Just a quick note on this; been busy settling in to my new place so I have a lot to say but not much time.
The health care proposal is grinding and painful to watch. What’s worst about all of it is I think everyone knows that the system will still suck no matter what happens. Such ennui is what I would blame for Obama’s polls dropping. Of course the Republicans finally found a topic to nail away on him for. That’s a pretty risky strategy on their part, but it has consolidated them a bit.
What I really want to say is that it seems ridiculous that we can’t even CONSIDER that health care in other countries might work better than our system. Frontline did a great story on looking at health care systems around the world to see what they did, including Taiwan, which started from scratch, taking the best from different systems.
What’s also ridiculous is that the Republicans fight tooth and nail against universal health care, even though the military operates under that system for not only servicemembers but also for their families. Yes, that most red-blooded system in America, the US military, uses SOCIALIZED HEALTH CARE paid by tax-payers!
Make sure you read/watch Bill Kristol telling Jon Stewart that military servicemembers deserve better care than American citizens. Kristol, of course, has never served.
I miss the military medical care cushion. So when my senior sergeants’ wives got pregnant, the Army paid for ALL of the costs associated with the pregnancy and delivery. When my friends got sick or hurt, the Army took care of them. Sure, some of the diagnoses and surgery were horrible, but the preventative care and defraying the costs that are associated with the medical system were superb.
It was wonderful to transfer to a new assignment on a new base, or deploy to Iraq, and NEVER HAVE TO WORRY ABOUT HEALTH CARE. It was a centralized system (although not yet on an online database that you have control over, like what Google Health is trying to do) and you’d always be taken care of.
The best part? Far less stress on everyone’s part, and the system wasn’t trying to make money off you. Not wholly, but partially, the system also had proper economic incentives to make you healthier faster instead of trying to rape your pocketbook.
I’ve read that China used to have proper incentives: if your health failed to improve, your doctor wouldn’t get paid. How did this end up working out, I wonder?
I would like to see health care examined as a guarantee under citizenship. I would hope that participating part of one’s identity and time to serve the government or military would confer upon that person the ability to receive a standard of health care so that he may be productive back to American society. But right now, under a poorly regulated private insurer system, insurance dominates by reducing people to normalized baselines where abnormalities are punished (read NYTimes’ article on defining “health”):
“And then there is a larger question. How does “absence of abnormality” affect our perception of health? This construct is both too narrow and too broad. It’s too narrow because there is more to being healthy than striving to avoid death and disease. Health is more than a physical state of being; it’s also a state of mind.
“And it’s too broad because all of us harbor abnormalities. The construct drives the system to look for things to be wrong — a search that will be successful in most of us. We then feel more vulnerable. This induced vulnerability undermines the very sense of well-being and resilience that in many ways defines health itself. Viewing health as the absence of abnormality thus conflicts with the desire for a healthier society.
“Furthermore, the strategy has created a host of other problems: doctors who are overwhelmed by the number of ailments their patients allegedly have (and who are often distracted from the most important ones); doctors in training who are increasingly confused about who is really sick and who is not; lawyers who increasingly have a field day with the charge of “failure to diagnose”; patients who get too much treatment or lose health insurance because they been given a new diagnosis; and a frazzled, fearful public adrift in a culture of disease. Oh, and did I mention that it has been a disaster for health-care costs?”
“The key thing you need to know about health care is that it depends crucially on insurance. You don’t know when or whether you’ll need treatment — but if you do, treatment can be extremely expensive, well beyond what most people can pay out of pocket. Triple coronary bypasses, not routine doctor’s visits, are where the real money is, so insurance is essential.
“Yet private markets for health insurance, left to their own devices, work very badly: insurers deny as many claims as possible, and they also try to avoid covering people who are likely to need care. Horror stories are legion: the insurance company that refused to pay for urgently needed cancer surgery because of questions about the patient’s acne treatment; the healthy young woman denied coverage because she briefly saw a psychologist after breaking up with her boyfriend.”
Until free market ideologues understand that productivity is a long-term affair and not just grinding more hours/day out of each employee for fewer wages, the resolution of the health care system in America will never take place. Wellness, preventative care, and incentivizing health care providers and insurers to make sure people actually are HEALTHY…those are the goals we’ll end up building our system for.
One last note: what if there were a private market of new incentive metrics? Or maybe this could even be a joint program with the doctors’ associations and NIH. What if we could come up with new happiness indices and measures of lifestyle health (how many times one exercises, how much one walks per day) that doesn’t penalize you in the context of what risk you pose to an insurer? We have virtually no lifestyle metrics that aren’t being kept from us and which aren’t being used to hurt our viability for insurance or recruitment. We need our own tools to measure our lives and form our own metrics of what we consider important to ourselves.
Thoughts? I’ve about given up on the US seriously reforming health care. It’s just not going to happen politically (we can’t even allow gays to openly serve in the military yet) unless a strong executive strong-arms it through — and that may not necessarily be a good thing.