Citizens have been listening to all the talking points and arguments thrown back and forth for years now. The debate about health care reform in the U.S. is nothing new – indeed it was only 16 years ago that political leaders last wasted a similarly endless amount of time and energy on the same issue. But the situation in the U.S. this time is different. Many believe the U.S. has entered into what history will call the Greater Depression when this era is compared to the 1930’s. The numbers (GDP, unemployment, housing sales, etc.) that the government agencies report are all suspect and have been shown to be manipulated for political reasons and cover. But they can only becloud for so long, as too many Americans have felt the fiscal crunch of living in the U.S. today. Indeed, it is more difficult than it has been in a very long time (for many different reasons), and as a result, people have learned to doubt what you tell them.
There are the obvious reasons for the pressure citizens feel, of course: unemployment; under-employment; higher costs of living; increased prices on essentials like food and fuel. But these realities are primarily felt by those who are not well-off. And by well-off, let’s qualify that not with numbers, but with this: if a family does not have to choose between essentials each week or pay period (i.e. “How much can we spend on groceries this week because the mortgage payment is due?”) they are better off than most. You, the political leadership in this country, as well as those who would advocate for policies that protect and maintain the status quo, fall into the well-off category.
You, our political leaders, don’t have to adjust your family budgets because essentials have risen in cost. You don’t have to cut back on the weekly grocery bill because your insurance premiums have risen as your employer continues to try and cut costs. You don’t have to worry about co-pays and out-of-pocket minimums that cut into your stagnant or declining wages. You don’t have to think about declining wages or lost hours that allow for you to pay the mortgage. In short, though you represent all citizens, you are not like the vast majority of them because your lives are devoid of the above realities.
The lower and middle classes do not have powerful lobbyists or organized industry groups. They don’t take you out for expensive meals or on trips to play golf in foreign countries. What they are, however, is the largest segment of that group you vowed to represent. Whether you like it or not, you represent the families who have taken up residence in one of the many tent cities that have become increasingly common. You represent the single parent who works more than 1 full-time job to try and make ends meet, yet just can’t seem to get there. You represent the family that struggles, not to move up the ladder, but to hang onto the rung they have called home for years. You represent people who have lost jobs, homes, work hours, take home pay and benefits, retirement and savings portfolio assets, and last but not least, a chance at the American Dream.
Your continued advocacy for a small percentage of the population – the wealthiest ones – who have been so generous to your re-election campaign coffers, is proof enough for a growing number of the rest of Americans that your votes and positions are for sale. While this is nothing new in the political system of the United States, it has become more and more dramatic as the largest corporations and financial firms continue to receive taxpayer dollars despite their contempt for citizens: as customers; as individuals; and as human beings. Simply stated, the populous has had enough. The level of contempt on that side of the fence is growing as fast as their increasing numbers.
You, our leaders, have the opportunity to implement a program that will help millions of people get and stay healthy. You have the opportunity to remove the threat of financial ruin due to medical conditions. You have the opportunity to make sure that some of their tax dollars are spent on programs that help more than just the few. The choice is not really yours – it is theirs. Polls have shown that the majority of Americans want a government funded insurance option or a single-payer system. It is not socialism (unless you consider the U.K., Japan and Germany all socialist countries and not capitalistic ones) to give the populace what it wants and needs. It is not “new” – universal health programs work everywhere else in the world. Indeed, the U.S. should be ashamed that the wealthiest nation on Earth does not provide this basic service to its citizens.
As it stands today, you have given away trillions to banks so that they can remain in business despite their poor decisions and yet demanded nothing of them. You have asked for no reforms that will prevent another disaster, yet the banks have access to unending amounts of cash from the Federal Reserve (at no interest, no less) while charging customers interest rates that approach 30%. Banks get to shed worthless assets at elevated prices because fair accounting standards and practices have been halted and the government backed entities Fannie Mae and Freddy Mac have been green lighted to purchase these worthless debts at close to face value. You have created a welfare system for the wealthiest, and left the rest of your charges to their own devices.
You have provided bailouts to everyone except your represented individual citizens. Don’t you think it’s time you did your jobs and represented the people who actually voted for you? Don’t you think it’s time to help the less fortunate and the rest of those who deserve better than what they have gotten from you and your cohorts? You should all hang your heads in shame for your petty bickering, blatant pandering and political grandstanding. You have had your opportunity to get your faces on T.V. – now go and do something the rest of the citizens of the U.S. deserve and will benefit from. Enact health care reform that will work.
If you need help, there are plenty of us out here with a solid understanding of the system’s real problems and the real solutions that will make it more efficient, more cost-effective and more beneficial. All you have to do now is your job.
Friday, September 4, 2009
Friday, August 28, 2009
Mr. Potter's Lullaby
After reading Nick Kristof’s column in the New York Times yesterday (available here), I was moved to investigate his chosen subject, former insurance industry executive Wendell Potter. After a quick Google search, I found an interview of Mr. Potter conducted by Bill Moyers that I thought might be good viewing. So last night, my wife and I sat down after getting our daughter to bed and began an evening of emotional distress.
The video (from PBS’s Bill Moyers’ Journal) with Potter (available here) was, to say the least, unsettling. In it, Mr. Potter describes how the largest insurance agencies in the country deplore competition and have worked tirelessly over the years not only to consolidate their hold on the market by buying up smaller companies, but to convince the public that any insurance not offered and provided through them is a wrong headed and un-American idea.
He talks specifically about the insurer’s aggressive pursuit of profits and the lengths to which they go to maintain them. Two such practices described were the canceling of policies as soon as holders are diagnosed with conditions that are expensive to treat, and increasing premiums on smaller business whose employees file expensive or too frequent claims so that the small business is priced out and forced to cancel coverage.
He describes the industry organization, Americas Health Insurance Plans (AHIP), and their concerted efforts in the early 1990’s to control the messages and talking points that most Americans would see and hear on the news or TV commercials. He is blatant in his descriptions of pressure being applied and bribes offered to legislators by the industry and their lobbyists. The goal was to direct the conversation away from fact and towards ideological lines, thus obfuscating any real attempt at conversations about reform. Quite simply, they wanted things to stay just as they were and they used every way possible to portray anyone who suggested reform as a danger to our society.
Potter’s description of the AHIP’s response to Michael Moore’s film, “Sicko” in 2007 is nothing short of astonishing. The coordination and logistics utilized to try and cut off debate about health care reform and blunt the impact of Mr. Moore’s film illustrate just how desperate the industry is to remain in control of health care in this country. Their companies are at stake, as well as the fortunes of the executives who run them, and they fight as though they have everything to lose – because they do.
The information gleaned from the video was not surprising. Neither my wife nor I were shocked to hear that Cigna and other insurers don’t want competition and that they are willing to lie and manipulate the message through media to maintain the status quo. What was surprising, and disturbing to watch, was this man – who has worked in the industry for decades and helped design the PR responses to such threats to their crystal towers – sit there and explain why he now decides to come forward and let the rest of America know just what he has been doing for the past 15-20 years. He claims he was moved when he attended a health fair in Virginia at which thousands of people sought care because they had no insurance and no access to affordable care because of it.
His descriptions of what he saw and how it moved him only served to infuriate me. He had never seen people suffer and go without because they had no ability to pay for care. It had never dawned on him that people who were removed from his company’s roles would be left with no way to pay for care they needed. He had lived in that ivory tower and had never bothered to look down and see what was under him. I was nauseous as he described flying on the Cigna corporate jet, eating a meal on a gold rimmed plate with gold plated utensils while his company worked diligently at not paying for the care of policy holders who had dutifully paid in their premiums.
I don’t know what to make of all of this yet. I’m still too unsure and unconvinced of this man’s motives to be sure he’s telling us all that we need to know. I don’t doubt anything he said, but I suspect that there’s much more and worse that we should have heard.
One thing is very clear though - the insurers have attempted to make their own actions invisible as much as possible. They have levied accusations of rationing and denying care against an as yet unexisting government run insurance plan, yet they themselves conduct these practices. It’s like Fox News accusing another network of bias while denying their own.
The former administration taught us all that if you accuse your opponent of something you yourself are doing, they spend lots of time and effort trying to disprove a negative and you are free to do whatever you want. Advocates of universal health have been defending the idea from almost everyone; meanwhile Cigna and its brethren are hiking rates and dropping expensive policy holders.
It’s enough to make me sick.
The video (from PBS’s Bill Moyers’ Journal) with Potter (available here) was, to say the least, unsettling. In it, Mr. Potter describes how the largest insurance agencies in the country deplore competition and have worked tirelessly over the years not only to consolidate their hold on the market by buying up smaller companies, but to convince the public that any insurance not offered and provided through them is a wrong headed and un-American idea.
He talks specifically about the insurer’s aggressive pursuit of profits and the lengths to which they go to maintain them. Two such practices described were the canceling of policies as soon as holders are diagnosed with conditions that are expensive to treat, and increasing premiums on smaller business whose employees file expensive or too frequent claims so that the small business is priced out and forced to cancel coverage.
He describes the industry organization, Americas Health Insurance Plans (AHIP), and their concerted efforts in the early 1990’s to control the messages and talking points that most Americans would see and hear on the news or TV commercials. He is blatant in his descriptions of pressure being applied and bribes offered to legislators by the industry and their lobbyists. The goal was to direct the conversation away from fact and towards ideological lines, thus obfuscating any real attempt at conversations about reform. Quite simply, they wanted things to stay just as they were and they used every way possible to portray anyone who suggested reform as a danger to our society.
Potter’s description of the AHIP’s response to Michael Moore’s film, “Sicko” in 2007 is nothing short of astonishing. The coordination and logistics utilized to try and cut off debate about health care reform and blunt the impact of Mr. Moore’s film illustrate just how desperate the industry is to remain in control of health care in this country. Their companies are at stake, as well as the fortunes of the executives who run them, and they fight as though they have everything to lose – because they do.
The information gleaned from the video was not surprising. Neither my wife nor I were shocked to hear that Cigna and other insurers don’t want competition and that they are willing to lie and manipulate the message through media to maintain the status quo. What was surprising, and disturbing to watch, was this man – who has worked in the industry for decades and helped design the PR responses to such threats to their crystal towers – sit there and explain why he now decides to come forward and let the rest of America know just what he has been doing for the past 15-20 years. He claims he was moved when he attended a health fair in Virginia at which thousands of people sought care because they had no insurance and no access to affordable care because of it.
His descriptions of what he saw and how it moved him only served to infuriate me. He had never seen people suffer and go without because they had no ability to pay for care. It had never dawned on him that people who were removed from his company’s roles would be left with no way to pay for care they needed. He had lived in that ivory tower and had never bothered to look down and see what was under him. I was nauseous as he described flying on the Cigna corporate jet, eating a meal on a gold rimmed plate with gold plated utensils while his company worked diligently at not paying for the care of policy holders who had dutifully paid in their premiums.
I don’t know what to make of all of this yet. I’m still too unsure and unconvinced of this man’s motives to be sure he’s telling us all that we need to know. I don’t doubt anything he said, but I suspect that there’s much more and worse that we should have heard.
One thing is very clear though - the insurers have attempted to make their own actions invisible as much as possible. They have levied accusations of rationing and denying care against an as yet unexisting government run insurance plan, yet they themselves conduct these practices. It’s like Fox News accusing another network of bias while denying their own.
The former administration taught us all that if you accuse your opponent of something you yourself are doing, they spend lots of time and effort trying to disprove a negative and you are free to do whatever you want. Advocates of universal health have been defending the idea from almost everyone; meanwhile Cigna and its brethren are hiking rates and dropping expensive policy holders.
It’s enough to make me sick.
Friday, August 21, 2009
Getting Closer
Health care reform, so we are being told, is being debated hotly all across the country. From town hall meetings to lunch rooms everywhere, people are arguing (sometimes forcefully) about how to remake the health care system better and reduce costs while still having a viable system. We have heard everything, from the arguments that “Obama Care” will kill grandma, to those that say anyone in the U.S., even illegals should get whatever they need for care.
I have been arguing for reform for a long time. Many of my friends and coworkers in the health care field disagreed for many years about what things should look like in any reform of the system. One friend in particular and I used to spar over what each of us thought should be included, and what the likelihood was that anything would ever really change.
My friend Mike is an ER physician. His career has involved taking care of people with life-threatening injuries, conditions and traumas as well as those with nothing more than a hang nail they feel needs to be evaluated. While he would be the first to tell you he has not seen it all, he has actually seen most of it and the rest is really just more of the same. His opinions, however, are not always based on his professional experience. They are often based on his ideological slant. He is a financial conservative who abhors large government spending and waste. Thus, for years he has argued against any government run single payer system due to his fear of spiraling cost and added bureaucracy that would stand in between his patients and himself. His biggest argument to me was often that the population would never accept any system that made patients more responsible for their own outcomes and limited care to reasonable levels.
We have been going back and forth on this for years. But last week, all that changed. When I started to talk to him about the proposals being considered in the House of Representatives, he became frustrated. He had actually tried reading the bill online and after more than 300 of the 1017 pages, he turned to me and said, “You know, you and I could fix this whole thing in about 10 pages and have a better system than the mess this is going to create.” He is right, of course. He looked at me and then told me that the only way to really do this and do it right would be to cover the basics for all citizens (preventative care, office visits, necessary tests and hospitalizations, medications, etc.), figure out how much that will cost, and then tax something everyone needs or uses so that no one escapes paying in something to keep the system solvent. Then the legal reforms would need to be put in place to protect providers from unreasonable lawsuits.
It was simple. It was brilliant. It would work. It was exactly what I had been saying to him for several years. The difference now, is that he believes the public will go for it. I don’t know what really changed his mind, but he has become convinced that not only is it possible, but now the above plan is the only real option.
I smiled and told him he was starting to sound like a Democrat. Not because he was really, but because it made him mad. That’s the kind of friend I am. Then I sat back and thought, “Hell, if the two of us have come to consensus, the debate is really not all that hard”. If a staunch fiscal conservative and a borderline socialist can agree on how to fix this mess, we need to hold the policy makers accountable – or go after their jobs.
So here’s your warning politicians – get your act together and get it done or else you won’t be getting emails and letters from people like me, you’ll be getting challenged for your coveted positions. Now shut up and get back to work.
I have been arguing for reform for a long time. Many of my friends and coworkers in the health care field disagreed for many years about what things should look like in any reform of the system. One friend in particular and I used to spar over what each of us thought should be included, and what the likelihood was that anything would ever really change.
My friend Mike is an ER physician. His career has involved taking care of people with life-threatening injuries, conditions and traumas as well as those with nothing more than a hang nail they feel needs to be evaluated. While he would be the first to tell you he has not seen it all, he has actually seen most of it and the rest is really just more of the same. His opinions, however, are not always based on his professional experience. They are often based on his ideological slant. He is a financial conservative who abhors large government spending and waste. Thus, for years he has argued against any government run single payer system due to his fear of spiraling cost and added bureaucracy that would stand in between his patients and himself. His biggest argument to me was often that the population would never accept any system that made patients more responsible for their own outcomes and limited care to reasonable levels.
We have been going back and forth on this for years. But last week, all that changed. When I started to talk to him about the proposals being considered in the House of Representatives, he became frustrated. He had actually tried reading the bill online and after more than 300 of the 1017 pages, he turned to me and said, “You know, you and I could fix this whole thing in about 10 pages and have a better system than the mess this is going to create.” He is right, of course. He looked at me and then told me that the only way to really do this and do it right would be to cover the basics for all citizens (preventative care, office visits, necessary tests and hospitalizations, medications, etc.), figure out how much that will cost, and then tax something everyone needs or uses so that no one escapes paying in something to keep the system solvent. Then the legal reforms would need to be put in place to protect providers from unreasonable lawsuits.
It was simple. It was brilliant. It would work. It was exactly what I had been saying to him for several years. The difference now, is that he believes the public will go for it. I don’t know what really changed his mind, but he has become convinced that not only is it possible, but now the above plan is the only real option.
I smiled and told him he was starting to sound like a Democrat. Not because he was really, but because it made him mad. That’s the kind of friend I am. Then I sat back and thought, “Hell, if the two of us have come to consensus, the debate is really not all that hard”. If a staunch fiscal conservative and a borderline socialist can agree on how to fix this mess, we need to hold the policy makers accountable – or go after their jobs.
So here’s your warning politicians – get your act together and get it done or else you won’t be getting emails and letters from people like me, you’ll be getting challenged for your coveted positions. Now shut up and get back to work.
Sunday, June 21, 2009
Keep Pushing
I'm fifty two minutes into a seventy minute run. Almost three quarters of the way home. My muscles are tired but they keep moving. I have three minutes before I get another sixty second break. The sweat is pouring out of me, running down my legs and into my shoes. I can feel the fluid squish with each stride and can hear it over the music pumping in my ears. Two and a half minutes left. Just keep going. Run with the beat of the drums. The Counting Crowes begin to play just a bit faster and I find the rhythm I was looking for. Two minutes to go. Stop looking at the time and just run with the beat. Squish. Squish. Squish.
When I began to run regularly just over a year ago, I would run for twenty minutes three to four times a week. Those twenty minutes seemed like an eternity then, but they paved the way forward and soon my times increased to thirty and forty minutes per workout. When I began to extend my runs to sixty minutes, I found that I tired so much that the majority of my last fifteen minutes was spent taking frequent thirty second rest breaks.
Then I read some advice in a blog about training for marathons that talked about the benefits of building a sixty second walk period for each mile run into a runner's routine. The theory was that because running was very intense, a brief break from it gave the muscles a chance to recover a bit, allowing the runner to run longer distances and times, while not being as tired at the end of the run. After using this method for a while now, I have found it works very well.
My job as a nurse is not really that different from my workouts. It is intense and consumes much energy, both physical and mental. It has been sixteen years that I have considered emergency medicine my home. It has been a comfortable place for long stretches, and I am good at it, but the years have worn me into a certain groove that occasionally requires some self extrication.
I have taken brief periods away from emergency work to try other venues, but direct patient care is never easy or simple. Working in management was a nice change for a while; the pace was good – a little slower and with regular and predictable hours. But it was filled with its own issues. After just a couple of years behind a desk, I was ready to return to what I did best. I had recharged my batteries and could again face the patient care world with a renewed enthusiasm.
My last break away from patient care was several years ago. It's time for another rest period. I can feel it in me like the sweat in my shoes. It's building and making it hard to continue. I go to work now and feel good for the first hour or so, then it goes to hell. I see things that just make me want to scream: another patient who was too lazy to call their doctor and ask for an appointment; another pregnant teenager who's smoking and is completely oblivious to what she is doing (and will be doing) to her child; more people who try to manipulate us to get pain meds because they have no other way to deal with their realities; another doctor who pissed off a patient that I now have to calm down so they don't leave ready to call their lawyer; another drunk looking to fight with the whole world. Squish. Squish. Squish.
I can't find my rhythm. Unlike when I run, at work the music has stopped and now the fatigue is too much to take. It's time to slow down and let myself heal a bit before I am too damaged to finish – and at my age I have too far to go to quit now. But a rest is just what I need. Less intensity – just for a while – so I can come back and go for another stretch at my natural speed.
My application for a new job is in and I am awaiting the call for an interview. I find myself daydreaming about working Monday through Friday, no nights or weekends and no holidays. In medicine, this is like winning the lottery. It's a twenty four hour a day world we work in, and the “regular” jobs with good hours and every weekend off are few and far between. The job I am applying for is in an office doing diagnostics. Not exactly what I see everyday now. In fact, it's a far cry from the ER. But if I can land this one, just have it for a while, it might just provide that break I need.
Just a few minutes left. Keep going. Find the rhythm. It won't be long now. I can make it. Squish. Squish. Squish.
When I began to run regularly just over a year ago, I would run for twenty minutes three to four times a week. Those twenty minutes seemed like an eternity then, but they paved the way forward and soon my times increased to thirty and forty minutes per workout. When I began to extend my runs to sixty minutes, I found that I tired so much that the majority of my last fifteen minutes was spent taking frequent thirty second rest breaks.
Then I read some advice in a blog about training for marathons that talked about the benefits of building a sixty second walk period for each mile run into a runner's routine. The theory was that because running was very intense, a brief break from it gave the muscles a chance to recover a bit, allowing the runner to run longer distances and times, while not being as tired at the end of the run. After using this method for a while now, I have found it works very well.
My job as a nurse is not really that different from my workouts. It is intense and consumes much energy, both physical and mental. It has been sixteen years that I have considered emergency medicine my home. It has been a comfortable place for long stretches, and I am good at it, but the years have worn me into a certain groove that occasionally requires some self extrication.
I have taken brief periods away from emergency work to try other venues, but direct patient care is never easy or simple. Working in management was a nice change for a while; the pace was good – a little slower and with regular and predictable hours. But it was filled with its own issues. After just a couple of years behind a desk, I was ready to return to what I did best. I had recharged my batteries and could again face the patient care world with a renewed enthusiasm.
My last break away from patient care was several years ago. It's time for another rest period. I can feel it in me like the sweat in my shoes. It's building and making it hard to continue. I go to work now and feel good for the first hour or so, then it goes to hell. I see things that just make me want to scream: another patient who was too lazy to call their doctor and ask for an appointment; another pregnant teenager who's smoking and is completely oblivious to what she is doing (and will be doing) to her child; more people who try to manipulate us to get pain meds because they have no other way to deal with their realities; another doctor who pissed off a patient that I now have to calm down so they don't leave ready to call their lawyer; another drunk looking to fight with the whole world. Squish. Squish. Squish.
I can't find my rhythm. Unlike when I run, at work the music has stopped and now the fatigue is too much to take. It's time to slow down and let myself heal a bit before I am too damaged to finish – and at my age I have too far to go to quit now. But a rest is just what I need. Less intensity – just for a while – so I can come back and go for another stretch at my natural speed.
My application for a new job is in and I am awaiting the call for an interview. I find myself daydreaming about working Monday through Friday, no nights or weekends and no holidays. In medicine, this is like winning the lottery. It's a twenty four hour a day world we work in, and the “regular” jobs with good hours and every weekend off are few and far between. The job I am applying for is in an office doing diagnostics. Not exactly what I see everyday now. In fact, it's a far cry from the ER. But if I can land this one, just have it for a while, it might just provide that break I need.
Just a few minutes left. Keep going. Find the rhythm. It won't be long now. I can make it. Squish. Squish. Squish.
Wednesday, May 13, 2009
It's Well Past Time
Another day, another disaster.
The news yesterday that the “trust funds” for Medicare and Social Security will both be depleted before previously thought left me with the sense that the only way forward is through an honest and frank discussion about our current financial predicament. But too often those conversations, even between people who care about the subject, are so overwhelming that they don't proceed very far. To understand how much debt we already carry and the trillions more we face in the very near future is to understand what hopelessness feels like.
Some will want to focus on what happened to bring us to this brink of financial disaster. Others will just want to scream from the rooftops until everyone is outraged enough to act. But neither approach will move us closer to fixing the mess – and fix it we must. We can talk about how we got here later, but for now the focus needs to be on how to get out of this mess.
So let's talk.
The Medicare trust fund will pay out more than it takes in this year for the first time since it was created. It will continue to do so over the next 8 years until 2017 when it will be completely depleted. This projection assumes that the tax rates do not increase. As of today, only the first $100,000 (or so) that a person earns each year is taxed to fund Medicare and Social Security. That means the bulk of funding comes from low to middle wage earners.
But so what if Medicare fails? What does it have to do with those of us who don't utilize Medicare? Well, for those of us who work in health care, we can expect that hospitals, clinics and nursing homes will close. Quite simply, health care cannot survive on reimbursements from private insurers alone – even if those insurers were in better financial shape and not in danger of going off the cliff themselves. Health care providers (and our patients) would have to make due with much less and accept it as the norm.
If Medicare fails, those who pay for private health insurance plans through their employers will see their rates go up dramatically. Since the health care system will have to function at some level, if Medicare is underfunded and/or not available, the private insurers of the world will have to make up the difference. Thus, premiums will rise as will co-pays and out of pocket expenses, and the list of uncovered conditions and procedures will grow as insurers quickly go broke.
It's likely that tens of millions of people would be added to the 48 million currently without insurance in this country. How pathetic. As the last wealthy industrialized nation on Earth who does not provide even a minimal health care safety net for its citizens, we should hang our heads in collective shame. That we will abandon citizens who have faithfully paid their taxes each year and believed that they would have at least some level of care available to them should make people furious.
As has long been the case with the United States, we have waited until the last possible moment to address major issues with more than just rhetoric.
What will need to happen is that taxes will need to be raised. It's really that simple. We need to bring in more money than we are now so that we can collectively pay for the programs we will all need. And before anyone starts to complain about how our taxes are too high already, just remember that without a social safety net like universal health care in place, financial disaster is as close as any traffic accident, stroke, heart attack or major surgery for too many. You think the financial world is in tough shape when people default on home loans? Wait until millions of families go into bankruptcy every year because of health care related debts.
We are well past the time to fix our health care system. A new system must be created that is adequately funded, financially responsible, realistic, fair and accessible. We need a system that will approach care from the direction of doing the most good for the greatest number with the funds available.
We do not need a system that is wasteful, or panders to what patients feel they need. We need a system that is responsible in its care decisions and realistic in its judgments. We can no longer afford to pay specialists outrageous sums to perform procedures that have little to no impact on outcome or quality of life. Our new system must cover the basics like preventative care, medications and necessary hospitalizations. We need to stop spending massive amounts of money on care that only benefits the providers and not the patients.
And people need to understand that we cannot live forever. People die. It's what we are all destined to do – no one is exempt. But we have a hard time with this reality in the U.S. We feel like we should go on forever if we so desire.
Well, thinking like that is why we spend a majority of Medicare dollars in the last 6 months of a person's life. It's O.K. to want to live as long as possible. It's unacceptable to expect the rest of society to pick up the tab for those extra few months that can cost more than the previous 25 years.
Because any new responsible system would be available to all, it should be funded by all. This can be done via a tax on all things consumable. If we had such a tax, it would collect from those who eat caviar as well as those who live on cheap booze and everyone in between. No one would be exempt from paying, just as no one would be exempt from utilizing. And we can afford this – especially if we all stop paying premiums to insurance companies. Insurance can be handled here as it is in most other countries – as a supplement to the government provided minimum plan.
Fixing this mess will not be easy. The lobbyists are out there already, spending their money and exerting their influence on our government trying to keep the status quo. It will be necessary for all of us to be willing to vote out any representative who refuses to help build a realistic universal health system. Show them their jobs are not our concern. Get involved – write letters, educate yourselves, call offices of representatives and let them know you expect more from your government. Turn off Fox News and get real. The truth is painful, but it must be faced.
If we don't fix health care now, all the other things that need fixing won't matter.
The news yesterday that the “trust funds” for Medicare and Social Security will both be depleted before previously thought left me with the sense that the only way forward is through an honest and frank discussion about our current financial predicament. But too often those conversations, even between people who care about the subject, are so overwhelming that they don't proceed very far. To understand how much debt we already carry and the trillions more we face in the very near future is to understand what hopelessness feels like.
Some will want to focus on what happened to bring us to this brink of financial disaster. Others will just want to scream from the rooftops until everyone is outraged enough to act. But neither approach will move us closer to fixing the mess – and fix it we must. We can talk about how we got here later, but for now the focus needs to be on how to get out of this mess.
So let's talk.
The Medicare trust fund will pay out more than it takes in this year for the first time since it was created. It will continue to do so over the next 8 years until 2017 when it will be completely depleted. This projection assumes that the tax rates do not increase. As of today, only the first $100,000 (or so) that a person earns each year is taxed to fund Medicare and Social Security. That means the bulk of funding comes from low to middle wage earners.
But so what if Medicare fails? What does it have to do with those of us who don't utilize Medicare? Well, for those of us who work in health care, we can expect that hospitals, clinics and nursing homes will close. Quite simply, health care cannot survive on reimbursements from private insurers alone – even if those insurers were in better financial shape and not in danger of going off the cliff themselves. Health care providers (and our patients) would have to make due with much less and accept it as the norm.
If Medicare fails, those who pay for private health insurance plans through their employers will see their rates go up dramatically. Since the health care system will have to function at some level, if Medicare is underfunded and/or not available, the private insurers of the world will have to make up the difference. Thus, premiums will rise as will co-pays and out of pocket expenses, and the list of uncovered conditions and procedures will grow as insurers quickly go broke.
It's likely that tens of millions of people would be added to the 48 million currently without insurance in this country. How pathetic. As the last wealthy industrialized nation on Earth who does not provide even a minimal health care safety net for its citizens, we should hang our heads in collective shame. That we will abandon citizens who have faithfully paid their taxes each year and believed that they would have at least some level of care available to them should make people furious.
As has long been the case with the United States, we have waited until the last possible moment to address major issues with more than just rhetoric.
What will need to happen is that taxes will need to be raised. It's really that simple. We need to bring in more money than we are now so that we can collectively pay for the programs we will all need. And before anyone starts to complain about how our taxes are too high already, just remember that without a social safety net like universal health care in place, financial disaster is as close as any traffic accident, stroke, heart attack or major surgery for too many. You think the financial world is in tough shape when people default on home loans? Wait until millions of families go into bankruptcy every year because of health care related debts.
We are well past the time to fix our health care system. A new system must be created that is adequately funded, financially responsible, realistic, fair and accessible. We need a system that will approach care from the direction of doing the most good for the greatest number with the funds available.
We do not need a system that is wasteful, or panders to what patients feel they need. We need a system that is responsible in its care decisions and realistic in its judgments. We can no longer afford to pay specialists outrageous sums to perform procedures that have little to no impact on outcome or quality of life. Our new system must cover the basics like preventative care, medications and necessary hospitalizations. We need to stop spending massive amounts of money on care that only benefits the providers and not the patients.
And people need to understand that we cannot live forever. People die. It's what we are all destined to do – no one is exempt. But we have a hard time with this reality in the U.S. We feel like we should go on forever if we so desire.
Well, thinking like that is why we spend a majority of Medicare dollars in the last 6 months of a person's life. It's O.K. to want to live as long as possible. It's unacceptable to expect the rest of society to pick up the tab for those extra few months that can cost more than the previous 25 years.
Because any new responsible system would be available to all, it should be funded by all. This can be done via a tax on all things consumable. If we had such a tax, it would collect from those who eat caviar as well as those who live on cheap booze and everyone in between. No one would be exempt from paying, just as no one would be exempt from utilizing. And we can afford this – especially if we all stop paying premiums to insurance companies. Insurance can be handled here as it is in most other countries – as a supplement to the government provided minimum plan.
Fixing this mess will not be easy. The lobbyists are out there already, spending their money and exerting their influence on our government trying to keep the status quo. It will be necessary for all of us to be willing to vote out any representative who refuses to help build a realistic universal health system. Show them their jobs are not our concern. Get involved – write letters, educate yourselves, call offices of representatives and let them know you expect more from your government. Turn off Fox News and get real. The truth is painful, but it must be faced.
If we don't fix health care now, all the other things that need fixing won't matter.
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