The reaction in certain quarters to the healthcare reform provisions of the stimulus bill now clearing
Congress lays bare the nature of opposition to the forthcoming fight for real change in healthcare: It will be viciousness at the top of the lungs. It will be a scorched-earth campaign. Its main weapon will be fear. It will be unencumbered by any actual knowledge, subtlety, awareness of history, or access to the thoughts of people who actually know what they are talking about. Its fury will be unloaded not just in service of narrow and inflexible political nostrums, but in the service of sectors of the industry which fear that a truly efficient and effective healthcare system would cripple their profit margins.
The fulminating rages across Rush Limbaugh's radio rants, Matt Drudge's blog, the editorial pages of the Wall Street Journal, and commentaries issued by conservative think tanks, all echoed around the blogosphere. The connections and logical leaps that they consistently make are rather startling to anyone who has been working on the systemic problems of U.S. healthcare for the last few decades. The prime targets of this offensive are comparative effectiveness research, to which the bill allocates $1.1 billion, and help for digitization. The federal government already pours over $300 million per year into comparative effectiveness research – using powerful medical and statistical techniques to determine the most effective and least costly ways to treat disease – through the National Institutes of Health and the Agency for Healthcare Research and Quality. But to Limbaugh and company, actually finding out what works and what doesn't automatically means having committees of government bureaucrats tell your doctor what to do. Research equals socialism. In this frame, digitization, which seemed to work out okay in airport kiosks, grocery stores, and the ATM down at the bank, means something entirely different in healthcare. It means the end of all medical privacy, all ability to choose, and all security in one's access to healthcare.
The irony is that these folks are all about the free market, about choice, about one of America's great skills, shopping. But Americans, and America, are truly dismal shoppers when it comes to healthcare, because we have no idea what we are buying. Neither we nor our proxies (the government, health plans, employers) have any clue what actually will keep us healthy or cure us, who is really good at it, or what it will really cost. As situations go, this is double-plus ungood.
The really sad irony is that we already have, in our system as it works today, every bad outcome these folks are imagining. We already have bureaucrats telling the doctors what they can and cannot do, and telling consumers what doctors they can go to, they're just private bureaucrats working for health plans, informed more by the balance sheet than by effectiveness studies. We already have people's private medical records being used to deny them coverage – by everyone except the government. We already have healthcare rationing, we just do it by ability to pay, by whether you still have a job, and by whether you have been visited by the dread "pre-existing conditions." With our current patchwork of plans tied to employment, many with very high deductibles and co-payments, many subject to rescission when they are most needed, most immune to lawsuit under ERISA, no American under the age of 65 can feel secure in their access to healthcare.
There is a good chance that this toxic brew will be effective. Comparative effectiveness research in political methodology shows that fear and ignorance are a powerful combination when administered in high enough doses. As the debate over the actual healthcare reform bill moves forward, we can expect massive volumes of this combination to be dumped on the public, and on those of us who have been trying to roll this boulder up the mountain for a long, long time.
Clarification…. Usually, in a setting such as this BLOG, this type of question is just ignored (in the BLOG). In this setting, “Experts” commenting in most blogs seem to usually be well-intended, but have little to no concept as to how their proposals are typically not possible or practical for the majority of medical practices (i.e. 1 to 3 clinicians). They are often in error, yet seldom in doubt. Their “deer in headlights” response to questions is a frequent give-away as to their lack of perspective in the settings a majority of care is delivered. The evidence is that attempting to generalize what has worked for larger practices (i.e. the 30%) generally fails in smaller ones (i.e. the 70%). Few “experts” understand this reality based on the evidence. Sad, because I think most of them seem to want to see the same end results that most patients would prefer (e.g. less waste, better information, and better care based on the evidence). I typically deal with dozens of physicians in more typical practices (i.e. smaller practices) every week. The vast majority I speak to feel the same way and desire less waste, want better information, and crave the information that would facilitate their efforts to deliver better care. However, the previous “experts” have created a system that does not allow this to happen.
I am a Finn living in the United States and here is my situation: at home in Finland I have the choice between
a) Almost-free national health care.
b) Immediate access to any private doctor in any specialty (you can usually get an appointment same day), for a fraction of the cost of same in the US.
c) Immediate access to emergency health care.
The health care is some of the best in the world. Just one statistic off the top of my head is infant mortality – next to nothing in Finland, whereas the US is something like number 18 globally.
In the US, I have access to one bad doctor (only one near me who was accepting new patients and accepts my insurance), no emergency access to speak of (7 hours wait for a few stitches), and whenever I do manage to get an appointment with a doctor, the only thing they are interested in is convincing me I have something that needs constant “monitoring” – meaning, constant milking of my insurance company. The healthcare facilities have a distinctly Soviet appearance (my doc’s office has mildew everywhere!), not the state-of-the-art gleam I am used at home. I have yet to locate an OB-GYN that will take me as a patient, and have forked over untold amounts of money to Planned Parenthood for health care my insurance is supposed to cover.
The result? I visit private doctors on my trips to Finland for my regular checkups. I get state of the art care and 50 euros for an uninsured, private doctor’s visit is better than trying to navigate the Soviet bureaucracy here in the United States. I get my health care when I want it, and who I want it with.
Americans: missing out big time. And dying from preventable diseases. Darwin award, anyone?
Hello Nate,
I think you may have a Freudian slip in your algebra up there. If you look at your assumptions:
X=T and U>Y
then T-U=Q MUST be smaller than X-Y=Z.
Since Q denotes the waste in a public system and Z the waste in a private system, I must conclude that your math agrees with my logic, even if you do not
Have a good evening….
Ok, it appears we accept that healthcare isn’t a “right”. Didn’t see a response to who might be forced to provide it… which begs the next question:
Under what circumstance is it ok to forcibly take from one what was justly acquired to give to another? Perimeter defense comes to mind… but doesn’t that sort of benefit everyone equally? Not to mentioned being a basic requirement of continued existence?
I would expect of a truly enlightened society (one that actually learns from history) a better grasp of the utter infeasibility of forced, collective redistribution to be a catalyst for human “progress” and a far greater appreciation for the limitlessly effective, focused, and agile capabilities of the worthwhile charities of human sp1rit.
Don’t have any friends that might be there in your hour of need? Sad. Might want to make some. Could try going to “chirtch” (just a thought, G@d forbid).
So what does it matter which method, mechanism, treatment, weighting, formula, program, qualification, or policy framework is used? It isn’t opposition to the fight for real change in healthcare… it’s opposition to the WRONG change in healthcare – which is the same opposition applied to the broader set of false premi(ses), straw arguments, and mis-guided euphoric/social consciousness/can’t we all just get along that brought us to this question.
ps – misspellings courtesy of a filter that apparently doesn’t like this kind of talk.
Nate, your math is a little sparse.
Profit is extracted at all levels of the chain. To get to Y you need to add profits (P). So Yt(total) equals P+P+P+P+P+P. The X then is inflated far beyond what is sustainable and hence why we pay twice as much as other industrialzed countries.
Spike- what I am saying is this: if YOU want to turn your health, and that of your family’s, over to some ‘data mining software’ and a complete reliance on available evidence for every possible diagnosis you could have, by all means it should be your right to do so.
Just do not coerce and compel the rest of us to be a part of that system.
Joe- then shame on you for not recognizing the policies being promoted today are the same fallacious ones that characterized the stagflation of the 1970s and the Ted Kennedy driven HMO Act of 1973.
Apologies if this double posts as my first attempt seems to have disappeard in the electronic black hole.
Nate, your math is a little sparse.
The Y in your calculation is made up of P(profit) at each level of the chain. So included in Y is P+P+P+P+P. That determines an X that is about twice what other countries pay. In a single-pay system the X is also made up of P but it’s small p as the components are regulated. P can also be eliminated from the insurance part along with a smaller A (administrative costs).
I’d just like to know where the Constitution authorizes any of this? And please, don’t say “promote the general welfare.” The Constitution lists specifically what government can do to promote the general welfare. Nowhere does it say anything about health care.
I am a Finn living in the United States and here is my situation: at home in Finland I have the choice between
a) Almost-free national health care.
b) Immediate access to any private doctor in any specialty (you can usually get an appointment same day), for a fraction of the cost of same in the US.
c) Immediate access to emergency health care.
The health care is some of the best in the world. Just one statistic off the top of my head is infant mortality – next to nothing in Finland, whereas the US is something like number 18 globally.
———
But we have a different system of government by design. In order for someone to have access to all that ‘free’ health care someone else has to pay. To force someone else to pay is to steal their justly acquired property by force. IOW, it steals my liberty.
is better than trying to navigate the Soviet bureaucracy here in the United States.
————–
And getting government involved is supposed to improve this? We do have socialized medicine run by the government. It’s called the VA and it is terrible.
How to buy prescription drugs…? My doctor prescribed vicodin for a while back, my back hurts, I think it is a great help, but in my country it is difficult to find, it is paramount to have my information on it and found information about findrxonline.com the medicine, because it provided me.
My question is this..If the goverment is going to help people with their healthcare costs who cannot afford it (medicaid) and if the health reform bill passes and more people must be helped in order to have insurance, many of those people choose to spend their money on non-life saving medicines but refuse to pay for the ones they really need. Also, why should people go to jail for not being able to buy health insurance but we are keeping and at many times giving free healthcare to illegal immigrants. Many parts of the bill could be good, but also very scary. But yes, we would be able to buy our own insurance with private money. Isnt that what a lot of people do now anyways?