Date: Thu, 10 Oct 2013 18:56:25 -0400 From: mark <whitroth at 5-cent.us> To: WSFA members <WSFAlist at KeithLynch.net> Subject: [WSFA] Re: A point of information about the government shutdown Reply-To: WSFA members <WSFAlist at KeithLynch.net> On 10/10/13 18:16, Walter Miles wrote: > Hello Mike > > WM>> Healthcare reform *could* have been the key to U.S. budget stability, > > MB> One of the points we agree on. Healthcare is one of the more likely > MB> things leading to bankruptcy for the country. The problem is that > MB> demanding that everyone get health insurance isn't the right starting > > Well, I'd be inclined to demand that everyone RECEIVE health insurance. > As Mark pointed out, Sen. Baucus (and others, many also Democrats) made > that more difficult. On the other hand, it's overwhelmingly Republicans who have fought tooth and nail since Truman against any kind of national health care system. And right now, I'm loosing pay because Republicans, and especially the neoConfederate "Tea Party" doesn't want the rest of everyone covered. > > MB> point. The right starting point is figuring out why health care costs > MB> so much here (and I think that health insurance is a prime suspect). > > Well, it's tough. First some not-very-insurancy aspects: > > *End of life care* > > My wife sees (and sometimes must give) care that she believes *reduces* > the quality of life of patients, and is unlikely to increase the length > of life. Mostly this is near the end, of course. This is happening in That's partly cultural - in this heavily Christian country, you gotta suffer, you can't simply say "enough", as well as the absolute fear of death that we push. <snip> > just for poor people. Talk of "death panels" sure didn't help. It may Which, I will note, was 500% from the right-wing media. The idea of someone with training discussing with someone whether the extreme treatment is actually going to help you live better, or just suffer longer, seems to bother them. And, of course, a panel looking at "well, they're going to go, and nothing we can do will make their lives worth living in the short time until they do, this is the wrong thing to try to keep them alive".... And, of course, the medical insurance companies don't *ever* do *that*, oh, my, no, they'll be happy to spend millions.... As a side note, I've told my wife that I do *not* want heroic measures, nor to be forced to stay here if it's a ton of money, and painful treatments, that give me another month or three of pain. Screw that noise - I never signed for that. <snip> > > *Fee For Service (kind of insurancoid)* > > We have a friend who works the part of the Pew Charitable Trust that does > public health research and advocacy. We were talking about government > provided care (Alaskan Native Health Service, in his case), and I said > that only the rich would get better care from a private fee for service > system. He said no, not even them, and gave an example: ANHS patients > with leg injuries would be required to have rest, or physical therapy, > etc. for months before surgery was scheduled. Often, they improved so > much that NO operation was needed. If money is no object, or an FFS I'll note that life expectancy is slightly *higher* in Europe, where they have national healthcare systems. Oh... and Medicare and Medicaid bankrupting us? We *know* what average costs are - I looked it up a while back, and it's something between $5k and $6K/yr... and that's without the large pool of healthy people that could/will be added with the ACA. > *Malpractice vs. quality control* > > I *do* believe the reports that malpractice insurance cost rose early in > the 2000s because of diminished financial market returns rather than > increased jury awards. But that *ain't* where it's at. The worst thing You're missing the real issue: over and over, I've read that 10% of the doctors are 90% of the malpractice suits. And that the medical boards really, *really* don't want to pull licenses. We need government-run ones, since we see, over and over, that "self-regulation" doesn't work. And they need to be aggressive. I have a friend in bumfuck OH who, about 10 years ago, was seeing a PT for a work-related injury. She started doing one exercise, and a PTA saw her, and said that was the *wrong* exercise, that would make it worse. She told the PT, and he went, yeah, I suppose, and gave her a different one. Then, a few months later, we were talking, and she told me a really weird story: she kept having problems getting to him (she worked third shift), and they kept rescheduling her. Then, one Thursday morning, she got there at her appointed time of 08:30, and the door's locked. She hears voices, and she finally knocks about 08:45. The office staff is there, and they tell her they don't know what's going on, that he walked out of the office Monday afternoon, and said he had a personal problem, and they hadn't seen him since. I was online, and wondered if OH had anything about actions against medical professionals... and they do. And I found him. Yeah, he had a personal problem: his license had just been yanked for drug abuse by him. And it had been suspended once or twice before for the same reason. And in the early nineties, right out of school, he'd been suspended for lack of attention to 17 post-surgical patients. And it had take more than a dozen years to cut this jerk out. That's not the only incident I know, either. <snip> > > I think there will be a sizeable payoff from better quality control. This > will be true for other advanced nations as well, so it won't catch us up > to them at all. I don't think they are *that* far ahead of us in this > area. Yet? > As they start *printing* out scrip, rather than handwriting it, that alone will help. We *need* a single payer, public option. There's a bill that's been introduced in both the House and Senate to do that. But that's *improving* the ACA, not starting from scratch. mark -- reen's Law of Debate: Anything is possible if you don't know what you're talking about.