Wednesday, March 24, 2010

Yet another dudes thoughts on health care reform, Midwest Geek style

I've started a post on this subject and the deleted it so many times. Finding my voice and saying what's on my mind has been so much harder then I ever thought it would be. I have good friends on all sides of this discussion. My self-censoring, biting my tongue was my effort not to strain relationships over this very difficult issue.

Let me preface everything with a disclosure you hopefully already know. I currently work for a very large health care provider. While I'm not a provider of health care services (aka: I'm not a doc, nurse, therapist, etc...) they do sign my paycheck and provide me an opportunity to work. I like that. These thoughts don't reflect my employer, my co-workers, the people that visit here, my wife, or even the guy walking down the street. These are my ideas. Take them as the ramblings of one dude trying to live it right here in the Midwest.

Enough of that.

So what's my take, my spin, my two cents? Well, hopefully it's more like a buck and quarter. I was actually disappointed in the legislation. My liberal friends will be all, "well, duh! It's because you are a conservative," and it wouldn't surprise me of my conservative friends aren't all like, "really? a pinko liberal like you isn't happy?" I'm what you call a moderate libertarian pragmatist. Pigeon hole that biatch.

So what's my beef with this new deal? My biggest beef is we missed a ginormous opportunity here. We could have actually made strides to reform the problems with the health care system. To look at it's failings and strengths and do something truly wonderful.

I know there are people out there, excited for this change. Excited that our government finally did something positive. A good friend of mine, Jennifer over at Poker, Politics & Purpose wrote a piece about some really shady stuff going on in California. Basically, it has to do with laws that shield the insurance companies from the prying eyes of say, their customers. It's some nasty stuff. She's excited for health care reform because it should stop the California health insurance companies from doing this crap. I felt bad she and others have to endure this. She's a single woman, who's self-employed as a writer. I admire her independence.

While I think that's a terrible system there in California, I failed to see why this was a reason to reform our NATION's health care system. I read through that and kept thinking to myself, "why do people live in California? who do they have in their government that allows stupid laws like this to exist? why, oh why have the people of California not revolted and stormed the legislature?" The problem she described wasn't with the insurance companies. Sure, those companies aren't gonna complain about laws like that, but they didn't make them laws. The government did. It's the government's fault they exist and more over, it's the people of California that let their representative government do this. Shift the blame to where it belongs...government.

And yet, we just turned over more of our lives to that entity.

The problem I saw with this whole health care debate was all the evidence, all the research was completely ignored. Emotions were allowed to take over. I've said this here before, it's one of my absolutely favorite questions, "how many anecdotes does it take to prove a point?" (I did a google search on the question, haha, my blog is the only one it returned...) It's a funny question to me, it always makes me chuckle. I laugh easily though. On a more serious note, in formal debate and in the legal system, you can't use an anecdote to prove a point. It's just a story. It's circumstantial and many times, it's emotional.

All the tragic stories in the world, don't prove what's wrong with the health care system. They just muddy the water.

Another friend of mine, Otis at Rapid Eye Reality, shared the story of the birth of his latest child. Otis works in the poker news arena. He's self insured and this story really moved me. The hospital they went to demonstrated everything that's wrong with American business ethics. Those money grubbing scumbags really did go to new lows in screwing over a hard work family in South Carolina. I'd strongly suggest that you follow the link and read the story.It's amazing to what depths a hospital/health care system will go to make a buck.

But while that story drives me to anger, I still don't think it's a reason to prosecute an entire industry. The story reads like any business horror story. If it had been any business doing this, other then a hospital, we'd be reading about how terrible THAT hospital is. What evil, deceitful people work at THAT hospital. We wouldn't just apply that story to a whole industry. We'd find out how common this is. We'd pressure the industry into changing it's practices, heck, we might even send an army of lawyers into their offices and investigate them for fraud.

I work at a different hospital in a different state. The laws are different here. You make a quote in any business, you have to stick to it. It's the law. Let's fix those laws and make sure that everyone has to play by the same ethical business practices that we expect.

The list of bad beat horror stories of our health care system are long. So long, you'd think that no one ever gets good, quality, affordable health care. I also started to notice just how many stories showed a change that we have been experiencing for a long time. Personal responsibility.

On NPR yesterday, I heard the conversation between a show host and two doctors. The doctors were chosen because one was for the new health care reform and the other was against. It was the usual pundit banter. One question really caught my attention. The host asked the guests if they had any personal stories to share about what's wrong with health care (more friggin' anecdotes...geez). The one doctor told the story of his dearly departed mother. She's had been a widow for a while. He checked on her from time to time and had discovered that she wasn't taking all of her medication. When he confronted her about this, she told him she was trying to spread them out because she was worried about the cost. This was his example of why we needed health care reform like the one just passed.

I sat there shocked. (not really, I've heard this before) The reason that we need to force everyone to buy health insurance, to tax everyone that already have it, to take away some benefits from seniors was because this man was too damn cheap to take care of his mother. He expected me, and everyone else to pay her bills. Why doesn't he step up to the plate and pay for her pills? It's his mother!

Health care should never be free because free is an illusion. The old Soviet union had single payer, nationalized health care. The lines were huge and no one wanted to be a doctor. Doctors got paid peanuts. Why do that when you could do something else, make more money, work less hours. One of the dirty little secrets about Medicare/Medicaid is that they are just price fixing schemes designed by the government. Most health care facilities raise their prices for everyone else to make up the difference they are losing because of the Medicare patients.

Here's how that system works. A dude, most likely in a suit, in an office in Washington DC looks at the menu of medical services people get. Next to the description is a box, the column header says, "Amount we will pay providers." He writes a number in that box. When a person goes to the hospital for something on that list, the hospital submits the bill using codes that date back to the 80's and can expect to get paid what that dude wrote in the box. When congress looks to save money on Medicare, they tell that guy in the office to make the numbers smaller in the box. He does that. Hospitals get smaller checks. No one bothers to check what the service really costs. You know, for things like, wages and benefits for the workers, the medicines and supplies. Many things that people have done every day cost more then the reimbursement paid by Medicare. Hospitals do the only thing they can, they raise the prices on everything else for everyone else.

Here in lies my rub with the new legislation. None of this is ever mentioned. Your doctor could totally suck. He might not even be able to treat a simple cut correctly. It doesn't matter, he'll get paid what ever that box the dude wrote in says he should get paid for doing what he did. Why didn't we fix that? Opportunity missed again.

One thing I do know, when people have no skin in the game, they take the game for what ever they can. The part of the system that I never once heard mentioned needing fixing were the people you see in the mirror. We, the people, are our own worst enemies when it comes to creating costs in the medical systems. When people have free (as in beer, to them, again it's really not free) health care, they go to the doctor for EVERYTHING. It used to be, we only went to the doctor when we were actually sick and needed one. Now, we go to the doctor, the doctor tells us we have a virus, like a cold, we demand that he fix it. He says there's nothing he can do, we say sure there is doc, you prescribe a pill to me and I'll come back later for more worthless visits and you can get paid for them too, if you don't I'll go to your competition and you won't get my, I mean my insurance companies, money. Doctor complies.

This may seem small or just a little stupid but it's costing everyone big dollars. That visit cost money, you know, staff, lights, that paper thing on the bed, clean equipment (that's now needing to be cleaned again cuz you touched it)...hopefully you see what I'm talking about. We've just expanded the number of people that will have access to do this to system more. More money wasted.

Again, another topic not touched.

Why didn't we look at what is really driving up cost? It was just assumed that the evil hospitals, greedy doctors and corrupt insurance companies are the root of all evil. We the people can't possibly be the source.

We missed a golden opportunity to actually fix the system. To make it work better. To find the real costs that make this so expensive. We found the scapegoats. We beat them into submission. Truth be damned. Pragmatism, what's that?

I would have loved it if we took the time to really understand the issues. To find the money leaks. I'm sure I missed something, this has been building up in me for weeks, and just now, I puked it onto the keyboard. I'm really hoping that people will understand my point of view. I was hoping to find more research, I had seen somewhere, that the MD Anderson Center in Texas spent more money on research then the entire nation of Canada. I worry that as we move to a single payer system, research will disappear. Much of that research is done here. Nations with single payer systems tend to spend far less and rely on others to do it. I hope we don't head that direction.

I really wanted to know what we spend trying heroic measures to keep our loved ones alive when, in the real world, there's no hope. We spare no expense, do what ever it takes to keep them alive. I have no idea how to fix this, but I have to believe there's a way, we as humans can learn to let go.

I should probably quit rambling. To those I've mentioned here, know this, I respect your opinions very much, I just chose to see them differently.

One more big block of ice removed from my ice jam otherwise known as writers block, out of the way. You feel better, I do?

Thanks to NapWarden at NapWarden Designs for the custom soap box graphics! You're awesome!


Jennifer said...

I appreciate what you said about my situation in California (and me!). One thing I should point out is that California is not the only state that protects the insurance companies & keeps their underwriting guidelines secret. I don't have a tally, but I'd venture to say that most states have those laws.

The main idea that I take issue with in your post is your contention that the tragic stories just muddy the water. I differ with you here because I believe the people and their stories ARE the center of this whole issue. And there are millions of horror stories and sad tales that end with the insurance companies winning and the patients going w/out care, medication, or insurance.

Thank you for expressing your opinion, which I respect greatly. We definitely differ on many points, but this is a way to have a civil discussion about it, and I appreciate that very much. :)

DuggleBogey said...

Interesting post, and I appreciate your point of view.

But I am unclear on your stand. You say near the beginning of your story that you're disappointed in the legislation, and you seem to be saying that it didn't take advantage of the opportunity for real reform.

Later in your story that you don't understand why we needed a national solution for a local problem in California et al.

You seem to be hinting that all the evidence is anecdotal, not a problem of policy.

Do you not think that something needed to be done on a national level about the health care system?

StB said...

Good stuff Captain. I agree with you. There was opportunity for real reform. Nothing has been done to lower costs and make health care affordable. And let's call it what it is. Health care, not health insurance. No one needs to buy health insurance. Oh wait, they didn't. One could save the money themselves. They could have done it with Healthcare Savings Plans but that will go to the wayside.

Bottom line... would it have hurt anyone in the D party to sit down with Rep Paul Ryan and work in ideas to lower cost? Because parties are stubborn (notice how I don't single either one of them out here)they felt the need to jam through what they wanted, not what worked out best for the peopel of the country.

Rian said...

RE: Your comment about heroic measures: I read a really interesting book many years ago: How We Die: Reflections on Life's Final Chapter

One point he made about government's interference in medicine- Did you know that it is IMPOSSIBLE to die of old age in this country? 'Old Age' is not a valid 'cause of death' on a death certificate. A culprit must be found.

I hear what you're saying. If they're gonna pass a law, could it at least be a smart one? One that the average person can read and understand? Whatever happened to the concept of a Patient's bill of rights/freedoms?

WeaselMomma said...

You bring up some very solid and valuable points.
I too have issues with the HCR and my list is different than this, but I am grateful for this food for thought.

surprised mom said...

Thank you for giving me more to think about regarding the new health care bill. There's so much I don't know and now I know a little bit more. I work for doctors, in their office, and a doctor signs my paycheck, too. So I am more interested in this subject than some. I want to be happy about this bill, but I'm not. There's too much that hasn't been decided or "reformed."

seashore subjects said...

I understand your points. And I agree with the personal responsibility issues. In the interest of debate, I would like to point out 2 things.

1. The government isn't the only price setter (via medicaid) Insurance companies also set rates and if you go to a doctor without insurance you will pay more than is you had insurance. This seems a bit whacked to me, but having experienced it, at a very brief point in my life when I wasn't covered, know it is true.
2. In many states people are required by law to have car insurance. Why? So when they hit you your car and people can be fixed. No one expects to crash, yet we pay thousands a year to cover ourselves in case. Most healthy people expect to stay that way. But, in the event something happens, they are treated and cared for regardless of their ability to pay. How many walk away from this debt? Then who is responsible for the money owed? Us. The insured or paying people pick up the cost in increased prices and fees. So, aren't we getting the short end of the shaft anyway?