Thursday, October 8, 2009

Victims of the Health Care Debate

The hardest thing to do in any discussion of an issue is not to beat the living shit out of a dead horse. However, two videos clarified in my mind why neither entrenched position can get anything resembling meaningful health care reform passed, and why, in the debate, the victims are the people that really need, deserve, and demand reform.

First, from the Will Ferrel and the folks at, a failure in the former:

Nice. Not much in the way of accuracy, or humor, or anything too redeemable, considering they seem to want to trade a hundred masters for one.

Not to be outdone in gratuitous sarcasm, from Andrew Breitbart's

I'll admit that, while I find this more relevant to my observations about the dangers of government-run health care and more factually accurate, it's just as bland and unfunny as the Will Ferrel clip.

But both of them have something in common: They highlight the people that should not be in charge of our health care system.

The reason our current insurance system does not work is because it resembles our political system: organized blocs of purchasers control the market and competition is stifled to the point that the insurance companies, with government support, rule the day.

But to take a system that is crippled by competition and give it to the government an entity that wouldn't know competition if the Olympics were coming to town (like Chicago) is simply an exacerbation of a mess. Because neither entity does (or should have to) care about you.

The ONLY solution to our current mess that will work is to take the power from both the companies, and their partners/ bitches/masters, the federal government and return it to the individual. The individual makes their own decision as to insurance, with the companies seeking customers individually, and the government returned to its role of enforcing valid contracts and protecting the rights of all individual.

So far though, I've heard no one really address this problem. Staying entrenched is always easier.


dmarks said...

Good point. Lack of choices and centralized control are a big problem with the current system, and I see the doomsday option (single payer) as the worst possible thing, as it gets rid of any choice and completely centralizes control.

Satyavati devi dasi said...

Didn't we come up with a good idea yesterday?

Put a time limit on government intervention, contingent on the industry's meeting a certain set of criteria that prove they can police themselves.

To come up with those criteria, form a committee made of industry reps, government reps, consumer reps and people from the healthcare end such as doctors and nurses.

The onus is then on the insurance industry: if they want the government out of their panty drawer, they clean up their shit. If they can't meet the criteria say at the end of five years, the government stays on their back full time. If they manage to prove they're on the ball (by meeting the criteria), the government backs down to periodic surveys, such as is done for hospitals and other healthcare facilities. Companies that don't meet criteria on those surveys get fined, punished, and in serious cases, put on (the only phrase I know is 'freezing admissions', which in this case would mean they could take on no new contracts until they come up to par.)

Anonymous said...

It amazes me that liberals and conservative alike can come up with many different ideas, and yet our government cannot. It's all or nothing with them and they are self destructing.

Patrick M said...

Dmarks, Jenn: The problem began when health care ceased to be a market and became a system. It's why most of us on the outside can see the answer, but the insurance cabals and the government bureucratons keep missing the mark.

Saty: In light of the above comment, the only problem I see with getting the committee together is that it's a gathering that will be primarily made up of the people that got us into this mess in the first place.

I really don't have an answer as to how to get people who have no interest in giving up their power to do so (and health care is power). Oh well, there's always 2010 and 2012 for the politicians.

Toad734 said...

So wait, you want compitition and you want people to be able to choose their own health insurance plan without getting screwed??

Looks like you support Obamas plan.

I think the crazy B girl was in the second video.

Satyavati devi dasi said...

Here's the thing on the committee: if you make it strictly governmental, the industry will scream. If you make it strictly industry, the criteria will be nonexistent. You need consumer representatives and you need healthcare representatives. The government has to be represented because they're the ones who are going to see if the criteria are met, and who will be on industry's back until they get it right. It basically has to be this way.

Some of the criteria I would personally set would include

-ending recission except in cases of proven and documented fraud

-eliminating the 'preexisting condition' as a disqualifier, and specifically mentioning that domestic violence is not a preexisting condition

-creating a basic coverage set, at a very basic price that virtually everyone could afford, to include: a well visit every six months, basic preventative diagnostics (chest xray annually for at-risk, biannually otherwise, annual pap, annual mammogram, EKG annually for at-risk, triannually otherwise), basic mental health and substance abuse, basic dentristy and basic pharmacy. An incentive could be repaid to the consumer for services not utilized in the course of the benefit year; in other words, if you don't have a substance abuse admission during the course of the benefit year, the following year is free, or charged at a reduced rate.

-creation of a standard, streamlined claim form that would work with all carriers

-establishing an 'a la carte' option for people who only want or need certain types of coverage, for example, the option to skip dental coverage and increase mental health coverage. The option to purchase this way could be higher priced to offset the additional administrative work it would take to put together what amounts to a customized package.

-Elimination of dollar-amount benefit caps

-Multiple tiers of benefits at progressively increasing prices-if you want absolutely everything covered at 100%, you can get that, for a price.

-Coverage for alternative therapies documented to be effective, such as acupuncture

-randomized reviews of a specific number of cases per quarter for every insurance carrier to ensure that proper procedures are being followed

-establishment of a universal omsbudsmans office, the same people responsible for the reviewing, certifying and monitoring carriers, to receive and investigate complaints of violations, with the power, in the case of actual violations, to overturn the carrier's decisions and to discipline them for infractions, from fines to freezing.

These are just a few of the things I can come up with off the top of my head. I would also, from a hospital point of view, set up standard rates. These would have to be regional because of the huge disparity in costs from one area of the country to another, but by making all hospitals in a region set up standard rates, it would simplify the payment process (rather than carriers negotiating individually with hospitals) and it would also force hospitals to focus on quality care to sell their services rather than on a 'discount' basis. This could also work for out of hospital providers.

Also, the pharmaceutical industry needs to be addressed and reformed. Some of this has already been done, in that companies are no longer allowed to distribute millions of dollars in useless toys to providers to sell their products. Patents should expire in ten years instead of twenty and orphan drugs should be covered by insurance companies even during the active patent. A company that sells a drug in another country should have to sell it here for the same price as they do there, rather than doubling or tripling the price. Overseas companies, if they can prove to the FDA that they are selling chemically equivalent drugs, should be allowed to sell them here at whatever price they do there; this would eliminate people buying drugs over borders, and the companies could be taxed on what they make here.

That's all I can come up with for the moment. I should take it to Washington.

dmarks said...

SDD: Your "Put a time limit on government intervention, contingent on the industry's meeting a certain set of criteria that prove they can police themselves." idea is indeed interesting.

But the only way I could consider it would be provisions to prevent the government from constantly "raising the bar" to prevent the insurance industry from meeting these standards. No unfunded mandates, new regulations, or other such interference.

Otherwise, I could see more government interference making it difficult for the companies to meet the "certain set of criteria".

Toad: No, in Obama's plan you get screwed. In many ways, including the tax on people who do not choose the government's preferred healthcare plans.

SDD said: "Also, the pharmaceutical industry needs to be addressed and reformed"

Let's hold on a minute. Don't kill the goose that lays the golden egg. While the insurance industry actually creates nothing of value, the drug industry does. Their products greatly benefit the entire world, actually, not just the US. I'd be awfully wary of tampering with it.

As for one of your ideas, "A company that sells a drug in another country should have to sell it here for the same price as they do there, rather than doubling or tripling the price", I would go about it another way. Free trade is great (and is in fact the most fair trade of all), and we need more of it. We need fewer trade restrictions. If we make sure to get rid of any restructions on importing these same drugs that cost 1/3 as much in other countries, the problem you name is solved. Not by adding regulations, but by removing unnessesary trade restrictions.

Satyavati devi dasi said...

That's why we include representatives from the insurance industry, healthcare industry and consumers on the committee: so that no one interest can take control of it.

And there are huge issues with the pharmaceutical industry. I personally know of a drug that cost $465 under patent and the following day, $11 as a generic. Cancer drugs in particular are obscenely overpriced ($900 for one dose of an anti-nausea drug) and so are many psychotropics (I don't mean your general xanax and valium, I mean drugs for people with serious mental illnesses). The biggest problem with getting foreign companies to import drugs at a reasonable price would be the pharmaceutical industry themselves.

And there's no reason that Merck, for example, who produces and sells here, can't price their drugs the same here as they do in the rest of the world. In fact, most of the companies who are producing here are international (Pfizer, Merck, Glaxo just to name a few), so I think that would kind of effectively circumvent the 'free trade' thing: they're already established, producing and selling in this country for exhorbitant rates the same drugs they're selling everywhere else for cheaper.

dmarks said...

Well, someone could buy those cheaper drugs from the other countries and sell them here. Ir they could just directly import them. If trade restrictions were lifted.

Satyavati devi dasi said...

Hello. Why do you have to import drugs made by an international company that produces and markets here? The drugs belong to them no matter what country they're producing them in. They don't need to be imported. If they can sell them for a third of the price in Europe or in Canada, they can sell the ones they're making here cheaper.

dmarks said...

SDD: Allowing the imports would be a simple and elegant way to get around the price difference problem. One that we arrive at by having less government regulation, not more.

Also, it might easily lead to them selling the drugs here cheaper. Regardless, lifting trade restrictions would make these drugs available here for just a little over 1/3 of the price.

Satyavati devi dasi said...

Again, why does a company need to import a drug it makes here?