Wednesday, March 07, 2007

Health Care System: It's About Taking Care of People's Health Needs, Stupid!

I'm going to ask you to do something that I guarantee is going to clear your head and let you think, really think -- and maybe strike a blow for better health care for yourself and for all the rest of us.

Don't be nervous. It's not an intelligence test and it doesn't hurt. Actually, since it involves throwing open the windows of your mind and letting fresh air circulate, it should be exhilerating.

Ready? Good. Close your eyes. Now tip your head to one side and shake it. Do the same on the other side. Repeat until you have emptied your head of all preconceptions about our health care system and all the ideological crap from special interests.

Look at you: Those eyes, they're positively sparkling; that look, why it's of an epic seeker of truth; those vibes, you've become that -- these days -- rare person with an open mind who views all ideologies with flint-eyed skepticism.

You're ready to do some straight thinking about our health care system. Okay, here we go. With your propaganda-free thinking cap on, imagine a health care system in America where:

People don't lie awake at night worrying about medical bills they can't pay.

Nobody goes bankrupt because of unpaid medical bills -- the number one reason Americans declare bankruptcy.

Huge health insurance companies don't have the power to decide whether you and I receive health care and what kind.

Nobody talks about health insurance and everybody talks about health care.

Doctors don't take orders from health insurance companies but decide with patients what kinds of care and tests patients should receive.

Competition is brisk and individual enterprise virulent as hospitals, physicians, and other providers try to outdo each other in the quality of patient care.

Preventive care is considered just as important as care for chronic diseases and problems.

Overall costs to America are significantly less than in the current system, the most expensive in the world, and health costs don't threaten to bankrupt the country.

Where everybody gets the health care they need, regardless of money or station in life, and every patient is treated exactly the same.

(Can you imagine the President of the United States, sniffling with a pesky cold, waiting his turn in a public hospital to see a doctor along with a roomful of fellow citizens? Preposterous? Tell me, who works for whom? In a democratic land that endows all citizens with equal human dignity and rights, shouldn't an American President who serves all of us properly insist that he or she be last to see the doctor -- and to feel duty-bound to do so?)

So, open-minded deep thinker, what kind of health care system would you like to see? How many like the present system? Put your hand up. Hmmmm, just few hands, all executives of health insurance companies I expect. No surprise there.

The present system, judging by the tons of money they make (check out the pay package of the departing CEO of United Health, "Mountain-of-Millions" McGuire), is all that health insurance companies could ask for in their wildest fantasies. The pay packages of health insurance executives at the handful of dominating mammoth companies would be enough to provide health care for literally millions of Americans. And that does not take into account administrative costs -- largely devoted to finding ways to deny care -- which would provide care for millions more.

How many would like a health care system incorporating the entire wish list above that you have been imagining. Wow-- look at all those hands. What does that say? Now that you think about it, do these imaginings actually make perfect sense for America's health care system? What do you think?

I think they do, but a half or more of all Americans don't agree and you may be one of them. You may think that the scenario outlined above is pie in the sky and even, with its whiffs of "socialized medicine" and "Hillarycare," vaguely un-American.

But, please, think. What you may really be doing is thoughtlessly clinging to an ideology-riven and failed health care system. I call it closed-mind syndrome and is characterized by rote non-thinking. All ideologues suffer from it. The cure is the way we started this post: empty the head of all pre-conceived notions and deeply held dogma, switch on a now tabula rasa brain. Think not just out of the box but as if there is NO box.

It's not easy breaking a lifelong acceptance of our health care system as we see it and as various compelling ideologues tell us it must be. Venturing out into the intellectual equivalent of the Wild West can be downright scary, but this is the only way to get free of all the false imperatives and distortions that millions of us have about our health care system.

Take the concept of health insurance itself. Few question its necessity. Even with mass denial of health care and costs that will certainly bankrupt the country without emergency changes now, political leaders and millions of Americans still think of our health system in terms of health insurance instead of health care.

Yet this may be one big reason why our health care system is sick while our health insurance industry is healthy. The big health insurance companies, United Health, Humana, Wellpoint, et al, are printing money. Their profits and stocks are soaring as never before. That would be fine, except that all those hundreds of millions are being swept right out of the health care system while more and more people are denied access to care.

Here's a bumper sticker I would like to see: It's not health insurance that we need, it's health care, stupid! Would someone please make this into a bumper sticker? I promise to order a bunch and give them away free. And, make no mistake, applying principles of insurance to health care really is stupid.

Insurance is all about risk and probability and it works fine in some areas, such as car insurance. Insurance company demographers can easily calculate the statistical probability of accidents among large populations of drivers and set premiums guaranteed to result in profits. The premiums of the many drivers who never have an accident and a claim more than pay for costs of the few accident-prone drivers.

When an insurance company tries to do the same thing in health care, what it comes up with is a population in which every "driver" is eventually going to have an "accident." Not only that, something approaching 100% will be repeat offenders. Not only that, the "accidents" do not result in one or two claims that is paid and done with, but the "accidents" and the claims go on and on and on.

What the health insurance industry sees is that every American needs health care and requires it for a lifetime. Its perfectly natural response is to try to deny as much care as possible. With astronomical claims, the health insurance industry charges astronomical premiums and employs care management (denial) specialists to rein in costs at the expense of patients. Of course, the premiums and care denials have to be high enough to guarantee astronomical pay and benefits to health insurance executives.

So we have situation where people are outraged that 47 million Americans lack health insurance when that is not even the problem. The real problem is that they lack access to health care. We have been conditioned to think of health care in terms of health insurance for so long that we can't imagine it any other way.

As a matter of fact, in the latest New York Times/CBS News Poll, a majority of Americans say that they want government guaranteed health insurance. Not health care, insurance. What they really want, of course, is health care but are conditioned to think only in terms of health insurance. Which is just hunky-dory with United Health whose advertising pounds into our heads the vital necessity of health insurance.

However, there are signs that the brainwashing is under serious attack. A high U.S. Government official by the name of David M. Walker demurs. He is the Comptroller General of the United States. If ever there was a non-ideologue, it is this fellow, shown in this official photograph.

David M. Walker became the seventh Comptroller General of the United States and began his 15-year term when he took his oath of office on November 9, 1998. As Comptroller General, Mr. Walker is the nation's chief accountability officer and head of the U.S. Government Accountability Office (GAO), a legislative branch agency founded in 1921.

GAO's mission is to help improve the performance and assure the accountability of the federal government for the benefit of the American people. Over the years, GAO has earned a reputation for professional objective, fact-based, and nonpartisan reviews of government issues and operations.

Mr. Walker has called the 2003 Medicare Drug Prescription Benefit "irresponsible" because of the huge increase in federal spending. The law, which was literally written by the drug industry, expressly forbids the government from negotiating better prescription drug prices with pharmaceutical companies.

In 2006, according to a new study by the AARP which represents millions of seniors, prescription drug prices rose by 6.2 percent which is twice the rate of inflation. The prices of some drugs used by seniors increased by much more. The price of the insomnia pill Ambien, for example, increased by 30 percent in 2006.

Comptroller Walker warned it would happen and it did. Lately, he has been going around the country with an even more dire message: that the galloping costs of our health care system threaten to bankrupt America.

He says we are heading straight for financial catastrophe. And if you think I am exaggerating his position, read some of his recent speeches and decide for yourself.

So if what we have now is financially unsustainable and fails to give millions of Americans access to health care, what kind of system did we imagine together at the beginning of this post? We imagined universal health care for all guaranteed by a single payer, the U.S. Government.

Go back and review each of the characteristics and you will see that they add up to only one thing, universal health care. It offers everything that we all want, have a right to, and can afford. It's a health care system worthy of the wealth and values of this great nation.

Single-payer universal health care appears to be on the table again for the first time since 1993 when Hillary Clinton tried and failed to get it through Congress. One 08 Democratic presidential candidate, John Edwards, has embraced it and has published a detailed universal health care plan, but one that remains linked to private health insurance.

While universal health care is being spoken of for the first time in years, it is still spoken quietly. Every public mention instantly attracts cries of "Hillarycare" and "socialized medicine." What's different from 14 years ago, however, is that these are cries and not screams. Still, ideologues never go quietly and never, never think anything new.

The health insurance industry, flush with billions in cash and riding high, has no intention of giving up multi-billion-dollar annual profit streams without a bitter fight. As the 2008 campaign heats up, get ready for a high-powered, slick, expensive, multi-media advertising campaign to make sure Americans continue thinking health insurance instead of health care.

So long and keep moving.



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