by Matthew Mintz, MD
There are certain actions we take even though we know that ultimately we will not be successful. Sometimes we do this out of hope for a better tomorrow (like playing the lottery) or because we are taking a moral stand (like supporting a candidate that has no chance of winning).
Supporting health care reform is probably a little of both.
Even if any of the currently proposed health care reform plans pass, it will make little impact on our crumbling health care system. That said, you MUST support health care reform now.
Why?
1. The current system is worse then broken. You probably know about the over 40 million Americans that lack health care coverage, and the fact that we pay more than any other country for health care, but have poorer health than most other countries. However, non-health related facts may be even more important.
The most common reason for bankruptcy in the US is medical bills. In addition, our nation’s industries can not compete in a global market because of health care costs. GM spends more on health care for its employees then the metal in the cars they make. The health care system is not only broken, it is crippling our entire company.
2. If we don’t act now, reform may never happen. Congress goes into recess at the end of the month. By mid-April, our representatives will start to focus on the mid-term elections. Thus, it is likely that nothing substantial will get done this spring, summer and fall until after November, 2010. If this is the case, regardless of the outcomes of the upcoming elections, no politician will want to tackle health care any time soon.
3. We are so close. We have never before had health care bills that have been passed in both the House and Senate. This is historic. We can’t stop now, because we may never get this close again.
4. There are actually some good things that will happen if reform is passed. Even if we don’t cover all the uninsured, any bill that covers millions more has to be worthwhile. Both side also seen to agree on eliminating pre-existing conditions and closing the Medicare Part D donut hole will be a major help to many of our seniors.
But the current health care reform proposals aren’t perfect. Here’s why.
1. Coverage is not enough. There are four major problems with our current health care system: lack of coverage (uninsured, underinsured, pre-existing conditions), escalating health care costs, a poor delivery system including a primary care shortage, and an unhealthy population.
The other issue, of course, is how to pay for any fixes. Current proposals pay lip service to all four, but really only address coverage. All are inter-related, so without addressing the others, your can’t fix the system. Massachusetts is a perfect example. After expanding coverage to all residents, the state found that there weren’t enough primary care doctors to see everyone. These newly insured patients ended up going to the ER, leading to dramatically increased costs for the state.
I believe we should have first addressed rising costs and our delivery system. Fixes include malpractice reform and restructuring our payment system which pays for tests and procedures over prevention and counselling.
2. You are probably not affected. If you are reading this, you are doing so a work (you have a job) or at home (you probably have a job if you can afford shelter with a computer and Internet connection). This means that you likely have health insurance that is provided by your employer, like most Americans between 21-65. Similarly, you are likely not happy about your escalating health insurance premiums and possibly frustrated by longer and longer waits for shorter and shorter appointments with your doctor.
However, you likely want to keep your doctor, are thankful you have coverage, and though you feel bad for the uninsured, you are more fearful of what substantial reform might mean for you. The good news is that whatever passes will likely not affect you. The bad news is that we will likely not get any real change until things get so bad that most Americans demand change.
3. Things are bound to get worse. Though our dysfunctional system and plans for reform may not affect you now, things will get worse. Without addressing costs, premiums will continue to go up and even more patients will lack the ability to afford health care coverage. Without addressing the bureaucracy of insurance paperwork and they pay disparity between specialists and primary care physicians, students will continue to go into non-primary care fields and current primary care doctors will retire. In addition, our nation is only getting older and fatter, and thus sicker and more expensive.
Bottom Line: Our health care system needs massive changes. This can’t be done quickly, so one piece of legislation will not fix it. It will take many years and many pieces of legislation just to start moving in the right direction. However, we have to start somewhere. Though the current proposals will not work, they are a first step. In addition, a millions of Americans will get coverage and we may get a few needed fixes. Yet, if we fail to take this first step, and don’t pass something soon, it may be a decade before health care reform is discussed again.
Matthew Mintz is an internal medicine physician and blogs at Dr. Mintz’ Blog.
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Your argument amounts to “Things are broken, we’ve got to do something!” But this kind of reasoning generally makes things worse.
The reason things are broken is not a “free market,” but the opposite: Too much government. Tax pressures and, in Massachusetts, explicit legal requirements, have pushed people into dependency on insurance companies. The patient is not the customer, and the doctor has to be primarily concerned with keeping the customer — the insurance company — happy. This isn’t the way insurance works in a free market. You don’t get oil changes from car insurance, or plumbing maintenance from home insurance.
But progressives campaign for more and more mandated coverage and requirements to purchase insurance, driving costs higher and increasing the economic wedge between doctor and patient.
The cure which you offer is to further increase the separation between doctor and patient. More of the disease doesn’t cure the condition.
We do indeed need “reform” in the way people get medical treatment, but not in the way progressives have hijacked the word. The government should be re-opening ways for people to pay for their own medical care and bypass both insurance companies and government. Congress won’t do this, of course; it would decrease their hold over us.
“The public is not strongly against health [financing] reform.” You always leave that word out.
But hey, no kidding genius. Of course they want health financing reform. So do I. I’d like to see interstate purchase of health insurance. Shadegg bill. I’d like to see more entities use HSA’s the way the State of Indiana does. Given that HSA’s have five years data showing they do work, given they have five years data showing they help rein in cost, they “bend the cost curve” as the policy wonks like to say, and given that the “reforms” contemplated so often try to kill them off, it’s clear that the goal of this Congress is control, not reform, not improvement.
To say polling shows “Americans want reform” is as insipid as saying Obama got more votes than a politician from a generation ago. What’s the significance of Obama getting more votes than Lincoln?
What the public doesn’t want is to do something stupid, just for the sake of doing something. That does not seem to slow you down.
Ah, finally, someone mentioned (in passing) the solution:
HSA’s.
BobBapaso it’s what the current Administration and Congress don’t want to hear. The one thing that has five years supportive data, is the one thing they don’t want to do.
It puts the healthcare dollar under the control of individuals.
That’s an existential threat to the left.
The recent economic stimulus package is a good example of what you end up having to do when you let a problem fester until it becomes a national emergency. We can do something about health care now, or we can do something about it later. But just like the economic stimulus, the longer we wait, the more massive and expensive it’s going to turn out to be.
Did you know that on page 425 of the health reform bill it says that a scheduled meeting every 5 years will have people on Medicare seeing counselors that will tell them the various ways to kill themselves painlessly? Think about it this way. How much are your parents worth to you? More than $400 billion?
D. Henry—-
I read page 425 of the Senate bill (as passed) and see nothing at all about counselors telling patients how to kill themselves. Read it yourself. You won’t find one word about suicide, death panels, killing oneself or anyone else. Nada.
That section of the bill provides reimbursement for physicians when they discuss living wills and advance medical directives with elder patients, something everyone of any age should do anyway. For an annotated discussion of that section of the Senate bill, see Wikipedia’s entry at http://en.wikipedia.org/wiki/America’s_Affordable_Health_Choices_Act_of_2009
I’ll happily pay my doc for her time and expertise so we can discuss end-of-life issues long before I need to make important decisions, knowing I might not make good choices in the heat of an emergency situation.
These bizarre rumors and myths are so easy to look up, I’m amazed people don’t spend the 15 seconds it takes to do so.
http://www.snopes.com/politics/medical/euthanasia.asp
I might be a little late coming to this discussion, but after reading the four arguments cited, I’m surprised.
1. The current system is worse then broken.
However terrible the current system is, it is due more to TOO MUCH GOVERNMENT MEDDLING AND CORRUPTION rather than not enough government. So then this is the argument to give up more individual control and hand it over to politicians?? How does that make sense?
2. If we don’t act now, reform may never happen.
When I was younger and more naive, I would go buy a car and the salesman would offer me a “special deal”, but hey, if I walked out of that lot without buying no, I may not be able to come back and get the same deal tomorrow. Does this kind of trick really fool anyone anymore?
3. We are so close.
Same argument as #2
4. There are actually some good things that will happen if reform is passed.
Such as what? Arbitrarily “giving coverage” to everyone sounds deceptively great, but it HAS to come from somewhere. There has to be a cost. Otherwise, why not pass even more “reform” bills giving everyone 5-bedroom homes, lifetime free gasoline, unlimited health care and all-the-ice-cream-you-can-eat.
Supporters of the bill cite this boost in “coverage” as being an improvement. What good is Medicare-for-all if providers stop taking Medicare? Or if good people stop going into medicine?
As a physician or if I were an insurance company, I would probably benefit from this bill going through. But I’m also a potential patient as are the members of my family and I care more about our health care options than I do about being in a special-interest group which can take advantage of lobbying the government to help me cheat the public.
I was not too concerned with health care reform until a short time ago. I have good coverage and purchased coverage for my two college aged sons that recently went off my policy. I was concerned with the rising cost for the premiums, co-pays,medications etc but not alarmingly so. That all changed when I went for an appointment and was presented with a new form requiring me to pay the insurance portion of the bill if not paid within 60 days by the insurance company. I was refused as a patient when I would not sign. Most middle class people do not have the funds to cover even one major medical event out of pocket-even if they eventually do recoup the funds from the insurance company. The willingness of doctors to turn away paying patients leads me to believe they can’t be suffering too much, at least not in my area. My respect for doctors and the medical industry in general is suffering due to the current climate. I am starting to feel like the medical community is trying to punish the patients for having insurance. I thought I was being a responsible medical consumer but now I feel it is pointless to plan. The medical industry is shooting itself in the foot. The whole county will be screaming for federalization if this keeps up.
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