AJ’s Page

Opinions and Such

Posts Tagged ‘humour’

WHAT’S HE SMOKING? Healthcare Reform Hinges on Obama Thinking Like a Non-Smoker

Posted by ajspage on June 25, 2009

President Obama demonstrates the neat little box around him that keeps this baby safe from third-hand smoke

President Obama demonstrates the imaginary box around him that smokers believe keeps this baby safe from third-hand smoke

I watched the televised White House infomercial on healthcare reform last night, and it occurred to me that the President is thinking like a smoker. Whether he’s quit the habit or not, we won’t get real reform until he starts thinking like a non-smoker.

You see, he wants reform that provides high quality care for all Americans, saves money and saves … money. But … BUTT… only if he doesn’t have to change anything for people who are happy with their current employer-provided insurance, i.e., mostly people who have never truly needed their coverage. (And people who work for Google. But let’s face it, we can’t all work for Google.)

This whole situation is reminiscent of restrictions on smoking, in the beginning. Smokers had a RIGHT, goddammit. So the rulemakers said, “If you like what you’re doing, no one is going to make you change, you go right on smoking where you are. We’ll just make these special non-smoking sections for everyone else so they can breathe.” Which of course didn’t work very well because only smokers think the smoke stays in a nice little box around them and doesn’t end up in everyone else’s hair, clothing and lungs.

Smoking rates (first-hand and second-hand) — and attendant cancer rates — didn’t really drop off until rulemakers finally got tough and made rules that guaranteed clean air in public spaces for everyone. Smokers can always take it somewhere else, but everyone else — especially workers, children, and people trying to kick the habit — everyone else suffers the consequences if they don’t.

Herein lies a core problem with the President’s healthcare reform proposal. Predicating reform on the requirement that those who don’t want anything to change must be allowed keep their employeer-sponsored insurance plans just as they are means we can’t clear the air, so to speak (or shovel out the barn, for a more apt analogy).

Because if we keep the existing insurance companies, we keep the $350 billion in wasted healthcare administration costs, and the billions more in profits they extract with that “wasted” paperwork. EVERYONE’S healthcare is that much more expensive. If a patient decides to spend his own money and have nothing to do with insurance companies, the extraordinary costs they foist on the system will still end up in that patient’s medical bills (and the crazymaking medical billing paperwork will still end up flooding his home and dominating his time when he is sick).

That patient can’t really opt for an insurance-free zone, where he doesn’t have to pay the odious insurance-waste-tax, because that waste will remain so long as private insurers remain.

In the forum tonight, President Obama talked about involving all the players: doctors, patients, insurance companies… But doctors and patients are necessary parts of the healthcare system, insurance companies are not, and they should not be afforded the same voice in reform because of their role in bringing our system to its knees.

People have to ask themselves: if your loved one needs expensive, life-saving medical care, and you are given a choice, would you, a) choose to err on the side of giving it to them, even if no one is 100% sure it will be worth it in the end, or b) choose to instead give the money to an insurance company to hire a bunch of paper pushers to screw a whole lot of people just like you for their profits?

Let me say it again: At least $350 billion wasted every year because of private insurance bureaucracy. What part of saving AT LEAST a trillion dollars in three years without spending a cent less on care don’t we understand?

Single-payer is working all over the world. In democracies. In democracies that have far better healthcare access and outcomes than we have. Even though, in most cases, they smoke more. Imagine that.

Posted in Healthcare, Opinions | Tagged: , , , , | Leave a Comment »

Healthcare Reform: Single-Payer vs. Public Option

Posted by ajspage on June 12, 2009

For the record, I have in the past touted a competing public plan, including writing to Eshoo about it.  I no longer believe it will work.
The reasons a competing public insurance plan won’t work are legion, but the most significant are:
1)  Having a competing plan will do nothing to eliminate the huge bureaucratic structure that burdens our health system to the tune of $450 billion a year, largely because of private insurers.  Doctors and hospitals will by necessity continue to maintain largely the same levels of paperwork structures to deal with private insurers that remain.
2)  This is such a monumental fight because of private insurance interests.  Leaving them at the table will mean they will not only eat our lunch again — they have already figured out how and have implemented some of those measures in the event of the most likely reforms.  They are not sitting around waiting for new rules to fight back, they are an adaptive, negative force in the system.  Their incentives do not and cannot coincide with the public interest.  If we want to be able to make incremental improvements in the future that are in the interest of the public and our nation, we need to fight this battle now, while we can, to WIN it.
3)  If insurers are forced to compete with a public option, they will find easy ways to sue the government (i.e., the US taxpayer) for anticompetitive practices.  And wearing opponents down with the legal system is insurance companies’ stock-in-trade.
4)  Philosophical opponents of reform (such as ideological right-wing) do not differentiate between any of the proposed reforms, they oppose them all.  We should be pushing the only one that has a chance of really WORKING, not setting ourselves up for failure after all this work.
I now believe a government run single-payer coverage within a private health delivery system is the only reform that can save significant costs and allow us to improve quality.
Some of the best arguments FOR single-payer can be found on http://www.pnhp.org Physicians for a National Health Plan.  Read the articles and testimonies by Dr. David Himmelstein, the Harvard doctor and professor whose group did the work that found that now over 60% of personal bankruptcies in this country are from healthcare costs and that the majority of those people had health insurance.  They have also looked at the different reform proposals to see where the cost savings are, and concluded that only single-payer coverage (within a private healthcare delivery system) will result in dramatically decreased costs while allowing universal care and improved quality.
I think the biggest fear people have in moving to single-payer (even though the care delivery system would be the same), is the fear of losing choice in their care.  Right now, choice is really the only power patients have to control quality.  You can tell them all you want that they won’t lose that, but they’ll continue to fear it unless the proposed reform demonstrates it in an obvious way.
I think we should move to single-payer with a three-tier cost/coverage structure:  the first tier that covers everyone and provides for all reasonable healthcare coverage that anyone could envision in a plan, a second tier that covers “extras” and allows more latitude to patients in choosing the avenues of their care, and a third tier that is far more expensive, but allows people even more discretion with their care choices.
In the proper implementation of the single-payer system, the first tier should actually cover everyone so well, that the other tiers eventually become unnecessary.  But some people will cling to them anyway.  And if the system isn’t implemented properly (if we get cheap and start rationing), the people who have the most fear of rationing will be able to avoid it, and still we will get the enormous savings and universal coverage overall.
I think this kind of structuring would appease much of the fear around a single-payer plan, because some people know they can always pay for “more” — and at least we will get the savings of single-payer.  And if we run up against problems, all of us in the public and medical profession can as a whole identify and demand improvements, instead of lone, sick patients and overburdened doctors fighting numerous well-armed profiteers.
A.J.

President Obama, who had the courage to stand up with a small minority of lawmakers and oppose the war in Iraq — knowing that his patriotism would be savagely attacked at a time when he had Presidential ambitions — this fearless and principled leader is for political expediency touting a watered down version of healthcare reform.  I hope he will reconsider and stand up for what is right, instead of forging a Frankensteinian-mashup that has no hope of ever running well:  tacking a public option onto the existing system.

For the record, I have in the past touted a competing public plan, including proposing the idea to my Congressional Representatives about it.  I no longer believe it will work.

We need to move to healthcare on the model of fire and police departments — any sector of the economy where citizens are uniquely vulnerable (such as when they are sick or in a life-threatening emergency) should not be subject to profiteering, because it’s just too easy to shake them down.

The reasons a competing public insurance plan won’t work are legion, but the most significant are:

1)  Having a competing plan will do nothing to eliminate the huge bureaucratic structure that burdens our health system to the tune of $450 billion a year, largely because of private insurers.  Doctors and hospitals will by necessity continue to maintain almost the same levels of paperwork structures to deal with private insurers that remain.

2)  This is such a monumental fight because of private insurance interests.  Leaving them at the table will mean they will not only eat our lunch again — they have already figured out how and have implemented some of those measures in the event of the most likely reforms.  They are not sitting around waiting for new rules to fight back, they are an adaptive, negative force in the system.  Their incentives do not and cannot coincide with the public interest.  If we want to be able to make incremental improvements in the future that are in the interest of the public and our nation, we need to fight this battle now, while we can, to WIN it.

3)  If insurers are forced to compete with a public option, they will find easy ways to sue the government (i.e., the US taxpayer) for anticompetitive practices.  And wearing opponents down with the legal system is insurance companies’ stock-in-trade.

4)  Philosophical opponents of reform (such as ideological right-wing) do not differentiate between any of the proposed reforms, they oppose them all.  We should be pushing the only one that has a chance of really WORKING, not setting ourselves up for failure after all this work.

I now believe a government run single-payer coverage within a private health delivery system is the only reform that can save significant costs and allow us to improve quality.

Some of the best arguments FOR single-payer can be found on http://www.pnhp.org Physicians for a National Health Plan.  Read the articles and testimonies by Dr. David Himmelstein, the Harvard doctor and professor whose group did the work that found that now over 60% of personal bankruptcies in this country are from healthcare costs and that the majority of those people had health insurance.  They have also looked at the different reform proposals to see where the cost savings are, and concluded that only single-payer coverage (within a private healthcare delivery system) will result in dramatically decreased costs while allowing universal care and improved quality.

I think the biggest fear people have in moving to single-payer (even though the care delivery system would be the same), is the fear of losing choice in their care.  Right now, choice is really the only power patients have to control quality.  You can tell them all you want that they won’t lose that, but they’ll continue to fear it unless the proposed reform demonstrates it in an obvious way.

I think we should move to single-payer with a three-tier cost/coverage structure:  the first tier that covers everyone and provides for all reasonable healthcare coverage that anyone could envision in a plan, a second tier that covers “extras” and allows more latitude to patients in choosing the avenues of their care, and a third tier that is far more expensive, but allows people even more discretion with their care choices.

In the proper implementation of the single-payer system, the first tier should actually cover everyone so well, that the other tiers eventually become unnecessary.  But some people will cling to them anyway.  And if the system isn’t implemented properly (if we get cheap and start rationing), the people who have the most fear of rationing will be able to avoid it, and still we will get the enormous savings and universal coverage overall.

I think this kind of structuring would appease much of the fear around a single-payer plan, because some people know they can always pay for “more” — and at least we will get the savings of single-payer.  And if we run up against problems, all of us in the public and medical profession can as a whole identify and demand improvements, instead of lone, sick patients and overburdened doctors fighting numerous well-armed profiteers.

Posted in Healthcare | Tagged: , , , , , | 3 Comments »

Yes We Can! Try

Posted by ajspage on April 13, 2009

My childhood rolls through my memories in great splashes of color, camp, and change: The first footprints of man in the dust of the moon, the power of flowers and smileys and beautiful blackness, impotent fallout shelters, inexorable smallpox and polio eradications, Newlyweds and Tijuana Brass, a voting rights act with a Capitol “V”, seven overly-prepared castaways on a three-hour tour, balled up Wonderbread, naked Barbies, Goldie Hawn’s bikini. All against a backdrop of grinding death — but not “war” — in Vietnam.

Mr. Spock and warp drive introduced the first glimmers of cool to geekdom, while a big green muppet living in a trashcan ushered in the social acceptability of uncivil discourse and compulsive hoarding.

It was all innocence and goading The Man, except for one great, irritating influence: the story of The Little Engine That Could. Or as it is known in the medical vernacular, It’s All In Your Head, and popularly, It’s All Your Fault.

You see, I grew up in a household where my foreign-born parents encouraged me to eat my vegetables through stories of poor, starving children in China — like my dad, and my aunts and uncles, surviving by the skin of their teeth (and some occasional tree bark) in war-ravaged Shanghai.

My parents had just survived monumental upheavals of history in which tens of millions of people died of starvation and violence through events they had no hand in and no control over.

By the worldview of this authoritative childhood allegory, these millions of extinguished voices merely lacked an appropriate psychologically-uplifting phrase to repeat in their hour of need.

Welcome to the world of infinite possibilities and crippling psychological barriers, where all things are possible if we merely try hard enough. If we merely believe.

This theme suffused nearly every film of my upbringing and beyond (I mean the films that came after the ones where the leading animal always died at the end). No matter how dangerous the obstacles, determined the enemy, or ill-prepared you The Hero are — if you try, you will win. If you believe, your team will prevail. If you build it, the ghosts of dead baseball heroes will befriend you and attract stop-and-go traffic to your cornfields.

Is this representative of reality? That all you have to do is TRY to change the world? That all you need is a little determination and you can create an industry of health”care” insurers to do nothing constructive but shake down the American public for billions in profits every year, and get them to pay hundreds of billions more for the paperwork you use to do it?**

Oh. Wait.

I get it now. Maybe sometimes we aren’t solving problems because everyone says we can’t. (That is, everyone except the leaders and majority of the public in every other industrialized nation in the world where they are getting, in most cases, better, universal healthcare on average, and in every case, for less money.) Maybe sometimes we aren’t solving problems because everyone we come across (locally) has a good reason that we can’t.

Because the tired old engines (sick people) are too, well, tired to do it. Because the big, strong, freight engines (lawmakers and businesspeople) are too busy and important. Because the shiny new engines (the wealthy) have no idea that insurance companies’ flying monkeys are going to dismantle them and scatter their parts to every corner of Oz the minute they really need their coverage.

That maybe, when a problem seems too big and complicated, sometimes our biggest barrier is overcoming the doubters and the naysayers around us. Not that it’s going to be easy to climb the mountain on a little engine. Or go to the moon in a tin can. Or rescue our Democracy by electing the first African-American President in the history of this great nation. But the journey of a thousand steps begins with, “Yes We Can!”

And we did. Let’s do it again.

*
*
*

** According to a Public Citizen study, every year we spend less than half of our $2.4 trillion healthcare economy on actual care, the rest is non-care related, such as $450 billion for bureaucracy, largely due to private health insurance.

Posted in Healthcare, Such | Tagged: , , | Leave a Comment »