Archive for Politics

Splitting the Healthcare Hairs

Posted by J. B. Robbins on August 24th, 2009 in Economics, Healthcare, Politics
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Opening Thoughts

As many observers of the Healthcare Reform debate may be experiencing, we are getting lost in the shuffle of political rhetoric, infectious innuendo, direct attacks and a general, overall, lack of substance. We are also getting drowned in non-specifics on what this debate is really about versus what reform really does, or should mean.

Over the course of this issue’s primary life during the current administration and congress, we have downgraded our discussions to describe all aspects as Healthcare Reform; but is “Healthcare Reform” really what is being said, or is needed and desired by “we, the people”.

There are really two points that need be accepted prior to continuing:

  1. Healthcare Services is the provisioning of care, of and for a patient, by a qualified medical doctor, nurse, technician, etc.
  2. Healthcare Insurance is the management of payment of healthcare services from a pool of money collected by insurance agencies to those who delivered the healthcare services.

With these points in mind, is “Healthcare Reform” really about transforming Healthcare Services, or the Healthcare Insurance business. I put forth here that it should be the later.

I heard it said recently (and I tend to agree) that the United States has excellent, world class comparable healthcare services and has been outstanding in providing advancements in treatments and diagnoses of many diseases. The only problem we have is access to those services. Those with the monetary means to afford either the best insurance or, in extreme cases, to pay directly for healthcare services, have access to the best quality of care. Those without the monetary means, through choosing a life-path or circumstances beyond their control, may be unable to elect insurance coverage or simply cannot afford it, resulting in the use of the hospital emergency room as their only method of access.

Worst of all, are the cases where the “pre-existing condition” raises its ugly head resulting in a denial of initial coverage or a drop of existing coverage. This is the insurance industry’s way of “reducing their risk”, a prime method for improving their financial and “value” position to investors, shareholders and they’re employed profit takers (CEOs, bonus collecting upper management). Insurance companies today are reaching harder and farther into our physiology and biology to find the way to get out of covering us. The natural long term outcome of this approach to healthcare service denial is best shown in the movie “Gattaca” in which your life, and what you do in it, is predetermined based on your genetic makeup at birth.

Changing Thoughts

I’ve discussed a reformation of our mindset on this debate before in “Healthcare Reform”, however, we also need to change our way of thinking about the debate…we should not be debating or legislating change on the delivery of Healthcare Service, but should be solely focused on legislating change in the Healthcare Insurance industry.

Throughout these last few months, “we the people”, our elected representatives and our media have degenerated into discussions of “Government Death Panels”, “The Government between you and your doctor”, and other nonsensical blathering. When, with simple thoughtfulness, we can all see that without legislation forcing the moral and ethical high-ground, insurance companies, left to their own devices, are chiefly motivated by profit for themselves and the list of profit takers mentioned earlier.

Which brings me to the crux of the matter: The “government option” (sometimes called a single payer option – not so, or sometimes, incorrectly). Since the private sector of our economy has as its chief motivator money, the public sector can, through provisioning of a better option, provide the motivation for private industry to make change to save itself and improve our access to care. The current “government employee” plan does not deny coverage or remove coverage for “pre-existing condition”, it provides choice in coverage and the freedom to change. It negotiates better rates than the private sector for the same quality of care, and has the added advantage of an immense pool of partakers funding its coffers, resulting in nearly (if not wholly) undetectable impact to individual cost when one individual in the pool develops an expensive disease.

So, why not make the “government option” (the option your congressional representative has) available to all. The next time you go through a “benefits enrollment” at work, you could have a choice of one or more private sector options and the government option. If the insurance companies know this is to happen, they will find a way to adapt very quickly, or go the way of the dodo.

On a “smaller” front, small-business in America is quickly finding itself simply unable to afford to provide healthcare insurance options to its employees. I’ve seen the impact of a single patient with cancer one year, drastically increasing the costs the next year for the other 80-plus employees, almost to the point of making it unaffordable. However, if we had a “government option” the small business could offer by utilizing and contributing lower cost premiums to that very large pool, small business would be able to hire talent at a more equitable rate to the big dogs. This would increase competition in the market place – something all “free-market economists” would agree is a very good thing as competition breads innovation.

Final Thoughts

The simple resolution to this debate is for us, our representatives and the media to stop focusing on nonsensical misdirection and focus on the task at hand: making the great healthcare services of this country equitably accessible to all. This task obviates the necessity for legislating regulation of the insurance companies to force equitable competition with a government option in the areas of exclusion, “pre-existing conditions”, and coverage drop prevention. What it also means is that the insurance companies will then be motivate to find ways to become more efficient – the result of which will likely be the vast implementations of data management and exchange technologies that past legislative activities have attempted to mandate.

As the current bill being bandied about is around 3000 pages, it makes sense that embedded in those reams of paper are a lot of appeasements for the insurance companies and other special interest with their hand out. Let’s change that: the provisions I’ve called for should be simple enough to write, after all, we managed to write a 6 page bill granting the ability to invade another country to the unchecked decision of but a few.

Healthcare Reform

Posted by J. B. Robbins on June 16th, 2009 in Healthcare, Politics
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Opening Thoughts

What does it really mean to “Reform Healthcare” in the United States? If you asked 1000 people, you would likely get 1000 different answers. Each individual, or someone close to them, has had their own unique experience of failure in the current system. The stories may be as commonplace as waiting six hours to be seen by a physician in Emergency while doubled over with abdominal pain, or as quietly sad as an Alzheimer’s patient experiencing a slow uncomfortable end over many months while bankruptcy swallows their family.

In the last few days and over the last twenty years or so, we have been talking about tweaking our existing approach to healthcare to try to overcome its current deficiencies. This would result in keeping insurance as the basis for reform. Even President Obama has been pitching the implementation of yet another insurance plan to increase competition. He has also indicated that this new insurance would include improved management of the process of obtaining healthcare and correct for many of the existing issues.

However, all the last twenty years of debate over Healthcare Reform has consistently missed one small fact:

You can insure against a traffic accident or a building burning down as they are events that are not guaranteed to occur. However, you cannot insure against old age taking a life. Life has determined, unequivocally, that we will, one day, expire in some, as yet, undeterminable way.

As the population of the United States ages and our youth, under the current system, becomes less and less healthy with the earlier onsets of preventable diseases such as obesity and juvenile Diabetes, Insurance, because it is a business, will continue to cleanout the costly in favor of the profitable. It would also be foolish not to believe, that in a future time of economic crisis, that cost cutting measures would also be applied to a government run insurance program.

Other factors to consider are some of the obvious ones, and some unspoken ones thrown around in this debate to date.

  • Healthcare insurance costs are quickly climbing to $1 out of $5 earned to $1 out of $3.
  • Time spent managing healthcare providers and the insurance companies have a greater impact than just calculable hours of lost work on the productivity of all around the afflicted.
  • One in three personal bankruptcies is a direct result of the failure of the current healthcare system.
  • A healthy people are a productive people.

Changing Thoughts

What has to happen here is a reformation of a way of thinking, first, then, and only then, a reformation of the system could be successful.

We need to change from believing that one can be insured against death to ensuring that our population leads long, healthy productive lives. And when the time comes that we are preparing to depart this life, that we are thanked by our society for our contribution with humane and compassionate care and comfort, with none of the blinding costs to us or our loved ones.

It is easy to understand that this approach does not cover those times of accidental death; when injuries sustained in a vehicular accident result in a trip to the hospital and, after some provisioning of care, still results in death. Just like the medical profession has its Hippocratic Oath as governance, we, as a people, should care enough about our community to cover the small discrepancies for the good of the many.

Additionally, the keywords in the above scenario are “accidental death” and “vehicular accident”. Many States in our Union are “No Fault” States that essential say no one can be held accountable, and consequently learn from their mistakes that resulted in vehicular accidents. This, as is healthcare today, is about protecting Insurance companies and not the driving population. If you haven’t seen it already, the pervasive theme here is Insurance companies have, in general, received more protection under the law and is considered the driving force for protection against the unknown.

But, wait a minute, human health is based on science; human biology and genetics are well studied and the number of treatable, or manageable health issues far outweighs the untreatable or unmanageable. With some hard work, based on statistics that the Insurance industry and Federal and State governments have in mass quantities, we could easily map out a median healthcare expense of a life in this country. We know that the Insurance companies can do this already, otherwise, they would all be out of business for poor “Risk Management”. However, the Insurance companies need to follow through and add in positive change factors such as controlling diet to reduce or eliminate the onset of Type-II Diabetes and provide incentives to other industries and the citizenry to change in support. Sadly, they are Insurance companies; in the business of taking in premiums and avoiding payouts for the sake of improving profits.

Therefore, the only entity with the broad reach to build the kind of system that reaches across multiple industries for the sake of its people is the Federal Government. It is the only place that can proportionally take in revenue from all of its customers (“we the people”) and coordinate the distribution of funds to (just to name a few):

  • Healthcare provisioning.
  • Paying for quality food for school lunchrooms instead of “fast-food”.
  • A “bike to work day” fuel tax credit (just brainstorming, but a true bonus here, keeps some carbon out of the air instead of buying carbon credits).
  • Setting up truly comfortable “thank you for your contribution” end-of-life care facilities, free for those in clinical need.
  • Funding research to eliminate or drastically control massively expensive diseases such as Alzheimer’s, Diabetes, or preventable cancers.

Closing Thoughts

Wouldn’t it be a great thing to have a government that spends less time plugging legal loopholes (or creating them for special interests) and focusing on management of punishment for mistakes and errors, but instead concentrate on creating legislation that improves our quality of life and overall health, helps us become more productive, and rewards us for doing the things that are good for our nation and, consequently, the global community. After all, it is the constitutional role of the Federal Government to provide for the defense of its nation and its people. This should, by any measure, include defense against disease, poverty, financial ruin and accidental death.

If you take away anything from all of this, let it be the thought of changing the way of thinking and focusing on can rather thancannot. If we stop and do this for a moment then start asking the questions of how we can help the government create a Healthcare Service industry in replacement of a Healthcare Insurance industry, when we reach our last days, we just might feel thanked and appreciated rather than neglected and forgotten.