health care reform: bulljive in america

lately it seems you cant turn on the tv or radio without hearing about health care reform…  it seems everyone is an expert even though most everyone has no real understanding of the economics or logistics of our nation’s hospitals.  anyways, according to this article i read on NPR’s website, one of the insurance companies former PR executives has been encouraging health care reform, claiming that insurance companies have been scrambling to prevent expensive, but much needed, reform to the health care system.

communism!

communism!

i think too much of the conversation about health care has been taking place between people who A.) have no connection to the health care industry and B.) have no understanding of the economics or logistics of hospitals and major health care reform.  the reality of US politics is the people who make all of our national decisions (and in the case of the media, shape our opinions) are tragically underqualified and often working not in the name of our collective interests but instead their own private agenda.  i digress, but let it be known that i work in one of the largest US hospitals (not for the hospital, but in the hospital) and i still feel like i am under-informed on the whole health care reform process.  below i have attached three news articles from the economist, my favorite and most reliable news source, that have helped me understand the current health reform bill.  furthermore, i found this article (with quotes from UNC’s own jonathan oberlander, no less) on npr’s website that i think explains a lot of the confusion and hyperbole surrounding the bills – as the same scare tactics have been used agains health care reform for a hundred years..

Health Reform: What Now for Obamacare? from the economist – explains the actual reforms along with costs of reform and current costs of our system

America’s Hospital Industry: Taking a Scalpel to Costs from the economist – explains the potential gains from reform as well as a perspective of the hospital management

Congress’s New Health-Care Plan: Soak the Rich from the economist – explains the problems with the bill, a few ways reform could be funded

obammunism

obammunism

without sounding overly preachy, although that time may have already passed, i have talked a little here and there with various surgeons and doctors and residents here at the #3 hospital in the country and i cant seem to understand the opposition to the bill.  it seems it concurrently saves money, increases quality and coverage as well as more specifically defines the standard of practice.  it just makes logical sense from the patient and health provider point of view.  i think the only good reason i have heard why it has taken such harsh criticism is that it is democratically sponsored and could potentially uninflate the enormous profits made by insurance companies.  otherwise it seems like people are cookin up a big ole pot of american bulljive about why this bill shouldnt pass.  i welcome concerns, questions and criticisms.

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9 responses to “health care reform: bulljive in america

  1. Is Gatsby dead? It’s almost been a month dry spell…

  2. I think you have answered your own questions as to why the bill is not good. I’ll quote:

    too much of the conversation about health care has been taking place between people who A.) have no connection to the health care industry and B.) have no understanding of the economics or logistics of hospitals and major health care reform. the reality of US politics is the people who make all of our national decisions (and in the case of the media, shape our opinions) are tragically underqualified and often working not in the name of our collective interests but instead their own private agenda.

    Our government can’t run anything right. What makes you think they can run a health care plan? They screwed up the cash for clunkers. They screw up just about everything they can get there hands on.

    We can’t afford it. It will heap a ridiculous amount of debt on our children’s heads.

    It increases bureaucracy.
    It kills kids (abortion).
    It raises taxes.
    It will drive out doctors to other professions. (can you say second rate care)
    It kills the free market.
    It will put people in jail.
    It is wrong on so many levels.

    Since you work in a hospital, tell me the last time a person was denied care due to lack of insurance.

    I believe that real health care reform should be in the way of tort reform. Get away from those frivolous lawsuits.

    But enough from me, this is your blog.

  3. Jimmy you actually bring up some good points. I think I can be unclear when I write things sometimes so let me elaborate. Some economists believe that subsidized health care will cost our government money over the next 20 years or so, while others believe it will save us money. Considering the US spends more money on health care already than any other country, I tend to believe modernization of records and improved treatment will help. Let me explain that last point (and hopefully answer your question about being denied health care for not having insurance). When someone NEEDS health care in the US, no hospital will deny them service no matter what their insurance status. However, a patient must have a life or death situation and once the person is stable – as in, if they were to walk out of the hospital they would not immediately die – they are no longer given health care and promptly kicked out. In fact, one of the reasons our health care system is so bad is because hospitals only do a minimal amount of service to the uninsured, until they get seriously sick and then require very expensive treatment. Many doctors, economists, and even politicians have noted that this type of service is what raises costs for american health care (others disagree, obviously). a better way for everyone would be to spend a little extra money up front to really make sure the disease is well treated, and then prevent an expensive critical situation down the road. I tend to agree with this because even if we break even or lose a little money, people will be dramatically more healthy and healthier people are cheaper to insure and provide care to.

    I understand that some people disagree with our health care plan because it will raise taxes, increase bureaucracy and hopefully it wont sponsor abortion. I am not sure it will drive doctors to other professions – if we reduce lawsuits it may even make it more lucrative to be a doctor, leading to more doctors. further, i think the market will stabilize since we will always have to provide health care so there will always be a demand for doctors. i hope nobody goes to jail but with the penalties for not providing insurance it may happen. ideally it will increase the free market – the government will provide competition for insurance companies that have largely faced no competition or regulation. i would also like to say that i am not really impressed with the bill that is going through our congress right now – it is neither an improvement or a real change from our current system. i think in an ideal world we would completely overhaul the system, but the way politics is in america we could never get support for that. its too bad politicians have to get in the way of the economists and doctors who actually understand what is going on. i appreciate your input and i also hope we should get rid of the frivolous lawsuits

  4. I appreciate your quick reply-

    Let me break down your arguments. This is going to be long.

    “Considering the US spends more money on health care already than any other country, I tend to believe modernization of records and improved treatment will help.” So, you think that adding another layer of bureaucracy to help modernize records will help save money? Insurance companies are in it to MAKE money. If any other system than what they are currently using made FISCAL sense, they would have already done it. We spend more money and we are the best because of it. Those UN report use jacked up criteria for rating a country’s health care. Stuff like: does the country provide free health care for everyone? Well obviously we don’t- so they rated us poorly. Look at the markets- look where people go for care. That should tell you who is the best.
    “ In fact, one of the reasons our health care system is so bad is because hospitals only do a minimal amount of service to the uninsured, until they get seriously sick and then require very expensive treatment. Many doctors, economists, and even politicians have noted that this type of service is what raises costs for american health care (others disagree, obviously).” So, again, if insurers could save money, thus make more, they WOULD. What raises costs is the fact that many illegal immigrants are provided care at the expense of me. Also, costs are raised when Doctors run every test in the book- even though they know they don’t need to- just to cover themselves in the event of a lawsuit. Also, I argue that your premise that the US health care system is bad. If it’s so bad, why do all the Saudi princes and the Russian drug lords come to the US? Why not Britain or Canada? Why do so many Canadians come to the US for treatment? Your appeal to authorities like doctors, economists and politicians are laughable. Only the doctor is a businessman (or should be). The rest are just looters of everyone else’s money. Ask a businessman (like a insurance company executive) how to save or make money- that’s where you’ll get the answer. FYI, making money is not evil. Insurance companies are in business to make money- let them. If you are jealous, start your own company. If you don’t like them, don’t buy insurance- no one is forcing you to- YET!

    “ a better way for everyone would be to spend a little extra money up front to really make sure the disease is well treated, and then prevent an expensive critical situation down the road. I tend to agree with this because even if we break even or lose a little money, people will be dramatically more healthy and healthier people are cheaper to insure and provide care to.” This is a circular argument. Who is it better for? The bum who won’t get off his tail and get a job? Also, whose money are we spending? It’s money Obama doesn’t have. It’s money that our kids will have to finance. That is wrong. More social welfare is not the answer.

    “I understand that some people disagree with our health care plan because it will raise taxes, increase bureaucracy and hopefully it won’t sponsor abortion.” Isn’t that reason enough?

    “ I am not sure it will drive doctors to other professions – if we reduce lawsuits it may even make it more lucrative to be a doctor, leading to more doctors.” Yes, that alone would work. But, when you couple the fact that medicare and medicad currently don’t pay what other insurances pay- you’ll understand when the best doctors aren’t found in the inner cities- they are found in wealthy suburbs. The same will happen with this new government insurance. No doctor will want to accept it b/c it wouldn’t pay. They would be forced to take it however and drive them out of business. Those that do stay in business would be the ones that are the bottom feeders- unable to make it in another profession. (would you rather go to a highly paid brain surgeon or a guy that does it the cheapest?)
    “ further, i think the market will stabilize since we will always have to provide health care so there will always be a demand for doctors.” We hardly have enough doctors now. Just wait till every Dick and Harry and Juan are in the same office waiting room. Also, in a typical economic model a higher demand generally equates to a higher price. This is not so with the Obama plan. Doctors would get paid low rates- regardless of demand. Actually- this is another good point. Doctors will now get paid less per patient- that means, to make the same amount of money, they have to see more patients…. Does that mean better care? I doubt it.

    “ i hope nobody goes to jail but with the penalties for not providing insurance it may happen.” And your OK with that!? The government has never in the history of our country FORCED someone to buy a product. They are taking away freedom. You would no longer have the freedom to say, “ I no longer want health care.” Say you were super rich, why would you need to buy health insurance? Could Bill Gates justify it? He is currently self insured.

    “ ideally it will increase the free market – the government will provide competition for insurance companies that have largely faced no competition or regulation.” You are deluding yourself. Insurance companies have plenty of competition already. (Aetna, American Association of Retired Persons, American Family Insurance, American National Insurance Company, Anthem Blue Cross and Blue Shield, Assurant, Blue Cross and Blue Shield Association, Cigna, EmblemHealth, Fortis, Golden Rule Insurance Company, Group Health, ooperative, Health Net, HealthMarkets) just to name a few. Obama plans to get rid of all these and have a single insurer- he’s said so himself. How can you compete with an entity that doesn’t have to make a profit?? Are you kidding, the insurance industry is already one of the most regulated industries in the nation. We don’t need more regulation- it stifles productivity.

    “ i would also like to say that i am not really impressed with the bill that is going through our congress right now – it is neither an improvement or a real change from our current system.” Then why are you for it?

    “ i think in an ideal world we would completely overhaul the system, but the way politics is in america we could never get support for that.” Thank God for that. Why does the government need to overhaul the system? It’s was working just fine until they started messing with it- messing with it more is not the answer.

    “ its too bad politicians have to get in the way of the economists and doctors who actually understand what is going on” Are these the same economist who claim the recession ended six months ago? Yeah, I have a lot of trust for those guys. Again, businessmen know business. Let them take care of it. Again, I know you see the truth in my arguments when you say that politicians are getting in the way. Keep the politicians out of it! Don’t support a congress that wants to take away your freedoms and screw our free market.

    Didn’t you read Atlas Shrugged? I’m disappointed you didn’t learn the lesson she tried to teach you.

    Last question. If you were sick with cancer, would you choose to go to Cuba (where they have free health care, or to the Mayo Clinic (private)? I’m sure you’d choose the Mayo Clinic. Why? Because money attracts the best doctors and the best equipment, drugs and care. Take away the money- and you take away the incentive for those things.

    I hate arguing on the internet. It’s just that I can’t understand why anyone would want such a ridiculous bill to pass. 54% of the nation is against it- yet our elected servants are ignoring us. That pisses me off.

  5. Jimmy,
    Again you have some good points, but I think maybe I can provide you with a different perspective on some of these arguments. First of all, I support the new bill reluctantly because our health care system IS very bad. in the next 10 years, Americans will be paying $38,000 PER HOUSEHOLD for insurance, and this is regardless of the whole health care bill; these statistics reflect what would happen if we kept at the rate of spending from before the 2008 election. During the bush administration, the net pay per employee in this country rose by 25%, however the actual income did not increase at all (this tidbit is from david frum, one of the economic advisors under the bush administration who actually realized how bad health insurance had become by the end of his term that he is now working hard to fix it). this 25% increase, quite literally, was just the cost of insuring the same customers. would you rather pay 25% more for the same thing, or get that 25% as cash and spend it however you want? obviously you would take the cash. This does not justify the current bill, but i am just establishing that our current system is terribly flawed and there is definitely change needed.
    although you can list a bunch of insurance companies, and i would agree that the insurance industry is fairly regulated, the problem is the wrong regulations are in place. and im in complete agreement that many times doctors are forced to perform tests or procedures that are unnecessary; one reason is because they have to “cover their asses” so that they dont miss a diagnosis and get sued. I agree that this needs to change.
    one other interesting thing that you may not have thought of. Dr. Jack Wennberg noticed in the 1970s that even across small regions, the amount of surgeries that were performed for the same injury varied differently. After studying eye surgeries in particular the numbers became more clear. They used eye surgeries because it is easy to quantify the degree of vision impairment – 20/20, 20/40 etc. Anyways, when you had one eye surgeon in an area, the patients in that region received surgery when it was necessary. When you had 2 doctors, the number of surgeries increased dramatically and when you had 3 doctors or more, the number of surgeries became huge. it turns out that the actual patient pool was so dilute that doctors started doing surgery when it wasnt necessary just to pay the bills. there are several studies on this and today these policies are beginning to shape the standards of medicine – when it is ok to do surgery and when it is overkill. furthermore, they found that not only were these doctors doing more surgeries than necessary, but they would do an extra delicate or costly surgery for no real reason, even though clinically they saw no improvement in health compared to people who had less expensive surgeries. so it turns out that you can have too many doctors. the reason i bring this up is because one of the points of this health care bill is to assign scores to doctors – its hard to explain but i will try. one score system would provide the cost per outcome for each doctor. for example, if you could be cured of your disease for $500 at one doctor vs. $2,000 at another, you would obviously go to the cheaper one, all things considered equal. another score would not be money based, but outcome based. for example, if you go to this doctor you will be cured 95% of the time vs. this doctor who would cure you 80% of the time. a third would be a combination of the two. this would literally give patients the advantage of a free market – full knowledge and unhindered freedom to change doctors. i think this would actually reduce costs by making doctors accountable for the quality of the care they provide. and im right there with you that the free market is the best way to handle services.
    regarding the government package – obamas desire to eliminate all other insurance companies is news to me. i hope this isnt true, but also it doesnt make any sense. why would he want to do that? i dont see any reason he could justify that
    finally, in regards to your “quality of care remark”. alot of patients do come from abroad to get operations performed in the US – most of the time money is not an issue for them. however for 99% of americans, the cost of health care is an issue. the obvious retort to your question regarding the US vs. Cuba comment is “would you rather have a surgery in america, or would you rather have no surgery at all because you cant afford it, even though you are an america, and you do not have insurance?”. this is the sad reality. luckily i do not have to make this choice because i have insurance provided by UCLA. ironically, many more people LEAVE the US to get surgery than come in to the US because you can get the same surgery for much less in china, india, brazil etc. interestingly though, the most cost efficient hospital in the US is the Veterans Affairs hospital here in Los Angeles – they have the best outcome per dollar. also interesting is that this hospital is entirely government sponsored and serves as the template for a potential universal health care system. they save alot of money by doing exactly what i was talking about earlier – diagnosing early with simple and medium cost treatments that save money down the road by preventing expensive emergencies and much more expensive but pointless treatments.
    i should make a note that i dont mind paying for illegals and bums and its not my childrens money because im still a child so its my money. i just think we are a country that shouldnt have to turn anyone away and it still shouldnt cost us that much money. i think the VA system serves as a perfect model for cheap, effective universal health care in the US so it troubles me that we actively choose to go with a more expensive, less effective system. and i dont think making money is evil, but i can make money by pointing a gun at someones head. that doesnt make it right. current insurance companies make ridiculous profits on sick people but still deny proper treatment from everyone who needs it. its troubling to me. even though the government is telling me i have to have insurance, i dont consider this a lack of freedom. when the government lowers taxes, they arent taking away your freedom to give money to the fed. are you really losing a freedom? when the government gives you health, are you really losing freedom? if so, think of all the people who could never have their health because for whatever reason they could not acquire insurance. is their freedom gains more important than your freedom losses?
    i guess to close this out, my opinion (which is no way expert, but i would say pretty well informed) is that universal health care will not cost anymore than our current system. in the next 10 years it will more than likely save all of us a lot of money, it will probably not dramatically worsen our lives or liberty, and we will probably be more healthy because of it.politicians will, and already have, messed up the bill, but it is a step in the right direction. our system right now is terribly flawed – we rank in the 40’s worldwide for infant survival rate and that does not include anything about whether or not we have universal insurance, just how well babies survive . its scary. i recommend you check out NPR’s special on health care – This American Life # 391 from 10/11/2009 called “More is Less”. It looks at how health care needs reform from the patient, doctor and insurance provider perspective and then follows that episode up with a second that goes into more depth about the flaws in our health care system. I appreciate your comments though, I can tell you really care and you have put a lot of thought in to this. I hope we can work out a system where we all get better service without the ridiculous costs. and i hate politicians too, but i dont trust rand completely

  6. I don’t think you can have it both ways dude.

    Also, check you sources. NPR is run by the government- what do you think they are going to tell you?

    Actually the US is #33 on the chart for infant mortality. (is this even a measure of health care?) http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

    And that’s probably NOT due to lack of healthcare- cause pregnancy is one of those “emergencies” that is already covered for free.

    But more likely due to the way WHO defines a live birth. Most European countries kill the unborn if they exhibit any signs of defects! Also, China kills girls on crowning. ” But the method of calculating IMR often varies widely between countries based on the way they define a live birth and how many premature infants are born in the country. The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.” Many countries, including the United States, Sweden or Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States Centers for Disease Control researchers,[6] some other countries differ in these practices.

    I don’t know why you are buying the crap that O’bamacare will cost the same or less. Please read this article from the CATO Institute: http://www.cato.org/pub_display.php?pub_id=10409

    The official white house line is that it will cost taxpayers $1.2 trillion. That’s 1.2 trillion in addition to what your ALREADY paying for insurance. For starters, $1 trillion of extra debt-financed spending would cause the government to pay about $300 billion of extra interest in the next decade.

    The House health-care bill gives a large subsidy to millions of families with incomes up to three times the poverty level (i.e., up to $66,000 now for a family of four) if they buy their insurance through one of the newly created “insurance exchanges,” but not if they get their insurance from their employer. The CBO’s cost estimate understates the number who would receive the subsidy because it ignores the incentive for many firms to drop employer-provided coverage. It also ignores the strong incentive that individuals would have to reduce reportable cash incomes to qualify for higher subsidy rates. The total cost of ObamaCare over the next decade likely would be closer to $2 trillion than to $1 trillion.

    What I’m getting at with the Cuba vs US health care is that we will turn into a Cuba-like system if we go down the path we are going. So, you either provide crappy coverage for everyone- or you charge for it and a small minority can’t afford it.

    Chris, sometimes no action is the best action.

  7. right. i should check my sources. next time i will go for something more reliable than published medical data from respected journals and NPR. something more like fox news or wikipedia.

  8. I had a lengthy response- but the page crashed….

    Anyhow. Now, that you know that it’s true- what Obama said about a single health care provider- does it still “make any sense?”

    “why would he want to do that?” No idea

    ” i dont see any reason he could justify that” Me either.

    So, you don’t like fox or wikipedia. What about the message? Did you like what Pelosi and Obama had to say? or are you just shooting the messenger?

    I am a veteran- I can tell you that the veteran’s hospitals SUCK. They suck b/c they have crappy doctors. Any doctor who knows his stuff gets out of the military and goes into private practice. EVERY time I’ve gone to a military doctor, they just sit there with WebMD and put in my complaints and then wait for the computer to tell them what to do. It’s cost efficient yes- they only have to pay the docs the military wage- but you get crap care.

    So, review your comments again. Are you still supporting this plan- despite all the negative things you’ve said about it?

    Raises taxes, written by unqualified politicans that care only about special interest groups, throwing people in jail, kills babies, increases costs, destroys the free market, lowers quality of care, makes no sense… shall I go on?

  9. Forgot to add about your infant mortality statement.

    Yes, pregnancy is one of those things that is covered whether you have insurance or not. Also, WIC provides FREE food for poor mothers and children and FREE health checkups both pre and neo natal. So, I again, I can’t say that Infant mortality rate is even a measure of health care in a nation- it reflexs more on what that nation considers a live birth.

    Can you address any of the things I’ve said? or are you just going to say that I’m making this stuff up or getting it from Fox?

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