>sigh<
Okay, I can’t resist. Here goes.
Two big problems with the health care system in this country. 1) It’s expensive. 2) Not everybody has access to it.
1) Expensive
Watched my retired parents deal with the first problem. Medicine is expensive, and so are doctors. On the surface, it appears that putting both under control of the federal government completely solves the problem. The government sets the price. Every doctor and nurse in the country is now a federal employee, and Uncle Sam now owns the pharmaceutical companies.
1a) Expensive: Postal solution
We’re still on problem one, right? Expensive? Okay, there’s two ways to deal with that. Always two ways. >sigh< One is to make the health care system like the Postal System, my current employer. I’ve been with the company for 21 years, and have had a good close-up view of how it works from the inside.
The US Postal System is going through a very rough patch right now, as with the downturn in the economy and changes in the way people do things, we’re losing a ton of money. There is pressure from every side on this company right now. Our customers want us to keep our prices down and continue to provide the same service as before, or better. Each post office is under pressure from management to increase revenue and reduce costs.
There are some things that the USPS could do that would help, but we can’t get them done. For instance, we could close a bunch of small, unprofitable post offices that one could argue aren’t needed because they’re close to bigger, more profitable ones. But they’ve been there for a hundred years, and their handful of customers complain to their representatives in Congress and Congress says no, you can’t close them. Or, we could consolidate certain parts of the company and let employees go, but they’re represented by Unions, which complain to the politicians, and no, you can’t let them go.
So let’s say instead of a local Postmaster, I’m now the local Healthmaster, running a small clinic in a small town. The people in the town wish I was better equipped and staffed, because I can’t do things like appendectomies or other surgical procedures. The US Health System won’t give me the money I would need to have an operating room and keep a surgeon on staff, because there aren’t enough people in my area to pay for it. He’d be playing solitaire all day because there’d only be two or three surgeries to perform every week, and the OR would collect dust. As would the surgeon’s skills.
So I get promoted, and instead of running a level 13 clinic I now run a level 18 hospital in a larger town. They’ve got OR’s and surgeons, but they work like slaves because all these people from the small outlying towns have to come here to get anything besides Band-Aids and flu shots. And word just came down the pipeline from HQ that the cost-of-living increases we were expecting have been postponed for another two years because the economy’s taken a bad turn and an election year’s coming up.
That pipeline, which comes from District Management, says that I have to trim my expenses, because more budget cuts are on the way. Oh, and there’s been more complaints that people in my area are being told they have to wait because there’s a line ahead of them waiting to see their doctor, and can we speed things up a little bit? And no, you can’t have more doctors because you’re not budgeted for them and besides it’s harder to get them because no one wants to go to medical school any more because the local mailman makes more than a doctor these days.
1b) Expensive: the Military Option
The military is a former employee of mine, so I’ve got a little insight into its workings as well. In my case, the US Navy. The other way to manage a federal health care system would be to do it like that. Hand it a blank check and give it anything it needs. So now I’m no longer the local Healthmaster, I’m Major Clogston, Commanding Officer of the local clinic.
Sitting here thinking about it, there’s a lot to be said for this method. The Captain of an aircraft carrier doesn’t think about the price of gas when planes are shooting down the flight deck, burning enough jet fuel to light Seattle. Neither does the commander of that tank brigade. People complain about the Pentagon’s budget, but by gosh when you need them you’re glad you’ve got the best.
But the US Health Corps’ budget would dwarf the Pentagon’s. The US Armed Forces together have about 210,000 active duty officers. There are approximately 1.5 million physicians in the United States. And then there’s all the nurses, and paramedics, and EMTs, and janitors, and office staff, and kitchen help, and pharmacists, just like the Army has enlisted men.
But the blank-check caution-to-the-wind method is the only way you’ll get doctors and pharmaceutical companies and medical equipment companies to continue to develop and produce at the levels they do now. Let’s face facts; countries that have single-payer health care systems come to us for drugs and medical equipment, and their doctors come here to work because they can make money. If you have figures that show otherwise, please put them in the comments sections of this blog.
And if you’re thinking that the military option is actually good, then I need to tell you something. When I was in the Navy, the striking thing that I will always remember about it was how much got stolen. We would have a working party unloading a truck full of food, and by the end of the day I would estimate a good third of it walked back off the ship, or went into somebody’s locker. And that happened with everything. Need a pair of pliers? A new toilet seat for your home? You name it, the base or ship or whatever has got piles of them lying around.
In my observation, I would guess that the people who work there steal a good portion of our military budget. The same thing would happen to a government-run health care system.
2) Access
I’m totally tired of all the hyperbole over how many people don’t have health insurance. If you show up at an emergency room, they have to take care of you. It’s the law. Then they send you a bill. That’s business. But you still get waited on, whether or not you ever pay it. I think everyone who thinks that health care should be free should immediately apply for medical school.
I agree with the people who say, whatever insurance system Congress and the President come up with should apply to them as well.
I would have less of a problem with what they call the public option if it were administered by the states instead of the federal government. There are a lot of advantages to state-level government programs, as I have discussed in other articles on this blog. Read them.
This brings us to Medicaid. Yes, there’s a lot about it that’s broken. So fix it! Here’s a link to a good article about Medicaid.
http://en.wikipedia.org/wiki/Medicaid
You improve Medicaid, you’ve solved the access problem.
3) Bullshit
That’s the biggest problem with the whole debate. There’s so much being said about reform that you can’t actually find out what the facts are. There’s 1100 or so pages of legislation floating around that nobody gets to see, or apparently can understand. Who writes this stuff?
Here’s an FYI fer ya. An insurance company is not a health care provider. It is an investment firm. Most of their profits come not from the premiums their customers pay, but from the investments they make with them. It’s like a bank. They don’t pay their staff and their light bill out of the deposits. Hell, they pay interest to the depositors! Then they invest the money on deposit.
But the government does not invest the money it gets from taxpayers. Whatever money the government pays to doctors and hospitals, it has to get it all from us. The next time a politician says they can do public option health insurance without increasing the deficit, you will know what a liar looks like.
And both sides are guilty. The people who owe their livelihoods to the current system are pulling out all the stops to fight the President’s reforms. Nothing breaks the back of a family’s finances quicker than a health issue. Have a heart attack, or get cancer, and you’re poor. There actually is an outcry for reform.
Unfortunately, the reforms being offered are all politically motivated. Special interest groups like insurance companies, AARP, drug companies and such are driving the debate for their own benefit. Left-leaning ideologues are trying to wrestle control away from corporations, but without thinking through what will happen when they do. They talk about tearing down an edifice of greed, but that same edifice serves millions of people. What will they replace it with?
The basis of what I’m trying to say is this; let’s not break the parts that work. You’ve got a better idea for a health care system? Fine. Start a company and sell subscriptions to it. Compete with the current options in the public market place. My suggestion for the government is to revamp and upgrade Medicaid. You come up with a way to have cheap doctors and drugs with no loss in quality, sign me up.
And for that matter, taking better care of yourself will go a long way in that department.
I’ll shut up now.
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