why it is so difficult to accept that good health is a human right… well what is your definition of a right? Calling health care a right simply means that the government cannot ban healthcare… having a right doesn’t guarantee any provisions. For example, you have a right to eat food, but no one is forced to provide food for you. So if you interpret healthcare as a right and it must be provided, why aren’t you a doctor? If you were a doctor, would you feel that you should provide your services for free since otherwise you would be infringing on someone’s rights?
Another local resident
August 26, 2009
@burgerboy – “PROFIT is why companies produce new and exciting drugs, treatments, etc.”
Which is exactly why this needs to be turned over to DOCTORS NOT COMPANIES and like it or not THE GOVERNMENT WILL HAVE TO MAKE THAT CHANGE HAPPEN because THE MARKET WON’T.
And Christ, the facts are in: USA does not have the best health care. Terrible infant mortality and life expectancy combined out-of-control cost-escalations (more than 10% each year!!!!1).
The whole idea of foisting health care costs onto employers, instead of health care customers (aka taxpayers), is B-R-O-K-E-N. It’s not even capitalism. It’s economic suicide.
Me
August 26, 2009
@Eisenvater Also, if “good health” is a right, does that mean the goverment should dis-allow fatty foods, mandate exercise, and ban alcohol, smoking, and dangerous activities? Doesn’t that also mean that God him/herself is breaking the rules by allowing babies to be born with health problems?
David Franks
August 26, 2009
Me–
So many philosophical hypotheses. So few solutions.
Me
August 26, 2009
Dammit, I’m an engineer not a doctor!
David Franks
August 26, 2009
Me–
I’m not a doctor, either, nor am I an engineer. But as an engineer, perhaps you can appreciate my position that when a problem is presented, objections without solutions indicate either a lack of analysis of the problem, or a denial that the problem exists. Objections without analysis are merely blather, and objections without a problem are a waste of energy and time.
Me
August 26, 2009
David –
I never intended for my coments to be taken as anything other than blather. I don’t think congress is reading the comments section of the Flyer and I don’t plan on running for public office so my ideas would go nowhere anyways.
This and other issues (social security, illegal immigrants, etc.) have been hanging around for a long time and anyone who thinks they can offer a sound solution with their limited knowledge on an internet blog is very naïve. The best I can do is vote and hope our elected officials can come up with something. I have health insurance and do not use it anyways so I don’t have a problem and am not going to pretend I am wise enough to fix the problem for everyone else.
Christopher Spencer
August 26, 2009
Thank you for writing this well articulated and informative essay, Mike Clark.
I do hope tort reform occurs alongside the establishment of a government-run medical insurance option. A solid but generous cap on how much money a person can get by suing a doctor or hospital would go a long way toward lowering costs as well.
David Franks
August 26, 2009
Me–
The problem is, threads like this do tremendous damage with blather. People who want to obstruct progress need merely to generate blather, and obstruction is strengthened. I like to think that anybody who read the article had some interest in the subject. I also like to think that at least a few of the readers of any thread I bother to post to are thoughtful enough to pick up something useful from amidst the blather, so that some of the damage is ameliorated. Certainly it is easy to goad the thoughtless to action; I hope the thoughtful can be spurred on as well.
If any thoughtful post in this thread causes you to think before you react to the next post you read, then one of my goals is accomplished. At the very least, if you are neutral toward the subject, you might refrain from adding to the blather, as it furthers the cause of obstruction.
Me
August 26, 2009
David –
In a nutshell:
– If my blather obstructs what you call “progress” than my job is done.
– If you must hear my solution, it is currently to do nothing. We have government programs to provide healthcare for the poor, elderly, and veterans. If you don’t fall into those categories, you can afford healthcare. Eisenvater says he knows people that can’t afford coverage and they stay in stool to keep affordable coverage. Seriously? I paid much more for school than a private insurance plan. I didn’t pay taxes when I was “poor” so I could have afforded heatlthcare, but you know what? I didn’t… I did have cable TV, a cell phone, and a pretty nice car though! If you really can’t afford insurance, you would be covered under medicaid!
– The social programs we do have like social security, medicaid, and medicare are not self sustaining and are running out of money. Shouldn’t we figure out how to fix those before adding more burden to the system?
– Do you realize that they have forecased a 9 trillion + deficit over the next 10 years? Do you realize that includes the expiration of Bush tax cuts, more middle class being caught by the alternative minimum tax, and federal spending increases in line with inflation (it is currently much higher)? Do you realize that doesn’t include health care reform which the congressional budget office has reported will not decrease health care costs (this refers specifically to the house bill out now)? How much money are we going to print? How much will our dollar be worth in 10 years if we continue down this path?
roberto campana
August 26, 2009
@Me – I understand your frustration with people who don’t want to buy insurance. Millions of these folks — as well as millions of other people who literally cannot get coverage because of pre-existing conditions — go to emergency rooms when they get sick or injured. They can’t pay the hospital, the hospital raises its rates and insurance costs go up for everybody else. That’s why a single-payer system that EVERYBODY pays into is vital. I don’t want to subsidize deadbeats. But even more than that, I don’t want people to suffer and die needlessly because they couldn’t get insurance.
It’s a drag on the economy when people declare bankruptcy because of medical bills (a phenomenon unheard of in other industrialized democracies). It’s a drag on the economy when some would-be entrepreneur with a great idea for a new business is afraid to take action because leaving his employer means leaving behind his insurance coverage. It’s a drag on the economy that 20,000 people a year die because of lack of insurance. And we all ought to be ashamed of ourselves for the system we have in place right now. It’s an embarrassment that, because we’re so beholden to a few insurance companies, we can’t make it work.
Regarding one’s right to healthcare: am I to understand that you believe that only the people who can afford it deserve to get treatment? What if police and fire protection were private enterprises? Would the working poor be left to fend for themselves because they didn’t deserve protection because they couldn’t afford it? Jesus, this debate really brings out the nastiness in some folks.
Me
August 26, 2009
@ Roberto – I’ll respond to each paragraph you wrote.
You say that people without insurance cost the system more because they go to the emergency room when they get sick or injured and then you say you don’t want people to suffer and die needlessly because they couldn’t get insurance. Those thoughts contradict each other. Either they “die from lack of insurance” or they get help at the emergency room thus averting death… which one is it? So you want a single payer system that everybody pays into… well, how much should everyone pay? Isn’t that a big part of the debate; that people can’t afford health insurance? Well if everyone pays, wouldn’t some not be able to afford that payment? Then we’re in the same situation we started at.
The drags you list are nothing compared to the cost of government provided healthcare and all that the current bill entails. As for the 20,000 people per year that “die from lack of insurance”, see my first response to you. Besides, 20,000 people die per year for TONS of things… unfortunately, death is a part of life. Following your logic, we should ban all things unhealthy and dangerous so everyone lives in capsules to stop all of these needless deaths.
As far as rights ago, see my previous post about the definition of a right. Regardless of rights, someone has to pay for a service rendered so in that respect, yes, only those that can afford treatment deserve it. Now, we have programs like medicaid to help those that can’t and emergency rooms don’t turn people away so in that sense, everyone does have healthcare. Police are paid for by the government because one of government’s responsibilities in the constitution is to protect rights from being infringed upon by others. Therefore if I am being robbed, my rights are being infringed upon, and the state is responsible for protecting me. Fire fighters are very similar because your burning house could spread to other houses or wooded areas so they are there to protect. I pay plenty for their services with my tax dollars and I have private insurance to pay for the damage.
This debate does bring out nastiness, but I seriously am a compassionate person. I just recognize that if everyone feels entitled to so many government handouts, our society will crumble when the government can’t afford those handouts. France and Africa are good expamples of this (France because of their super sweet work regulations and the joblessness that is a side effect, and Africa because subsidies stifle real economic growth there). If healthcare is such a basic human right and we’re really doing this out of compassion, then why are we concerned about only Americans’ health? Even the worst horros of our system don’t compare to medical problems with poorer countries.
Finally, even if everyone agreed with government health care and it being a basic human right, how do we pay for it? Someone has to pay and China is getting tired of buying our debt.
Eisenvater
August 26, 2009
@Me: I’m not sure how considering health a basic human right requires me to become a doctor, but education is also a basic human right, and that’s one of the reasons I went into teaching. I can’t do it all, you know.
If you really need a standard definition of “human rights,” I recommend a look at your and other democratic countries’ constitutions, the UN’s Universal Declaration of Human Rights, works by assorted philosophers, politicians, and civil rights leaders, and your common sense.
My point was that health is both a human right and an economic factor. They are not mutually exclusive. Providing affordable health care is not motivated solely by compassion. Very few societies and economies function on the basis of compassion. As I said before, ALL industrialized countries offer what you reject, and they’re still prosperous places where people live longer than in the U.S. and don’t have to fear bankruptcy because they can’t pay their medical bills. How do all those countries do that? Why are their citizens not demanding an American-style system?
Healthy/healthier people can contribute more to the economy. If 20,000 people die because they are denied treatment, then there is a negative effect on the economy. And I’m not sure how you’re able to reconcile your nonchalant dismissal of those 20,000 avoidable deaths as being just “a part of life” with your claim that you are a compassionate person.
And no, Medicaid does not cover all people who cannot afford to buy health insurance or are turned away by insurers because of pre-existing conditions. The self-employed, under-employed, and new graduates who can’t find jobs are some of the people who often don’t meet the requirements.
07stiltd
August 26, 2009
What we really need in this country is some personal responsibility injected into the debate. As soon as I start seeing more healthy looking people walking around instead of our ever expanding community of fatties, I’ll start caring about their health and offer some empathy. Until then, please keep the gov’t from digging deeper into my pocket. Thank you.
burgerboy
August 26, 2009
Maybe its karma, but I found out today I got dropped from my single payer healthcare coverage.
But my first thought isn’t how to get someone else to pay for it for me. Its to shop around, find a new policy and pay for it, because I view that as an essential bill to pay, just like electricity, gas, water and (gasp) cable and internet.
I know there are a LOT of people out there who could afford it for themselves, but since it requires forward-thinking and there isn’t an immediate pay-off, they’ll never bother.
I know that I make more than the average Arkansan, but at the same time, I also went without cable tv for 7 months this year because I didn’t NEED it and decided to save a little money until the economy gets more certain. Football season, though, I bump it back up so I can see the Hogs. I do view it as a luxury, though.
Guess what I eat for lunch some days? A can of pintos for 82 cents from Wal Mart. I take pride in saving money and being independent.
So much lefty-ism just sounds to me like people trying to wrangle money from others, stuff they haven’t earned and therefore aren’t due.
I hate how achievement and wealth-creation is being demonized by this administration.
David Franks
August 26, 2009
Me–
Thank you for expressing an opinion, and for making your position clear. However, you and burgerboy seem to think that the alternatives are to do nothing or have a government-operated single-payer system. That simpply isn’t true. I suggested two approaches above that are neither public nor single-payer, and there are plenty of other approaches that are not government handouts.
Yes, people die of all sorts of causes, but why not take steps to prevent deaths that can be prevented (well, postponed) with accessible health care?
burgerboy–
Wouldn’t it be to your advantage to shop around among better coverage options with lower costs because the market made it possible?
You spend 82 cents for lunch? Extravagance!
07stiltd–
What if the market made it possible for insurance coverage to include nutrition counseling and consistent doctor visits that could prevent the obesity that so offends you?
Those of you who are so concerned about whether somebody might get something they don’t “deserve” or didn’t “earn”: Arkansas is a net recipient state for federal revenues. Roads, dams, large-scale water projects, post offices and other amenities are provided largely through contributions from taxpayers in other states. Do you deserve transportation infrastructure, a source of drinking water, and so on? What did you do to earn them?
Jonah
August 27, 2009
Burgerboy said “As for the 20,000 people per year that “die from lack of insurance”, see my first response to you. Besides, 20,000 people die per year for TONS of things… unfortunately, death is a part of life. Following your logic, we should ban all things unhealthy and dangerous so everyone lives in capsules to stop all of these needless deaths.”
Way to be false-logical… The government should do every practical thing to prevent needless deaths, and in the majority of cases (including the ones you mention) education is the most responsible preventable measure. Hence we see things like disclaimers, regulations on outfitters for adventure sports, and required certifications for professionals in most fields associated with danger.
Following your logic, we shouldn’t care about anything that kills us because the death-to-new-productive-citizen ratio would supposedly reach a steady-state of acceptable (if not prosperous) economic activity. Let’s just forget prosecuting murder, since murder is a predictable part of our theoretical steady-state productive-citizen-producing system.
Heck, let’s just take it one step farther. I mean, why should regulation restrict anything at all if “market forces” and the “invisible hand” are just going to force a steady-state onto every metric we choose to examine? Why bother regulating speed limits, sewer systems, or police forces? “After all, if government would stop f’ing with the market it would all just work itself out.”
… Puh-lease! The fact is, insurance companies keep doctors from helping patients make decisions; the market provides incentives reinforcing the divide via fraudulent and litigious claims from both sides; and America has unacceptable health care results.
These facts are de facto proof that the current system doesn’t work, and in the words of the founders, “From time to time the tree of liberty must be watered with the blood of [the establishment].”
What it means is, if we want a health care plan that works and doesn’t drain our economy more and more and more every year, we need fundamental health care reform on almost every level, and if followed, your hyperbolic conclusions would prove themselves to be only delays, refusing to bear long-term economic fruit.
But hey, if you really believe profit-motivated bureaucrats are better at making health care policy than doctors and other health care professionals, be vocal about it and be our guest. It’s certainly your first amendment right to ignore the facts and broadcast it.
Mike Clark
August 27, 2009
Thank you everyone for the lively debate. I’m sorry I haven’t had time to respond throughout (you wouldn’t want me posting at work anyway!), but many comments I would have made have already been made by others. I do want to jump in with a few more comments though.
One thing I left out of the letter was support for universal electronic medical records. Transitioning to this system should save money in the long run by decreasing administrative costs, plus we get the bonus of increased safety for the patient by giving every player in their health care access to the same information.
Say “Patient X” just sees one doctor for everything and uses the same pharmacy to fill every prescription, and never has to be hospitalized for anything. This situation is close to ideal since all the patient’s information resides in one of two locations. This is not a typical situation. In the real world, sick people see more than one doctor, they use different pharmacies, and sometimes have to be hospitalized. Medical records are portable, but as things are now, acquiring them costs time and money.
Here’s a real world situation. Just yesterday I had a situation where a patient was getting warfarin, a blood thinner, from one doctor. A second doctor sent in a prescription for a cholesterol medication for the patient. It just so happened that this new drug, from this different doctor, could potentially increase the effect of the patient’s warfarin and cause them to bleed more easily. If that patient had decided to fill the warfarin at a different pharmacy, I probably wouldn’t have known about this potential interaction, and the patient could have been harmed.
It’s true that insurance companies provide screening for interactions like this, so that any pharmacy their patients use has access to the same information, but as we all know, not everybody has insurance.
One last thought before I have to get ready for work. It’s easy to identify who believes health care should be a commodity. Some here have said, and I’ll paraphrase, “if you can’t afford it you don’t deserve it.” Usually they don’t broadcast their position that plainly. Usually they betray themselves by referring to recipients of health care as customers rather than patients.
Heather
August 27, 2009
burgerboy: I hate how achievement and wealth-creation is being demonized by this administration.
Seems unfair to blame it on the administration alone, that’s happening on a societal scale, and not due to current administration but frustration with the current state of things which could be as easily attributed to the negative impact of past administrations…
Sorry to hear about your insurance though, as a single mom who has been without insurance for over a year now it pretty much blows. Good luck on finding a new (hopefully affordable) policy, and I hope you get to keep your football regardless. :)
Me
August 27, 2009
@ Heather – Achievement and wealth-creation are being demonized on a societal scale? Seriously? Does anyone else looking at this website agree with that statement? I am not doubting you per se, but that is a huge revelation if it is true.
roberto campana
August 27, 2009
@Me- you wrote “You say that people without insurance cost the system more because they go to the emergency room when they get sick or injured and then you say you don’t want people to suffer and die needlessly because they couldn’t get insurance. Those thoughts contradict each other. Either they “die from lack of insurance” or they get help at the emergency room thus averting death… which one is it?”
Both are true. Based on the comment above, and several others you’ve posted on this forum, it seems that you see the world in either/or terms. But the conditions I cited are in no way contradictory. Yes, 20,000 people a year die because they lack health insurance, and therefore can’t get their chronic diseases treated. And yes, people without insurance — and there are a hell of a lot more than 20,000 — get injured or quickly become sick and go to the ER, can’t pay and drive up costs.
Also, it’s not a handout if you’re paying for it. Under single-payer systems, everyone pays in.
Something else you wrote: “As far as rights ago, see my previous post about the definition of a right. Regardless of rights, someone has to pay for a service rendered so in that respect, yes, only those that can afford treatment deserve it.”
So let me understand this. What you’re saying is that my 57-year-old father, who is a small business owner, who earns a somewhat decent living, pays taxes and otherwise contributes to society and who has a pre-existing condition that precludes him from coverage DOESN’T DESERVE HEALTHCARE BECAUSE HE CAN’T AFFORD IT!?! That is beyond the pale.
For the dismantling of all your other statements, I defer to Eisenvater.
Oh, and because you and burgerboy seem to be such big fans of the insurance companies, here’s a former insider’s take on these companies and what motivates them: http://tinyurl.com/odg4nj
Believe it or not, there are things that are more important than enriching shareholders. Health care is one of those things.
Me
August 27, 2009
Roberto and others refrence a great arguement about coverage for pre-existing conditions and I completely agree that our system has failed on that note. I do agree that our government should address this issue. I understand insurance charging more for pre-existing conditions, but I don’t think those conditions should be flat out denied for coverage. There should be some regulations that require a reasonable premium (as opposed to denial of coverage) for those with PEC. I could see government assistance (like medicaid) for those that can’t afford the coverage. No problems there.
I like the idea of an plan that competes with employer funded plans. One huge flaw with our system is that it is mostly tied to your job because workers with benefits get half of their plan paid for plus the entire company negotiates for a plan. It also means that people who don’t have benefits can’t afford coverage in the same market as people that do. If employers gave the money they spend for that straight to the workers and opened competition for personal policies I think that could go a long way. Heck, I would hate it if my auto insurance was completely tied to my job.
I just don’t think we should have a government plan for everyone and that’s what we’ll get eventually. That opens the door for a whole new level of control, grows the government immensly, and costs a lot of money that we don’t have.
I also like electronic records… how many dang forms does one person fill out in their lifetime and how many accidents could have been avoided by sharing data.
I’m glad there is such debate about this topic and I think that will go a long way towards some sound solutions. There is no quick fix for this but there are positive steps we can take.
Mike Clark
August 27, 2009
@Me – I know we disagree on many things, but I am glad we can find some common ground, particularly regarding electronic records and ending the economic abuse of people with pre-existing conditions. Maybe we can build on that. If more people were willing to engage in civil discourse we could get a lot more done. If you like any of these ideas, pass them on!
Me
August 28, 2009
@Mike – I do agree with some of the problems that people have with the system, but I just don’t think a government option is the answer. They will be an unfair competitor and private insurance will be wiped out by them eventually. I know the insurance companies aren’t loved by everyone in this discussion, but just like corporations, it’s a “can’t live with them, can’t live without them” scenario. The closest thing we have to a government run social system like this is our education system and we also complain that it is horribly broken. I would love to fix all of the problems but I absolutely do not have that kind of faith in our government. There should be some more regulation (I hate to say that, but it is true) but our government was not meant to directly run so many social programs, banks, car companies, etc. If we have a public option that can’t sustain itself, they will have to get the funding from something. The logical way to increase funding is by increasing taxes. The logical tax increases to fund healthcare are increases to “bad” things like alcohol, tobacco, fatty foods, sugary drinks, etc. I don’t want a nanny state.
David Franks
August 28, 2009
Me–
It’s good of you to acknowledge that there are problems that need to be addressed. But as long as you participate in the arm-waving blather you espoused earlier in this thread, and as long as you continue to claim that a “nanny state” is the only possible outcome of health care reform, those problems– which are your problems, too– will continue to grow.
I’ve not seen that the government has taken direct control of the banking or automobile industries, any more than the other stockholders have. As for operating social programs, if the purpose of government is to provide a safe environment within which individuals and businesses can flourish, then how is assuring that exemplary health care is available to all not a function of government? You’ve not yet objected to the interstate system or Beaver Lake as examples of “nanny state” policies.
Mike Clark
August 28, 2009
@Me – I don’t share the belief that a government funded public option would wipe out private insurers. Even so, I don’t understand the reasoning behind objecting to a public option because it would be too popular.
@David – I completely agree that we should ban direct-to-consumer advertising for prescription drugs.
And just to clarify, the last sentence of my last post wasn’t directed specifically at Me. If anybody reading this thread agrees with any of the ideas that have been bouncing around, please pass them on, whether in conversation or in letters to the media/elected officials.
Me
August 28, 2009
@ Mike – I do think a government option would push out private insurers for a few reasons:
First, the reason it would be more “popular” is because since government doesn’t have to make a profit (among other reasons), they would be cheaper. Since most people with private insurance get it through their employer (who usually covers half the costs), their employer will go for the cheapest option and would drop private insurance regardless of the quality of service.
Second, the current bill funds the public option partially by taxing the private option contributions and adding a fee for employers that don’t provide benefits. Once again that drives employers to the public option.
Third, there are several recordings of Obama specifically stating (before he became president) that his goal is to create a single payer system with the government as the sole supplier. He even says it may take 10-20 years after the public option is created, but states it will eventually happen.
Fourth, the public option represents a “competitor” that is the same entity that writes the regulations, gets funding from tax dollars, does not have to make a profit, and can print money and raise taxes if they are too much in the red. Imagine if the government became a competitor in any other industry. They invested in the auto industry and then gave tax dollars to fund a cash for clunkers program that primarily benefited the auto industry! I know other auto companies benefited from that but it is a great example of how they can write the rules to benefit their cause (It is also a great example of a really bad program that was sugar coated to look good but that’s another story). They did the same thing with the financial industry.
Me
August 28, 2009
@ David – I undstand that doing nothing means that some of the problems will grow. I also believe that other problems will grow much quicker if the government passes a huge sweeping bill with public options.
The interstates and Beaver Lake are very different government programs from what government healthcare would be. Those have nothing to do with my nanny state argument and I think are different from healthcare that I don’t even want to spend any time arguing about them. Education is really the only comparable government program I can think of.
You state you haven’t seen the government take control of banking and auto any more than the stock holders. First off, the stock holders of a publicly traded company should have much more control because they (as a group) own the company. Second off, the government has exerted a TON of control in those industries… are you serious? There is a ton of regulation, tons of money flowing from tax payers to the companies, takeovers, programs to “stimulate” the industries, etc. TONS of control… even before the stimulus… I don’t even know where to start with that counter arguement.
David Franks
August 28, 2009
Me–
I took your reference to the auto and banking industries to refer to the bailout, which is why I responded as I did. I am well aware that the government exerts regulatory authority over the banking industry and over automobiles. They apparently didn’t do a very good job of regulating banking/finance, which helped to get our economy to this point, but that only shows how bad the situation could have been without any regulation at all. Are you suggesting that the government create regulations to give stockholders more control, or do you think this will happen by magic?
How does a stimulus measure like Cash for Clunkers “control” the auto industry? It seems to have done more to control consumers.
My reference to Beaver Lake and the interstate system gets back to my previous post in which I asked whether people must “deserve” or “earn” some redistribution of tax dollars– a point which neither you nor burgerboy has addressed.
RE your points to Mr. Clark:
First– why shouldn’t the government make a profit on health care, if it can? Profit could be used to pay for Medicare, and would make it easier for private insurance to compete. As a “stockholder in the government, I wouldn’t object to a profitable government program. (This assumes that money is the only kind of profit to be made; we all profit from better health care in non-monetary ways.)
Second– If all options for health care become competitive, employers would not necessarily be driven to the public option. And if s public option makes insurance more available to individuals, a crossover program could be developed that could take some of the burden off of employers.
Third– Although Obama might be on record as advocating a single-payer program, he has deliberately left it to Congress to create health-care reform.
Fourth– Either you haven’t read my first post to this thread, or you’ve forgotten or ignored it. A public option need not be run by the government. I think the Cash for Clunkers program was kind of dumb, but I’ll bet the people who were able to cash in on it would dispute your claim tha the government was the primary beneficiary.
Me
August 28, 2009
David –
Each paragraph will address yours in order here:
You are right that the government didn’t do a good job of regulating the banking and finance industry, but that doesn’t mean there wasn’t enough regulation. There was no regulation on transations that should have been regulated and there were markets (like housing) that were over regulated and that helped cause the catastrophie. There are many in government, private industries, and consumers that share the blame for that.
Cash for clunkers doesn’t change or control the whole auto industry but think about what it does: The government invests in an auto company that is having a hard time. To stimulate sales (only new car sales) they create a program that destroys “clunkers” and gives great incentive to trade in old vehicles for new. The environment isn’t helped becuase the reduction in mpg is more than offset by the impact of producing a new car. The consumer isn’t helped because if you are driving what should be a $500 clunker, you cannot afford a brand new car. The only one helped was the auto industry and that is why the government did it. If the government gave money to have people buy my product it would make a huge change in what I do and I would call that control to some extent. That isn’t the best example of control and I didn’t intend to use that as my control argument, that was just an example of government writing the rules to benefit the industry they are in.
Interstates and Beaver lake are totally different because we don’t have private companies building lakes and infrastructure.
Why shouldn’t the government make a profit off of healthcare? You really are asking that question? First off, it is not the government’s job to be a business entity… if that were the case, they would be no different from any rich investor that tries to make money any way it can in the private sector. There are tons of things the government could do to make a profit, but they don’t because they’re the government, not a venture capitalist firm and they can’t compete with private citizens. Secondly, the whole purpose of the public option would be to create an affordable solution for people. If the government created a system that is profitable, it wouldn’t be any more affordable. That doesn’t even make sense… don’t you think the insurance companies would cover pre existing conditions and lower their premiums if they could still be profitable by doing that?
I do think employers would be driven to the public option. If a program is developed to move everything to individuals instead of employers, that might change some things, but as long as it is funded by employers, they will go for the bottom dollar regardless of quality.
Do you really think government works that way? War is also something left up to congress but Bush is still responsible for our involvement in the last two wars, right? Congress writes the bill but to act like they aren’t influenced by what the president wants is silly.
If the public option isn’t run by the government, then who is it run by? Health insurance companies? Isn’t that one of your gripes in the first place?
Me
August 28, 2009
Also – another thought on why the government option can’t be profitable: We have 11 trillion in debt with a forecast of 9 trillion more over the next 10 years… Nope, we’re not going to be profitable anytime soon! If we were a business we would have filed bankrupcy a long long long time ago.
Me
August 28, 2009
I wonder… Why can’t health insurance be more like auto insurance? No one gets denied for pre existing conditions, it covers only major problems, and each individual buys a plan that is right for them. Health insurance does not insure health, it really insures the financial assets of a person or family in the event of a tragic health problem. Auto insurance doesn’t cover oil changes, tires, etc; it is there to keep people from going broke in the event of a major problem (wreck). The real issue here is that health insurance has become a catch all, one fits all policy. I have the same policy as people twice my age with chronic diseases and that drives up costs for everyone. Smaller stuff really shouldn’t be covered by health insurance but the costs for smaller stuff needs to be reduced (tort reform would go a long way towards that).
Just a thought I had… back to work now.
Mike Clark
August 29, 2009
I want to respond to a few things in David’s last comment responding to Me. David’s second and third responses are right on. But, I don’t think a public option should be for-profit. If it begins to take in more money than it spends, then something should be done to decrease premiums or increase reimbursement to providers.
As to Me’s fourth point, it’s only because health care is such an important socioeconomic and moral issue that I feel it’s justified for the government to step in with a competitive public option. Letting the free market run health care under the current regulatory climate has been disastrous so far. Getting increased regulation over preexisting conditions and the like would be better than nothing, but a strong public option gives us the benefit of real competition. Do you think the private insurers would just fold on Day 1, or do you think they would actually try to make their plans competitive?
The auto insurance comparison is a bit flawed. You seriously don’t see the stakes are way higher when talking about health insurance versus auto insurance? That a person’s health and well-being shouldn’t be treated the same as a replaceable piece of property?
Me
August 29, 2009
Mike, I know automobiles are very different than humans’ well being, but I think the concepts I brought up still apply. The main point I had was about personalized coverage. That’s a major flaw in our current system and I think more people could afford coverage if it weren’t for blanket policies offered through an employer.
Mike Clark
August 29, 2009
Fair enough. I’m hoping you can elaborate on what you mean by personalized coverage, though.
Me
August 30, 2009
By personalized coverage, I mean the ability to choose the coverage individually as opposed to having an employer funded option that is the same for everyone at the workplace. A healthy person in their 20′s should be able to get a better rate than an older person with a chronic disease. In other words, there should be different “risk groups” similar to auto insurance. If I sought out a plan outside of my work plan, I’m sure I could do more of that but it would still be tough to compte to whatever the employer picks to fund. Things like choosing a deductible would be nice. The reality is that some people cost the insurance companies a lot more than others and it makes since to charge premiums accordingly. At least that wouldn’t be as harsh as simply dissallowing those with pre existing conditions.
David Franks
August 30, 2009
Me–
If “it is not the government’s job to be a business entity”, why do conservatives demand that the government be run like a business? I take it you’re not a conservative. Anyway, much government inefficiency is the direct result of trying to not operate at a profit.
First you said that Cash for Clunkers helped the government. Now you say it helped the auto industry.
Again, my mention of the interstate system and Beaver Lake is strictly in regard to the fact that they redistribute wealth to your benefit, and I want to know how you earned or deserve that redistribution. If you don’t want to answer that question, that’s fine; perhaps you’ll tell me instead why it’s okay to redistribute wealth for some things, but not for health care.
Dr. Clark–
Turning profit from a public health-care plan back into the plan is what I was talking about earlier when I suggested that a better product is as good a dividend as dollars– when the stockholders and users of the product are the same people.
David Franks
August 30, 2009
Me–
By the way, I think greater individualization of health insurance is a good idea. It would tend to tailor risk/benefit calculations to the policyholder (which shouldn’t be a problem) and makes insurance a bit less like legalized gambling. Carried too far, though, it would do away with the insurance industry entirely, and it would replace noncoverage of pre-existing conditions with unaffordable coverage for pre-existing conditions.
Innarested Observer
August 31, 2009
Mike, I will vote with my dollars and support your business. Others responding on this thread, should you have jobs, I will boycott your businesses.
Me
August 31, 2009
@ David –
Being a “business entity” as I described earlier and running programs like a business are different concepts. What conservatives mean by running the government like a business is basically meaning take the costs into consideration and try to use resources efficiently. The government shouldn’t compete with private industry directly but apply some business thinking to their social programs if they want them to be sustainable. The biggest conservative arguement is that we simply can’t afford to help everyone for everything. If you look at our budget numbers, you would see that we are way more in the red, way more risky, and way more inefficient than any sustainable business.
As for my discussion of the cash for clunkers program, I did not contradict. Remember, the government just dumped $50 billion into the auto industry so what helps one helps the other at this point.
As for the interstates and Beaver lake; the reason the government pays for roads and water is because no one would live in our country without them and they keep people spending and thus generating sales tax revenue. The interstate project was a huge “stimulus” at one point designed to boost jobs and the economy. I never said I was opposed to any government spending and every man is for himself; that is anarchy. I am taxed 30% on my income, $100/month on my property, and about 10% of everything I buy. I sure as heck expect some return for that money in the form of government spending; it is just a matter of where you draw the line and what we can afford without taxing even more.
If the individual plans made coverage unaffordable for pre existing conditions then perhaps that person would be eligible for medicaid? All that really means is that the costs are more in line with reality… a goverment option will have to handle the increased costs just like any other plan. It isn’t like if the government steps in that all of the sudden healthcare is free. The devil’s in the details and unfortunatly those with more expensive problems are going to have to pay more or be subsidized more.
@Innarested observer: You seriously want to boycott business that respond to somone’s blog? We’re all being civil here and having a nice debate.
Innarested Observer
August 31, 2009
@Me — Civil, riiiiight. You’re the exemplar of civil. I’ll interpret your specious argument that “we simply can’t afford to help everyone for everything” as meaning bailout for banks, failed large businesses = OK; help for citizens without health care = tough luck. Civilized. You can’t hang with me, son.
Of course I want to boycott businesses that display no concern for others. And that’s my right. And I back it up. If you tell me where you work, I can assure you that I won’t darken your door.
Me
August 31, 2009
@ Innarested:
When did I ever say that the bailout for banks and failed large businesses = OK?!
And if you think I’m not civil, notice the only name calling I did was directed at you after your last statement.
If you think I have no concern for others you obviously do not know me and haven’t really understood my previous comments. If I could wave a magic wand and make everyone’s health needs go away I would. Unfortunately I don’t and it doesn’t help anyone to go with an all or nothing approach. If you are so compassionate, why don’t you just become a doctor and fix everyone up for free!
By the way, I do not own my business so it would be completely rude of you to boycott my workplace because of my feelings.
Innarested Observer
August 31, 2009
Well, buddy, all I know is I stated my feelings and that prompted you to say I was a “douche.” So to me, Me, that is not “civil” behavior in my neighborhood.
I’m not a doctor, don’t play one on television, but I work in a public service capacity and I see people who are hurting every day. A lot of pain I see comes from people with exorbitant medical costs. The system has failed them, and I can say that I haven’t seen a single deadbeat among them. Most are just hardworking folks who live paycheck to paycheck, and when a health crisis hits, it doesn’t always even matter if they have insurance — they’re in big trouble.
I love the hypocrisy of many of those who are politically conservative… these are the people who purport to be guided by Christian values. But many, they don’t live those values. They just figure the poor can just eat it.
That ain’t how I roll. Any system will spawn jerks who try and cheat or game the system. Right now, the gamers are the big medical industries who deny coverage and never lose sight of the bottom line. The big money gamers — not the chump trying to live slack and suck on the government teat. I despise both of them. But millions of INNOCENT people don’t have basic health care, and in the wealthiest country in the history of the planet, that’s an obscenity that has to end.
At the end of the day, I’m going to side with Mike Clark, a professional speaking of his own industry, instead of someone who only brings weak, unsupported arguments and GOP talking points.
Innarested Observer
August 31, 2009
And BOOM goes the dynamite.
Me
August 31, 2009
@ Innarested:
I’ll reply to you and then I’m done sending time on this post:
1) I became less than civil when you said you would boycott my business for expressing my thoughts. At least calling you a name once wouldn’t hurt either of our livlihoods.
2) The system may be broken, but if not for the public service you provide, the *gasp* “evil” healthcare insurance companies, and doctors who perform work for well less than the work is worth, those people would be left to suffer with no help and die. Don’t take what we do have for granted and don’t bite the hand that feeds.
3) I am not politically conservative nor have I brought up any Christian values. I simply believe we can’t just throw trillions of dollars at a program in the name of compassion and think our intentions will solve everything. There must be a smarter way.
4) To you the insurance companies are evil and are cheating the system. To me, they provide a needed service and if it could be provided cheaper (notwhithstanding subsidies) then a competing insurance company would be doing that. They aren’t perfect and I agree with proper regulation from the government to fix some problems with our system. To me your argument is the same as what I hear about corporations… they are all greedy, evil, and are feeding off of society… but good luck getting a job without them. Hey, maybe you could start an insurance company since you see all the problems “they” cause and you apparently think they charge too much. You could just offer cheaper plans to undercut them, right?
David Franks
August 31, 2009
Me (even though you’re not reading this)–
“As for the interstates and Beaver lake; the reason the government pays for roads and water is because no one would live in our country without them and they keep people spending and thus generating sales tax revenue.”
Your suggestion that nobody would live in this country without the interstate system and Beaver Lake seems ironic: literally and figuratively, nobody would live in this country without good health. And there is plenty of evidence that healthy people are more productive and live longer, spending and generating sales tax revenue.
Again, health care reform can be accomplished within the private insurance industry, so there need be no gross outlay of public funding. I guess I can admire your persistence in ignoring this fact– in the same way I can admire the way a dog will run in front of a car: it doesn’t hurt the dog until it kills it, and the fact that it impedes traffic for everybody else is of no concern to the dog.
You’ve drawn your line in the wrong place.
David Franks
August 31, 2009
And it’s a shame the exchange in this thread got out of hand– I hate to lose a good contributor.
David Franks
September 1, 2009
Suddenly I have the urge to get a tubal reversal. Does anybody know where I might get one?
Dustin
September 1, 2009
@David Franks. Freakin’ spammers. He’s outta here.
Sandy
September 2, 2009
Thanks for the post Mr. Clark. But let’s not forget two classes of patients you don’t see. One is the person who has no insurance, and even if a doctor agrees to see him for free, discovers the medication is $200 or $1000 and can’t get it filled anyway. And the other is the Arkansas Medicaid patient who only gets 3 prescriptions a month, or at least it used to be that way.
I would call both of those scenarios rationing.
Mike Clark
September 2, 2009
Again, sorry I haven’t had time to reply regularly. David, I think we just disagreed in semantics :) Me, sorry to lose you in this debate. Spammers, GTFO.
@Sandy – I see both of those types of patients on a daily basis. I mean, how else are they gonna find out their meds are $200 or $1000 unless they come see me? For the former type, I am happy to recommend less expensive alternatives to the prescriber, and usually we can achieve a good outcome at a much lower cost.
For the latter type, Arkansas Medicaid allows an extension of benefits (EOB) which must be initiated by the patient’s primary care physician, which will allow the patient to get up to 6 prescriptions a month. I wouldn’t call this rationing since care isn’t absolutely denied. AR Medicaid is gracious enough to allow us to reverse claims after the fact, so if a patient needs an expensive drug after they’ve already used up their slots for the month, we can have the patient pay the cash price for a cheaper drug and then use that drug’s slot for the more expensive one.
I wouldn’t blame anyone for calling this rationing even though I disagree, but also consider the financial and safety implications of having a large number of potentially interacting or clinically unnecessary medications on board. (http://en.wikipedia.org/wiki/Polypharmacy)
hoglvr
October 1, 2009
wow!?
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