Now, who would have said something like this? Given the fully polarize environment that exists in this country today, I'm sure each side will point the finger at the other and say either it is a right wing agitator or some loony left wing liberal. Anyone have a clue, how about a picture???"I am concerned for the security of our great Nation; not so much because of any threat from without, but because of the insidious forces working from within."
Recognize this man, General Douglass MacArthur. I didn't realize what insight he had into the day-day political arena until I started seeing some of his quotes. A new fan to be sure. So, what is he, a right wing agitator, or a left wing loony? How about just what he thought he was, a patriot who wanted nothing more than the best for his country and wasn't afraid to say what he thought regarding what it took to achieve that end. No matter the consequence, no matter who he bucked, no matter the outcome.
Now, as my first personal post, I have a lot of medical history and have learned from the school of hard knocks about how well our health care "system" works and doesn't work. I'm lucky, I'm still here, and like the proverbial bad penny, still showing up and getting more involved, and now speaking up. I know I won't get everything in here, but every journey starts with a first step and this one is mine. As a way to see where I come from, in this 1 hour round-table produced by TPT in Minneapolis, you can see various thoughts, and my 30 minute interview was trimmed down to about 90 seconds, actually, not to bad.
http://www.mnchannel.org/video_archive.php?video_id=22
I now speak up on health care from the patient side of the house and what I see going on from the distribution of funds and where the money is going. I can't stand what I now see going on during the recess regarding the poisoning and statements being made. People standing up on the floor of congress perpetuating nothing but pure lies, and as history as shown, if you say these things long enough, they begin to stick.
Unfortunately, Health Care Reform doesn't fit into our tidy world of immediate news and 30 second sound bites. People actually have to take some time to read, think, and understand the aspects here. Just like Medicine is not a one sided view of the world either, this debate should be framed from a holistic view, but, alas it is not. There are several aspects that must come together, that in balance will achieve a truly American solution that can give the best of all worlds.
Therefore, here is Ken's Health Care Manifesto:
- Payment Reform
First off, stop the MADNESS of pay for service and not results!! This is crazy, pure insanity and there are people making a lot of money for just doing one service item after another. And, if they refer something like an MRI scan to a service provider they have an alliance with, they get a finders fee to boot. Great work if you can get it. Read this article:
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
From this you can see the disparity of paying for value/quality and paying for service. This is key, without the teeth of this type of change in any bill that comes forth, IMHO, DOA! Don't bother, we won't get anything from a cost perspective. This is true reform, this is true change, and there are people making a lot of money spending a lot of money trying to stop it. Don't let them, stand up and yell for the right stuff, this is where we must draw the line in the sand and not retreat.
- True Competition, not Coo-petition
I'm a capitalist, don't ever challenge that. I have 30 years in the software industry and even though I was dumped on the street in the most unethical of circumstances, my stance hasn't changed. I understand what real competition does to improve a business, I also understand what happens when those rules are circumvented and unfair advantage is given. I believe Health Care is a right, not a privilege. As a right, it is very difficult to provide service when one is beholden to the stockholder, and not the patient. The correct result is not achieved overall for society. By sub-pooling, rescinding, and other activities, the Health Care Insurance companies are making a tidy sum. Are there record profits right now, no, remember we are in a recession. But, don't see many of them going Chapter 11 either. As Rush, says, look it up. Get the facts.
They aren't hurting, but the general populace is because they can't afford COBRA. The company I was with merged with another, we had 200 people and those who where let go at the time of the merger had COBRA payments of $1800/month. Really, I should say no one had payments, who could afford that? I was let go four months later, I was on disability and recovering from Leukemia, my payments were $1200/month, I had no choice. The only reason it was less is because now the pool was 500. Do the math, if the pool was 1000, it keeps going down and becomes more reasonable. Imagine if you where going for individual insurance? Don't even ask what the number would be. Now, look at the 6 million unemployed right now. Imagine if there were in one pool. Why did the stimulus plan just pay 60% of COBRA when we could have put them all on Fed Insurance until they found another job? They could have afforded paying the premiums out of unemployment insurance. The government would have saved millions, billions? The insurance would of had to compete on a different forum, now we're talking reform and change? Why wasn't this done instead of rolling over and just paying into the insurance funds?
So, now everyone gets hung up on the public option. Well, look at Fannie Mae and Freddie Mac. Here we have public options for mortgages with FHA loans. Much easier to get into a house if you qualify, doesn't appear to have hurt the rest of the industry for conventional loans. Can you imagine what the terms of those loans would be if the FHA option wasn't there. I'll give you a hint, look at my previous paragraph. Reign it in, and we will get our Health Care costs relative to a competitive % of GDP, allow more money to go to salaries instead of expenses that go to insurance companies, and allow the upcoming recovery to really boom.
- Tort Reform
Very simple concept, loser pays. We are the only Western country that doesn't have that. If the Bar Association wants to fight it tooth and nail, then at least give the proviso that this rule applies on malpractice suits. I am a volunteer chair of a Sub Committee for the State of MN and have seen members of my committee, prestigious, knowledgeable, MD's argue that their studies backing their positions aren't relevant. It's easy to see how any lawyer can bring some expert in to back a claim. Therefore, many Doctors practice defensive medicine to protect themselves. It drives up costs. Does malpractice occur, yes. When it does, claimants have the right for restitution. However, the numbers are not consistent with the degree of malpractice.
Lawyers contend that if this policy were put in place, then many people wouldn't have a chance of having their claim. Two words, pro bono. If one feels that strong, then make their case. If also means that the delaying tactics and unnecessary delays that drive up costs under a siege mentality must also be contained to level the field.
- Personal Responsibility
Now comes the real hard part, each of us has to step up to the plate. No one is invincible, you are going to have something happen to you at some time, count on it. Therefore, each of us has to participate. Whether you like Social Security or not, when you turn 65 and you start getting checks in the mail and your health care is taken care of , you don't complain as much. So, time to deal with it for when you are younger than 65 as well. You can't just be a ward of the state and suddenly show up in the ER and have a problem with no insurance and the file Ch. 11 and the hospital gets the bill. Remember, the larger the pool, the more the cost is spread out and the cheaper for all of us.
If you don't get this, how many of you on your car insurance have to pay for uninsured motorists? Same concept, paying for those who don't. No one should have a free ride, America first, we're all int this together.
However, that is the easy part, the hard part is life style. If you lead a risky lifestyle, then guess what, you need to pay more. Why should others pay for you? Now it's a little like auto insurance, if you have a DWI, guess what, your rates go up. Guess what, if you smoke, if your BMI is way out of whack, nothing like a little financial incentive to help correct the problem. Imagine on your health care premiums you saw a line item for high risk individual compensation even thou you weren't high risk? How happy would that make you?
Lets understand the financial s of smoking in the workplace. It wasn't because corporate America wanted to do the right thing, it was because the insurance companies realized costs could go down if this one item was removed from the work place. The fewer smokers, the less lung cancer and other related diseases. This has spurred huge anti-smoking campaigns and at least in this one area, seen improvement.
Ken Zaiken
8/11/2009
P.S. Here is an article someone sent me after reading my initial tirade. Obviously a much better writer than I am.
http://www.newsweek.com/id/209817/output/print
8/15/2009
Additional input and comments
Bipartisan Plan from the Senate:
At last, rationale thought, now, how come this article has not received the kind of media coverage that the shout downs have. I don't have confirmation yet, but a statistic I saw was that 17/23 town hall meetings were orderly, but our hyped up 24/7 news hilited the 7. Here is some great news that should have been all over everything? What happened ???
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/04/AR2009080402523.html
Charles Krauthammer: A Better Plan
This isn't all that bad actually. He has two points, one on benefits and one on tort reform. I am in favor or driving out the lay people who are swayed by legal rhetoric. I am concerned about the makeup of the group that would decide and a binary view of just losing your license does not yield enough options. But, this does give another aspect to tort reform other than putting a ceiling on how much malpractice rewards can be given out, that doesn't solve the problem.
I agree it makes no sense that corporations can fully deduct their medical benefits payments as expenses but an individual buying private insurance cannot. Now, it itemizing, there is that 7% threshold at which time expenses can begin to be deducted. But, this does appear to be unfair and some equity should be brought between the two.
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080602933.html
Lastly, get the facts, please!! There is so much dis-information out there. I tend to like PolitiFact. The pants on fire does send a strong message, and as said, this isn't easy stuff, so easy to get caught up on a hot button. Take the time, do your homework, please.
http://www.politifact.com/truth-o-meter/rulings/pants-fire/
Other comments:
On Tort Reform, when I say loser pays, I mean the loser pays the expenses for the winner. One other item I had forgot to mention, mandate. Everyone has to be in. Lots of people when they are younger than 65 complain about Social Security taxes, that they are 65. Then all of a sudden they get highly subsidized medical and a monthly check from the government. The complaints do go down. The same should occur with Health Care, pay to play. It is like when we buy car insurance and there is this line item for uninsured motorist. Doesn't that get you mad knowing that you are paying because someone else isn't? In reality, we pay now. The cost for medical services does have a cost shift in it to help the providers cover the costs of treating uninsured patients. Of course this needs to be progressive based on need, but whether it's employer based, personal, public option, exchange, whatever, everyone has to play.
8/20/2009
Case in point, here is a story from Tuesday's USA Today that talks about how unemployed people are jumping on the COBRA bandwagon as part of the stimulus package. I think it is great that this is an affordable option, I just disagree that is was a government giveaway to the insurance companies to make it happen.
http://www.usatoday.com/money/perfi/columnist/block/2009-03-02-stimulus-cobra-health-premiums_N.htm
On the same day, USA Today also had an article on a topic that is not getting the attention it deserves, the unbalance of skilled General and Geriactric MD that are needed given the demographic shift over the next 10 years. If we don't start dealing with this now, we will just have another crisis on our hands that will take dire measures to fix. It takes 10-12 years to train someone for this role.
http://www.usatoday.com/news/health/2009-08-17-doctor-gp-shortage_N.htm
9/16/2009
OK, I admit this is from Rolling Stone Magazine, and some of the writeup here is rather blunt, but it is a real in your face view of what is going on and very sobering. Especially seeing this was written on 9/3 and today Baucus came out with his first draft. Rather foretelling, and sad. We need change and I fear it may be slipping away.
http://www.linkedin.com/news?viewArticle=&articleID=68331589&gid=1866463&articleURL=http%3A%2F%2Fwww.rollingstone.com%2Fpolitics%2Fstory%2F29988909%2Fsick_and_wrong%2F1&urlhash=dgGU&trk=news_discuss
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