Thursday, February 26, 2009

Initial Thoughts

President Obama has begun his health care reform crusade. Today, he will release a proposal that details a funding plan for what he has in mind. Over a ten year period, $630 billion dollars will be raised via the "restructuring" of the American tax system. This is only the initial salvo. Several thoughts:

1) Everyone speaks of how "bold" and "courageous" the President is for taking on health care reform at a time when the nation teeters on the verge of financial collapse. From a metaphysical angle, I find this quite interesting. I think it says something about the American soul that we don't hesitate to question the wisdom of forking over a trillion dollars of public money to greedy/stupid corporate entities/banks/brokerage houses (within a matter of months), but health care, something tangible, universally acknowledged as a public good, health care is the last "national emergency" addressed and the costs of addressing it will come not from the current national coffers but rather from the pockets of "wealthy" Americans over the course of a ten year period.

2) The "plan" (if that's what you want to call it) is frighteningly devoid of any real details or specifics. Harry Reid hopes to have a plan cobbled together by the end of the year. Really? Nobody has any concrete ideas for a solution but we're going to make money avilable for that eventual plan nonetheless? Again, the discourse remains in the lofty plane of Principles and Aims. Aim for universal coverage. Aim for cost containment. The only thing concrete is the moolah that will be steadily emptied from my pocket over the next ten years. And is this even enough? $650 billion over ten years? I realize this is just a "down payment" (current Obamaphile jargon), and Congress/state governments will be forced to come up with at least another 30-40 billion/year (i.e. new taxes), but I think we know enough about the federal government by now to realize that its ability to make long term cost predictions is shaky at best.

3) There are so many facets of American health care that need addressed, it's hard to imagine how we will be able to navigate out of this morass. It like deciding to have a neighborhood baseball game and everyone shows up naked. Certain factions clamor for gloves. Others are demanding clothes/uniforms. The catcher contingent won't play unless protective cup are purchased. You're the manager and everyone is yelling and screaming and you just don't know where to begin. Here's just a sample rundown:
- 48 million without insurance. What is the plan to cover them? Nationalized Medicaid/Medicare? A combination of private and public insurance?
-Who is going to be providing all this government-subsidized care? There's already a shortage of primary care docs. Cutting Medicare/Medicaid reimbursements at the same time that you're increasing the workload for physicians is a sure way alienate the very people (doctors) any reform plan needs in order to assure a smooth transition and funtionality.
- How exactly are costs going to be cut? Rationing? Government bureaucracy dictums on when/how/where a physician can order a certain test/procedure?

4) It seems to me that a tiered system of health care is inevitable. Those who depend on the public dime will receive coverage that necessarily differs from that of those who work fulltime and contribute to their own health plan. This ought not to be shameful or controversial. We can agree that food, shelter, and health care are fundamental tenets of a dignified human existence. One ought not to have to go without food. A family of four should not have to sleep under a highway underpass. An elderly woman should be able to have her breast cancer treated without worry of declaring bankruptcy. But if you're receiving food stamps or WIC aid you shouldn't be able to eat out at Olive Garden or buy a three pound tenderloin with your public assistance. A homeless person shouldn't be able to move into the Ritz Carlton until he gets his affairs in order and is able to rent an apartment. Similarly, those who cannot afford private medical care will have to utilize the expanded County/public hospital system which may mean long lines, waiting longer for elective surgery, denied MRI procedures for chronic back pain, and an overall higher level of inconvenience/irritation.

5) The burden for this is going to obviously fall on the backs of a minority of Americans. The highest tax bracket will return to 39.6% (incidentally, I love how this is called "rolling back tax breaks" as if giving 35% of your income instead of 40% to the federal government is some sort of scam that needs to be rectified). The AMT will be adjusted for inflation. Again, our federal government just got done doling out a trillion dollars to Wall Street, the automotive industry, mortagage lenders, and AIG. But health care is apparently different. Apparently health care reform depends on taking more money from people like me, who already pay a substanial percentage of earnings into the public kitty. Now all I need is for Max Baucus to push through "budget neutral" reform and further Medicare cutbacks on lap chole/hernia reimbursement and I'll drop into a lower tax bracket. I can't wait.


Andrew_M_Garland said...

An egomaniacal ruler doesn't need or want a plan, in the sense that the little people seem to want. How can the vast complexity of vast plans be explained to the masses or be put on paper? "We are in uncharted waters". Who needs a plan. Sail on!

Leading The People

----- excerpt -----
They have a solution that will work if we would only stop arguing and agree with them.

They may need to omit some information about the new arrangements and what these will cost. They observe that ordinary people do not think well enough to make decisions in their own long-term best interest.

Dissenters are either uninformed or selfish.

There is no need to argue about the specific meanings of words. The good of the society justifies telling some lies, if it comes to that.

The solution requires that we all pitch in and not be greedy. The people with the most resources will put their extra income or property into the pot.

They will modify or replace the solution if it doesn't work. They will design a new solution the same way they designed the first solution, through thought, research, and discussion among themselves. Further solutions may require more resources.
----- /excerpt -----

Anonymous said...

Maybe if they cut out all the unnecessary treatment we may end up with more doctors than we need. Maybe some doctors will have to move to less popular areas to maintain their "earning-power".

Electronic health records are crucial because they can be data mined to determine best practice. Health providers that follow best practice should be immune from lawsuits. Simplistic I know, but so is doctor-knows-best give me a big bag of money and don't tell me how to do my job.

If the government is going to pour trillions in it might as well get value for money.

Jeffrey Parks MD FACS said...

I agree. Doctors need to do their part. Evidence based practice (protected from tort litigation) needs to be the standard. We need to get away from the shotgun consult approach to medicine (old lady with a UTI does not need ID, GI, pulonary consults). We need to stop writing prescriptions for the latest, new fangled drugs that are ten times as expensive as older, just as efficacious meds. We need more medical students to be enticed into going into primary care. These are doable changes. The problem is, this Obama administration is asking physicians to also fund the overall scheme.

MissFifi said...

I am not a huge fan of Electronic Medical Records being the first thing our President wants to tackle in regards to healthcare. We have a nursing shortage and general practioner shortage. We need incentives to make nurses want to teach, we need to get rid of the ridiculous amount of paperwork forced on RN's and DR's from Health Insurance companies so they can actually concentrate on their job. What also bugs me is there are a ridiculous amount of tests being performed on people only days before they die. I want more details but I guess I will wait like everyone else