A national health reform leader made the argument to me today that we have a moral obligation to provide health care to all Americans. I asked him to define “all” Americans to clarify his position, and am awaiting his answer.
1. Do we have a moral obligation to provide health care to all Americans?
2. Do we have a moral obligation to provide all forms of health care to all Americans, or do some people have the right to use services not financially available to others?
3. Is there a place at which the public's (i.e. government's) moral obligation ends, and government must decide to cease offering it?
Perhaps you might say it depends on what the meaning of “we” is. Is “we” all U.S. residents or just those here legally - or just citizens?
And if we have this obligation, should this care be delivered and/or paid for by governments, private insurances, charities, and/or personal service?
This is a tough question. How it is answered will have a profound impact on health care reform.
It is not so different from questions about our moral obligation to provide food, shelter, and clothing for everyone. We already provide food stamps, WIC, Section 8 housing, vouchers for necessities, at taxpayer expense. It is likely that during the 1960s, we asked and answered the moral question that yes, every American has a right to these essentials, even if it cost taxpayers some of their livelihood.
Help me think this through.
Wednesday, March 18, 2009
Thursday, September 25, 2008
Mortgage Bailouts and Health Reform
What does the mortgage crisis have to do with the future of health care reform? Plenty.
Stan J. Liebowitz, economics professor at the University of Texas at Dallas, tracked the intervention of the federal government into mortgage lending during the past 20 years. Boiling it down: In the name of home ownership, economic laws were suspended so that people without assets could buy houses. Should we be surprised when they cannot pay for them, and when they are foreclosed upon?
Now economists insist that free markets cannot adequately serve the lending industry, and that is why the federal government must step in to rescue it.
The commonality with health care reform is twofold:
1. The federal government, since at least 1965, has continuously ratcheted up its involvement in the payment and delivery of health care. States have either stayed a step ahead of the feds, or followed closely behind. Government has nearly destroyed the health care market economy.
2. The same logic used to justify a federal bailout of mortgage lenders and the banking industry will be used to reform health care. We have been told for decades that health care cannot operate in a free market environment. When it fails to meet governments’ goals for it, our vaunted U.S. health system, so the politicos will claim, need to be rescued by the government.
The big difference is that we have time to do something about health reform. An army of health insurance agents can dispatch itself to work overtime to convert the insurance market to consumer-directed health plans.
Only by bringing consumer (aka voter) pressure on Washington, D.C. and state capitals will the United States be able to avoid a national health plan. I am convinced that without such a movement, the march to socialized medicine will reach the tipping point by 2012-2014.
Please, don’t let this happen.
Stan J. Liebowitz, economics professor at the University of Texas at Dallas, tracked the intervention of the federal government into mortgage lending during the past 20 years. Boiling it down: In the name of home ownership, economic laws were suspended so that people without assets could buy houses. Should we be surprised when they cannot pay for them, and when they are foreclosed upon?
Now economists insist that free markets cannot adequately serve the lending industry, and that is why the federal government must step in to rescue it.
The commonality with health care reform is twofold:
1. The federal government, since at least 1965, has continuously ratcheted up its involvement in the payment and delivery of health care. States have either stayed a step ahead of the feds, or followed closely behind. Government has nearly destroyed the health care market economy.
2. The same logic used to justify a federal bailout of mortgage lenders and the banking industry will be used to reform health care. We have been told for decades that health care cannot operate in a free market environment. When it fails to meet governments’ goals for it, our vaunted U.S. health system, so the politicos will claim, need to be rescued by the government.
The big difference is that we have time to do something about health reform. An army of health insurance agents can dispatch itself to work overtime to convert the insurance market to consumer-directed health plans.
Only by bringing consumer (aka voter) pressure on Washington, D.C. and state capitals will the United States be able to avoid a national health plan. I am convinced that without such a movement, the march to socialized medicine will reach the tipping point by 2012-2014.
Please, don’t let this happen.
Monday, September 1, 2008
The uninsured in America
We're not doing so bad after all.
The U.S. Census Bureau has lit the fuse for the next battle in health care reform. The uninsured rate and numbers have dwindled, and that is good news. Why they dwindled might seem not so good.
Allegedly, now only 45.7 million of us are without insurance (or as our detractors say, "are without health care); about 15.3 percent of the current population. The drop is attributed to more people enrolling onto government health plans (more than 300,000 in Massachusetts along, thanks to the Connector).
On the other hand, this means that more than 255 million Americans are covered under a health plan.
Stick with me on this: At 255 million (the number of Americans with a health plan) it would make a country the third largest in the world, next to China and India. That we have the resources and systems in place to insure so many people (more than eight times the population of Canada) is a great accomplishment.
202 million Americans get their insurance through an employer, a number that held steady. The rate (just under 60 percent) is lower, but that is not so dismal news. After all, we have been fighting a difficult economy. I think it is a strong indicator of the important people place on group insurance.
Of the remaining folks without insurance, no more than 15 million, or five percent, are chronically uninsured. Those aged 18-34 comprised 54 percent of the uninsured, and that produces an interesting and vitally important issue.
The drive toward "universal health care" is a misnomer. The honest term is "mandatory universal health care," meaning forcing everyone by law to purchase health insurance. Now think about this.
If more than half of the uninsured are aged younger than 35, and we use the law to force them to buy health insurance, what does this mean? It means that we want young, healthy people to underwrite the cost of older people - of us Baby Boomers. Once again, the Baby Boomers want to be bailed out by someone else.
The other fascinating uninsured statistic is that of the new immigrants, who still make up 33 percent of the uninsured. Well over half of the uninsured, and many in this category, qualify for government health care, but refuse to sign up.
There are many reasons to reform U.S. health care, but the uninsured rate is not one of them. Don't let anyone get away with that myth any longer.
The U.S. Census Bureau has lit the fuse for the next battle in health care reform. The uninsured rate and numbers have dwindled, and that is good news. Why they dwindled might seem not so good.
Allegedly, now only 45.7 million of us are without insurance (or as our detractors say, "are without health care); about 15.3 percent of the current population. The drop is attributed to more people enrolling onto government health plans (more than 300,000 in Massachusetts along, thanks to the Connector).
On the other hand, this means that more than 255 million Americans are covered under a health plan.
Stick with me on this: At 255 million (the number of Americans with a health plan) it would make a country the third largest in the world, next to China and India. That we have the resources and systems in place to insure so many people (more than eight times the population of Canada) is a great accomplishment.
202 million Americans get their insurance through an employer, a number that held steady. The rate (just under 60 percent) is lower, but that is not so dismal news. After all, we have been fighting a difficult economy. I think it is a strong indicator of the important people place on group insurance.
Of the remaining folks without insurance, no more than 15 million, or five percent, are chronically uninsured. Those aged 18-34 comprised 54 percent of the uninsured, and that produces an interesting and vitally important issue.
The drive toward "universal health care" is a misnomer. The honest term is "mandatory universal health care," meaning forcing everyone by law to purchase health insurance. Now think about this.
If more than half of the uninsured are aged younger than 35, and we use the law to force them to buy health insurance, what does this mean? It means that we want young, healthy people to underwrite the cost of older people - of us Baby Boomers. Once again, the Baby Boomers want to be bailed out by someone else.
The other fascinating uninsured statistic is that of the new immigrants, who still make up 33 percent of the uninsured. Well over half of the uninsured, and many in this category, qualify for government health care, but refuse to sign up.
There are many reasons to reform U.S. health care, but the uninsured rate is not one of them. Don't let anyone get away with that myth any longer.
Tuesday, August 19, 2008
Harry and Louise have mellowed
Harry and Louise are back.
Remember them? They were trotted out during the height of HillaryCare in the 1990s. People who believed that Mrs. Clinton’s purpose was to move us to government-run health care used the ads to stop her in her tracks.
Harry and Louise appear to have mellowed.
You can see it for yourself at http://www.harryandlouisereturn.com/. This is the newest ad, and it is meant to throw resolution of health care into the lap of the next president.
From where I sit, asking the politicians to solve the health care dilemma is a prescription for problems. Every time they step in to help, it gets more complicated and expensive.
The ad, however, takes no explicit sides. But since it prominently mentions access to care and affordability of health insurance, it tries to set the debate.
These are real problems, and they need real solutions. The political arena is the worst place to get this done, although it obviously cannot be ignored.
Political leaders use health care reform to gain votes. Those who are serious, like Mrs. Clinton, are the ones who will advance their government solutions based on the appearance of a groundswell of support.
The answer to what ails U.S. health care lies primarily in two areas: We must become healthier. We must become involved in paying for, and therefore knowing about, the cost of care.
Politicians are building the case to tell us how to live, what to eat, where to go, and what to do. That runs contrary to traditional U.S. culture. Maybe Americans have become passive enough to accept top down directives. What do you think?
Clearly, most top down health reform points toward mandatory coverage, forcing more people to pay more to do more and will end up costing more. For certain, politicians cannot solve the spending problem by managing spending.
Remember them? They were trotted out during the height of HillaryCare in the 1990s. People who believed that Mrs. Clinton’s purpose was to move us to government-run health care used the ads to stop her in her tracks.
Harry and Louise appear to have mellowed.
You can see it for yourself at http://www.harryandlouisereturn.com/. This is the newest ad, and it is meant to throw resolution of health care into the lap of the next president.
From where I sit, asking the politicians to solve the health care dilemma is a prescription for problems. Every time they step in to help, it gets more complicated and expensive.
The ad, however, takes no explicit sides. But since it prominently mentions access to care and affordability of health insurance, it tries to set the debate.
These are real problems, and they need real solutions. The political arena is the worst place to get this done, although it obviously cannot be ignored.
Political leaders use health care reform to gain votes. Those who are serious, like Mrs. Clinton, are the ones who will advance their government solutions based on the appearance of a groundswell of support.
The answer to what ails U.S. health care lies primarily in two areas: We must become healthier. We must become involved in paying for, and therefore knowing about, the cost of care.
Politicians are building the case to tell us how to live, what to eat, where to go, and what to do. That runs contrary to traditional U.S. culture. Maybe Americans have become passive enough to accept top down directives. What do you think?
Clearly, most top down health reform points toward mandatory coverage, forcing more people to pay more to do more and will end up costing more. For certain, politicians cannot solve the spending problem by managing spending.
Monday, August 18, 2008
Why health care costs so much
Greg Dattilo and I are writing a new book. Our working title is “Why health care costs so much.”
I had a practical example on July 31.
Early that afternoon I suffered chest pains. (Since them, I have been calling them chest “aches.”) At the time, all I knew is that they did not stop. Feeling pains in the chest and the accompanying pressure is disconcerting, to say the least.
I called my doctor, planning to go to the clinic. They gave me to a triage nurse.
The triage nurse demanded I call the paramedics. She told my wife absolutely not to drive me to the ER. I felt stupid, because the pains (ache) were higher up in the chest. I had no other symptoms of a heart attack. But she insisted.
At the ER, two EKGs, blood work, and a chest X-ray indicated that whatever I had, it was not my heart. Yet, the ER doctor suggested I say overnight in the hospital and get a stress test.
I went home. Five days later, I had the stress test, but my insurance agent told me I had already spent all my deductible. I had the nuclear stress test, by the way.
The great news: My heart is 100 percent. The not so great news: I still have the achy chest, but it is far less of a problem. Tomorrow, the endoscopy. I told my doctors to look up helicobacter pylori (check it out at www.helico.com). We may be on to something here.
Why do we spend so much on health care? To date, I am guessing we’ve spent $5,000-$6,000 on this incident, although I have only seen the $1,600 charge for the paramedics. And there is more to come.
On July 31, there is no question I needed to see a doctor. Maybe even in the ER. Maybe.
My story, however, does indicate in a small way why health care costs so much.
Defensive medicine played a role. If the triage nurse had agreed with me, and I had suffered a heart attack on the way to the clinic, she fears getting sued. If the ER doctor had not offered the chance for me to be admitted, and I suffered a heart attack at home, he fears being sued (he admitted to me that the number one reason ER doctors get sued are chest pain issues).
Okay. They were all doing their job, and did it professionally. I get it. But I also realize that I spent at least $4,500 that accomplished only two things; it gave me peace of mind about my heart and it ate up my deductible.
So, of course, that means I am now considering other medical irritations that just might need treatment this year, instead of next. I admit it. I am just as human as the other 304 million Americans. The deductible has been met. What is your next question?
Oh, did I mention, I have a high deductible health plan and an HSA. And am I ever glad I have the HSA! And a good heart.
I had a practical example on July 31.
Early that afternoon I suffered chest pains. (Since them, I have been calling them chest “aches.”) At the time, all I knew is that they did not stop. Feeling pains in the chest and the accompanying pressure is disconcerting, to say the least.
I called my doctor, planning to go to the clinic. They gave me to a triage nurse.
The triage nurse demanded I call the paramedics. She told my wife absolutely not to drive me to the ER. I felt stupid, because the pains (ache) were higher up in the chest. I had no other symptoms of a heart attack. But she insisted.
At the ER, two EKGs, blood work, and a chest X-ray indicated that whatever I had, it was not my heart. Yet, the ER doctor suggested I say overnight in the hospital and get a stress test.
I went home. Five days later, I had the stress test, but my insurance agent told me I had already spent all my deductible. I had the nuclear stress test, by the way.
The great news: My heart is 100 percent. The not so great news: I still have the achy chest, but it is far less of a problem. Tomorrow, the endoscopy. I told my doctors to look up helicobacter pylori (check it out at www.helico.com). We may be on to something here.
Why do we spend so much on health care? To date, I am guessing we’ve spent $5,000-$6,000 on this incident, although I have only seen the $1,600 charge for the paramedics. And there is more to come.
On July 31, there is no question I needed to see a doctor. Maybe even in the ER. Maybe.
My story, however, does indicate in a small way why health care costs so much.
Defensive medicine played a role. If the triage nurse had agreed with me, and I had suffered a heart attack on the way to the clinic, she fears getting sued. If the ER doctor had not offered the chance for me to be admitted, and I suffered a heart attack at home, he fears being sued (he admitted to me that the number one reason ER doctors get sued are chest pain issues).
Okay. They were all doing their job, and did it professionally. I get it. But I also realize that I spent at least $4,500 that accomplished only two things; it gave me peace of mind about my heart and it ate up my deductible.
So, of course, that means I am now considering other medical irritations that just might need treatment this year, instead of next. I admit it. I am just as human as the other 304 million Americans. The deductible has been met. What is your next question?
Oh, did I mention, I have a high deductible health plan and an HSA. And am I ever glad I have the HSA! And a good heart.
Sunday, August 10, 2008
Obesity weighs down emergency costs
There is near unanimous agreement that obesity drives health spending higher. We understand this regarding diabetes, heart disease, blood pressure and other diseases.
I was struck by this additional cost that certainly never before crossed my mind. It is an indicator of how interrelated are the hidden costs of health care, and why it is so hard to get the health system under control.
The paragraphs below are lifted from “How To Purchase A Power Cot,” a sales brochure from MonsterMedic, a manufactuer of equipment used by Emergency Medical Technicians on ambulances.
Consider the additional cost for workers’ compensation insurance, heavier duty equipment, lost days to injury, short and long term disability insurance, not to mention pain and suffering of the medic.
“It is widely known that patients in the U.S. on average are getting heavier. Some experts estimate that about two-thirds of American adults are overweight or obese; 3.8 million people are over 300 pounds, over 400,000 carry 400 pounds or more.
“Obesity creates more medical risk factors and consequently, more emergency calls. A heavier patient creates a hardship for the EMT as the amount of weight to lift is more, the risk of cot tipping is higher, and the loss of control of the cot is more prevalent. Of course, this affects the safe transfer of the patient.
“It also presents a risk to the EMT. More weight to lift creates more physical strain on the EMT, especially to their back, shoulders, and knees. The highest percentage of the EMT back injuries occur when they need to bend down over the patient to raise them from the ground. Another common accident is when the EMT has to react unexpectedly to a cot that has become out of control.
“It’s not difficult to connect the dots.
“As patients become bigger, the EMTs face more physical challenges when transporting them. A look at current statistics point out that ambulance cart tipping is increasing and EMT back injuries are on the rise.
“As the general population changes, we must adjust the way we serve them.”
Now that is an understatement.
I was struck by this additional cost that certainly never before crossed my mind. It is an indicator of how interrelated are the hidden costs of health care, and why it is so hard to get the health system under control.
The paragraphs below are lifted from “How To Purchase A Power Cot,” a sales brochure from MonsterMedic, a manufactuer of equipment used by Emergency Medical Technicians on ambulances.
Consider the additional cost for workers’ compensation insurance, heavier duty equipment, lost days to injury, short and long term disability insurance, not to mention pain and suffering of the medic.
“It is widely known that patients in the U.S. on average are getting heavier. Some experts estimate that about two-thirds of American adults are overweight or obese; 3.8 million people are over 300 pounds, over 400,000 carry 400 pounds or more.
“Obesity creates more medical risk factors and consequently, more emergency calls. A heavier patient creates a hardship for the EMT as the amount of weight to lift is more, the risk of cot tipping is higher, and the loss of control of the cot is more prevalent. Of course, this affects the safe transfer of the patient.
“It also presents a risk to the EMT. More weight to lift creates more physical strain on the EMT, especially to their back, shoulders, and knees. The highest percentage of the EMT back injuries occur when they need to bend down over the patient to raise them from the ground. Another common accident is when the EMT has to react unexpectedly to a cot that has become out of control.
“It’s not difficult to connect the dots.
“As patients become bigger, the EMTs face more physical challenges when transporting them. A look at current statistics point out that ambulance cart tipping is increasing and EMT back injuries are on the rise.
“As the general population changes, we must adjust the way we serve them.”
Now that is an understatement.
Thursday, June 12, 2008
"EMR, call home"
Can electronic medical records (EMR) save us?
Technology has done marvelous things to better human life. It seems only normal, then, that we would turn to electronic medical records (technology) to help solve our health care spending problems.
Eventually, we might even get there. I sure hope so, but it will take a while – maybe a decade, or two.
Dr. Richard Reece has been reporting on the business of health care for more than 40 years. He informs me that today, about 10 percent of hospitals and a like number of doctors are using electronic medical records. That is a good start.
But there is a huge pushback by doctors, because it is expensive, time-consuming, and is viewed as adding very little to their ability to practice medicine. Before doctors commit thousands of dollars to convert their office and patient records to such a system, they will have to see its medical benefits, or a great deal of savings in streamlined record-keeping.
A second issue, seldom addressed, is that the emerging EMR systems speak but one language – the language of their own kind. That is, they do not speak to other EMR systems operated by other doctors and hospitals. Over time, this should be able to be resolved, but to find the common language and/or the translator that acts as a go-between will be costly, and in itself, create errors and misinformation.
Dr. Reece points out, too, that doctors in one specialty often need to know different information than doctors in another specialty. What is vitally important to the podiatrist, and about which he or she would take pains to record, is of very little interest to the pediatrician (who has his or her own specific needs for patient history).
I don’t write this as a doom-and-gloom commentary, but a realistic one. Reece said, “Someday, I suppose someone will come up with an algorithm to tie all this together,” but it may take 20 years to get there.
In the meantime, the most pressing need is to change patient behavior, in the way they take care of themselves, and how they spend their own health dollars. We cannot hope that technology will offset bad personal decisions.
Technology has done marvelous things to better human life. It seems only normal, then, that we would turn to electronic medical records (technology) to help solve our health care spending problems.
Eventually, we might even get there. I sure hope so, but it will take a while – maybe a decade, or two.
Dr. Richard Reece has been reporting on the business of health care for more than 40 years. He informs me that today, about 10 percent of hospitals and a like number of doctors are using electronic medical records. That is a good start.
But there is a huge pushback by doctors, because it is expensive, time-consuming, and is viewed as adding very little to their ability to practice medicine. Before doctors commit thousands of dollars to convert their office and patient records to such a system, they will have to see its medical benefits, or a great deal of savings in streamlined record-keeping.
A second issue, seldom addressed, is that the emerging EMR systems speak but one language – the language of their own kind. That is, they do not speak to other EMR systems operated by other doctors and hospitals. Over time, this should be able to be resolved, but to find the common language and/or the translator that acts as a go-between will be costly, and in itself, create errors and misinformation.
Dr. Reece points out, too, that doctors in one specialty often need to know different information than doctors in another specialty. What is vitally important to the podiatrist, and about which he or she would take pains to record, is of very little interest to the pediatrician (who has his or her own specific needs for patient history).
I don’t write this as a doom-and-gloom commentary, but a realistic one. Reece said, “Someday, I suppose someone will come up with an algorithm to tie all this together,” but it may take 20 years to get there.
In the meantime, the most pressing need is to change patient behavior, in the way they take care of themselves, and how they spend their own health dollars. We cannot hope that technology will offset bad personal decisions.
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