So Much for Stirring the Pot

The problem, of course, with trying to stir up controversy is that you need mindless gullible folks who think with their emotions, respond from their gut with kneejerk vehemence in order to do it right. To the best of my knowledge, I don't have any readers like that and, if I do, they don't generally show up in my comments.

Since my readers are overwhelmingly intelligent and thoughtful, they gave courteous considered answers that made sense, which, although not adding to the controversy, does make for a much more pleasant conversation.

Now, the Mother and I spoke of many other things regarding healthcare reform. I'm going to include many of them and I won't be making a distinction between ideas she had and ones I had. That's not entirely fair to her, of course, so I encourage you to assume the ideas you like are hers and the ones you don't are mine. That ought to even things out nicely. That and she is encouraged to jump in if I've misrepresented her views in any way.

The Mother and I address this problem from different directions. I don't know that we are looking for different results (though I suspect we have different levels of confidence that anything appreciable will be done to address it any time soon), but we are seeing it from different sides. I am looking as a patient, as a citizen, where prices appear ungodly high and, though I have good insurance that reduces it drastically (a) the costs are still very high for a quite healthy family - aside from the high cost of the insurance itself - and (b) I know personally half a dozen families devastated by the high cost of medical care for a loved one. And that's aside from the millions in this country who have no protection. Not only are they not cared for in a way that could preclude serious maladies, because they have no insurance, medical care when they have serious conditions are much more costly and still fall on us to pay - in medical costs for those costs absorbed by hospitals (and higher insurance premiums and copays as a result) and in higher taxes.

The Mother (paraphrasing from our conversations) doesn't see a way to reduce costs without making some serious changes to how we do things. Cost reduction must include (some of these are mine):

• Reducing outlay for the care of those who have no chance of survival and no quality of life - to what degree, well, there's a debate (as I discussed yesterday). This includes limiting care for those who will not help themselves.
  
• Tort reform to limit malpractice to a reasonable level and assure that cases are not tried that are not based on solid fact. Malpractice insurance, even for successful doctors, is outrageous and, believe me, that increases the cost for all of us. Don't think that the fact that we have the highest healthcare costs is completely unrelated to our rampant litigiousness. Even clearly baseless lawsuits can be expensive because the one suing is not held responsible for the costs (something I'm all behind).
  
• Administrative costs. Most doctor's offices have more staff to deal with (often fight with) insurance companies/medicare/medicaid and submit 18 kagillion different forms in triplicate to get reimbursement often months later. Money spent on administration goes into fees for service and money not spent on nurses or other medical support.
• Doing something about the high cost of medical education. Most doctors don't get to practice until they're practically in their thirties. That's a long time to live without a viable income aside from what can be hundreds of thousands of student loans. Doctors are a huge boon to any society, but the exigencies of becoming a doctor forces a certain level of greed on them just to survive and recover. It makes sense to provide some sort of subsidization, especially to encourage doctors to go into some of the less lucrative but undermanned subprofessions.
  

Now, the Mother is scared to death that a public option will be like Medicare, which, in her (and other doctors she knows' opinion) starves doctors for fees, reduces fees willy nilly whenever funds are cut without rhyme or reason. Clearly, there are other doctors who agree and, at least a handful who do not. I don't know what it's really like, whether it's an inherent problem with the system, whether the recent privatization is a factor, whether this is a side effect of having a vehemently anti-medicare faction in the government (either dominating Congress or the White House or both) since 1980 (with the exception of 2 years). Possibly, it is a factor of all three, but what I can say is that there is a significant potential for a public option to be mismanaged due to the political winds that blow and suck in Washington, because of factions that actively want it to fail will work to ensure it's failure, because a long term program is always struggling in an environment that changes the budgetary rules every year.

But, here's the thing, there are powers that very much want to have a viable healthcare system, one that doesn't leave huge swathes of the populace at a disadvantage, powers that want the right healthcare for everyone. They know very well that an option that doesn't work is more hindrance than a help toward their goal. It is very much in their interest (and surely the rest of our interest) to find an option that works because I believe very much that it's possible. The industrialized world beyond our borders is proof positive in my opinion that it can exist (and I find it every bit as compelling as the evidence of vaccination's great good).

In healthcare reform, in my opinion, involves several medical things and several nonmedical things. It's about reducing cost, preferably by removing as much from the equation as possible that isn't medical (and yes, that can include health insurance, but also administrative costs, protection against unreasonable lawsuits), while (a) improving care by reducing unnecessary errors (I'm of course for electronic records) and penalties for excessive secondary infections or surgical botching, and (b) providing care to everyone in a reasonable way, which, in my opinion, would also reduce costs associated with nonemergency medical care in an emergency setting, and reducing the burden of preventable disease. The cost of a mammogram is far less than the cost of treating stage 4 breast cancer, but people without insurance are going to end up with the latter if they can't afford the former.

It is about reducing the overall cost, but I don't see it, if it can be done intelligently, reducing the burden on the citizens because we're already paying for all those that don't care until its too late, by those who can't afford it, and, of course, for billions of dollars in profit to the health insurance "industry". Big pharma is a whole other topic, of course. I want to see a big change in where the money's going: to doctors and medical practicioners instead of lawyers and insurance companies - if we can do it, doctors won't go broke and we'll pay less than we did before. For better care.

Tomorrow, I'm going to postulate one way I could see doing it. So, if you feel like arguing, get ready. Or practice on this post. :)

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