Comments on: S. Robert Snodgrass: Slogans are only words

By: BladeDoc

BladeDoc — Wed, 23 Apr 2008 01:53:00 +0000

Dr. Mintz — your #3 is not true. There’s pretty good data coming out that diabetes, obesity and smoking (for example) costs a lot of money up front but actually saves money overall because people are boxing before they end up with Alzheimer’s in a nursing home. For just one study see http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0050029&ct=1

By: Anonymous

Anonymous — Tue, 22 Apr 2008 18:18:00 +0000

Anon 7:29 PM
The United States is one of the few if not the only country that allows medical insurance to be sold for profit.

That's just plain not true. Health insurance is sold privately, by for profit insurance companies, all over the world.

Fortis is just one example.

By: Dr. Matthew Mintz

Dr. Matthew Mintz — Mon, 21 Apr 2008 13:14:00 +0000

Talking about truly fixing health care invites difficult conversations. It is not a surprise that policiticians steer clear of this. Sen. Clinton essentially admits in her “I have the scars to prove it” stump speech on health care that she pushed too hard the first time around. We want everybody to have everything and not cost too much, and this is simply impossible. Even if we had Medicare for all and incentives for doctors to go into/stay in primary care fields, the system would still be broken. Here are a few difficult conversations we need to have in order to fix health care:
1. Rationing. You can’t pay for everything. As an example, we spend a ridiculous amount of money on the first and last 30 days of life. When grandma goes into the ICU without much hope of any future viability, she is often kept alive for days because the family want to do “everything,” sometimes even if that isn’t what grandma would have wanted. And if you think pulling the plug (or saying insurance won’t pay to keep the plug in) on grandma is a tough one for our country, try the 1 pound, drug addicted, preemie that will stay in the NICU for months, with a high probability of problems down the road. Based on our country’s division on abortion, we are just not ready for this one. Ironically, we already have rationing, it is just irrational rationing.
2. Tiered health care. We would like health care to be a right, but it is currently a business. With retainer medicine growing, tiered medicine will continue without a public debate. Currently our education system is tiered, and though there are issues (lack of resources for inner city schools, falling behind compared to other countries), as a country we don’t seem to have a problem with it. We would need to decide what basic health care rights are guaranteed for all, and if you want more, it’s going to have to be out of pocket. As above, we currently have a tiered system: the insured who are both rich and poor, and those without insurance.
3. Changing our unhealthy ways. Though technology (new drugs, new tests, new procedures) is likely the biggest driver for rising health care costs, our country’s lifestyle and the chronic diseases it leads to (diabetes, emphysema, cardiovascular disease) is also a major player. We literally want to have our cake and eat it too. Solutions need to be both societal and individual. Is our country ready for a junk food tax? Are we ready to say that if you are overweight, you need to pay more towards health care? Are we ready to look at and eventually spend money on infrastructure that allow people to exericse and eat healthier?

By: Anonymous

Anonymous — Mon, 21 Apr 2008 08:57:00 +0000

And your point anon 7:29? We live in a capitalistic model do you think these insurance company’s are going to do this for free? If you want NHS then just say it. Otherwise your statement is totally meaningless.

By: Anonymous

Anonymous — Mon, 21 Apr 2008 00:29:00 +0000

The United States is one of the few if not the only country that allows medical insurance to be sold for profit.

By: maggie mahar

maggie mahar — Sun, 20 Apr 2008 17:55:00 +0000

S. Robert Snodgras:

Yes, yes and yes.

Not too long ago, I interviewed Dr Don Berwick, head of the Institute for HealthCare Improvement, and he expressed his concern that "the American public just isn't mature enough" for the health reform we need.

And by "mature enough" he didn't mean "old enough."

It's the emphasis on "me" rather than "we" which undermines the social solidarity needed for to create an affordable, sustainable, high quality health care system for everyone.

I think some reform-minded politician understand this. I pretty certain that Krugman does. But many are afraid to talk about costs and sacrifice because they fear that means giving ammunition to the conservatives who don't want reform.

I don't agree. I think we should pre-empt the conservatives by saying, yes, this will cost money. Their could be significant savings down the road if we reduce waste, refuse to be gouged, etc., but the savings will come in the medium to long-term, not up front.

And we need to acknowledge that while many Americans get too little healthcare, many are getting too much care int he form of unnecessary tests, operations, hospitalizations, over-priced medications, etc.

My husband just went to a new opthamalagist for a second opinion because we both had been feeling that our current doctor was too rushed, wasn't paying attention etc.

Our old doctor had my husband scheduled for cataract operations in each eye--the first was supposed to take place a week ago. My husband just didn't feel comfortable and cancelled.

He went to a new opthamalogist recommended by a doctor who I know, still assuming that he needed a cataract operation.

This second opthamalogist spent a long time examining him, and shocked my husband by saying no, he doesn't need an operation at this time. . .

The vision in one eye is 20/20! In the other eye, it's not as good, but still no need for the opeartion . . .

Returning to health reform, I'm not giving up. (And I'm certainly not suggesting that Berwick is either.)

By: Trent

Trent — Sun, 20 Apr 2008 16:27:00 +0000

One big mistake - military spending is half of the discretionary portion of the budegt. This is itself less than half of the overall federal budget, meaning that military spending is about 20% of the overall federal budget.

And I would argue it needs to be mentioned that federal spending is a little more than half of overall government spending (if you consider state and local spending), meaning military spending is something like 14% of all government spending.

The idea that government social spending is crowded out by military spending is highly falacious. I would never argue that military spending is not highly wasteful, it is no used for often bad purposes, and it doesn't subsidize the rest of the world; but it is important to not use misleading numbers.

By: DDx:dx

DDx:dx — Sun, 20 Apr 2008 15:45:00 +0000

I can see what I want for a healthcare system, but I can’t see how to get there from here. My concepts wouldn’t be popular. Too many people would be out of jobs. And what I want is quite different from what the people I see in the ER want…Generic IS just fine for me.
So the slogans spout.
If we want to spend less money on healthcare, then cut the Medicare budget. Employers can stop offering insurance benefits. Costs will go down. But THAT isn’t REALLY what we want, we whine…And the politician avoids the difficult choice, like the doctor avoids the difficult discussion. About uncertainty, risk, responsibility…
And getting somewhere in political America requires compromise. Just like education of the ignorant requires listening to the student. Neither of which one has to do on ones blog…Here in cyberspace we can avoid responsibility to our colleagues and fellow citizens with ease. It’s those face to face discussions that are tough.

By: Anonymous

Anonymous — Sun, 20 Apr 2008 14:50:00 +0000

Yeah, socialist control freaks running healthcare. That’s the ticket. Works great in Zimbabwe and North Korea.