Elections/Voting resources

[amirm]

With respect to healthcare reform, you could not have crafted a worse 'solution' than that enacted. Here is my response to an editorial in a NJ publication from last summer. I have underlined text from the original editorial for clarity:...

Mark, that was an exceptionally well written piece. The quality of writing and research far exceeds much of what is written in national newspapers and magazines! Here, I am not talking about the positions you are taking but rather, the fullness and crispness of your arguments.

Would love to see someone taking the opposite position and discuss the same points. An invited debate topic maybe?

I am fortunate enough to have a very good attorney. Their engagement letter which you sign to use their services says you are free to dispute any bill they send you and simply pay what you think you should! But I have seen the other extreme. I have seen my employer settle legal cases where we were clearly in the right because just getting prepared to go to court could cost $4M so any settlement less than that could be accepted, regardless of merit!

 

[amirm]

Our government has HUGE opportunities to cut expenses but they don't. Fraud, corruption, excessive salaries, bloated organizations, inefficient operations are all well documented. Unnecessary organizations (e.g. Maybe the IRS)

My favorite talk show host had an anecdotal example of this yesterday. He was lamenting at the government spending $2.3 million dollars to reduce freeway noise with nearly zero impact. He said the people living near the freeway were already compensated for the noise because of the lower house costs! Here is the article: http://www.mynorthwest.com/category/local_news_articles/20101104/$2.3-million-WSDOT-experiment-disappoints/

"$2.3 million WSDOT experiment disappoints

Residents complained for years about the noise coming from I-5 Ship Canal Bridge, and the Washington State Department of Transportation thought it had the answer.

In mid-October, WSDOT hung hundreds of insulation-filled vinyl-and-cloth panels from the bridge's upper deck to help absorb the sound, but the change in noise to Eastlake neighbors has been minimal.

In tests conducted by WSDOT, results found a reduction of noise adding up to only one or two decibels.

The panels were a $2.3 million experiment meant to reduce noise by four to five decibels. Similar panels had been previously used in indoor situations, like manufacturing plants.

WSDOT was worried about trying concrete barriers because they would have been too heavy for the Ship Canal Bridge.

Some residents have noticed a difference. After the panels went up initially, residents on Allison Street said they'd heard a big reduction in the noise.

Other neighbors said haven't noticed any noise reduction. "

If we have $2.3M to experiment with noise reduction on a freeway, I would say there haven't been enough cuts....

 

[jazdoc]

Amir and Lee,

Thank you for the kind words.

The situation would be comical if it wasn't so serious...Unfortunately, last weeks election will change little. There is an army of faceless bureaucrats, within an alphabet soup of government agencies, answerable to no voter, who will spend the next 2+ years remorselessly churning out reams of regulations to 'to fill in the blanks' of HCR legislation that will affect every part of our lives, often with unintended consequences. Truly the fulfillment of our soon to be departed House Speaker's admission that "we will have to pass the bill to find out what is in it"

Mark

 

[RBFC]

One of the most important pieces of legislation in our lifetime, and the people we trust to serve our interests had very little idea what they were voting on. A selected list of "bullet points" was provided to Congress members, hitting the popular points about covering dependents until age 26, no pre-existing condition clauses, etc....

I feel that the last great medical generation is those of us who are nearing retirement.

Lee

 

[Phelonious Ponk]

We have the horrible sausage that is our insurance/healthcare policy, not because the Republicans were obstructionist, the Democrats were duplicitous, and Washington is ultimately run by civil servants, though all of that is certainly true. We have a GOP Medicare prescription drug bill that specifically prohibits negotiating the cost of prescription drugs on behalf of our country's largest insurance group, and a Democratic insurance reform bill that compels the entire nation to become the insurance industry's customers with no legal or market mechanism to control costs in return for that remarkable gift, because our representative democracy represents the lobbyists on K Street and their corporate sponsors, not us.

It is really that simple, and nothing with the economic power of insurance can be reformed in the interests of the people until our political system is reformed. I'd start by defining libel and bribery the same for our politicians as we do for ourselves. I'd go on to legislating the private money out of public elections altogether, eliminating earmarks, cleaning up K street -- sweeping electoral and ethics reforms. Will it ever happen? It seems unlikely, impossible with a Supreme Court that has defined international corporations doing business in the US as individuals, with the rights of individuals and the power to buy as much influence as they can afford. But maybe it can happen if things get bad enough. We'll see...

Tim

 

[Steve williams]

Nicely written article Mark. It's good to see a physician still fervent about the cause. I grew up in Canada and graduated Medical School before many of you were even born. I practised for my first 5 years of private practice in my home town of Toronto. When I went out into practice my malpractice insurance policy was a whopping $25/year. When I moved to California in 1978 my final Canadian malpractice premium had risen to $250. When I left in 1978 , at that time Toronto had a population of well over 1 million people and the city had one CT scanner in the entire city. Patients were transported at all times of day and night from hospitals all over the city to the one hospital which had the CT for their test.I can recall as an intern having one of my patients transported over 30 miles for a CT scan at When I arrived in Southern California and opened practice I was fascinated that every hospital, small or large had at least one CT scanner.

What also fascinated me about the insanity of healthcare here was brought to light with the number of illegal immigrants crossing the Mexican border in order to have their babies. At that time I was in south Orange County where many of these women would show up in active labor at our hospital. Of course we provided care and delivered their babies. Surprisingly the next day our Social Services in the hospital managed to get MediCal (California's version of Medicaid) for all of these patients who all disappeared after they were discharged only to have them drain resources from our healthcare budget. What to me was ludicrous in our system is that from time to time we would all have patients who had fallen on some hard times and either lost their medical insurance or didn't have any coverage at all. These people were all US citizens, tax payors, who had fallen on some hard times but otherwise had a place to live. Literally NONE of these patients, all US citizens, qualified for MediCal and were literally made bankrupt by having to pay the unusually high fees charged by hospitals to these poor unfortunate people. I could never understand how our system supports illegal aliens but refuses to support our own citizens.

I got involved in my hospital politics rising through the ranks until I became Chief of Staff and ultimately a member of our Board of Directors. During that time my eyes were opened to the broken medical care system we have in this country. I agree with all of Mark's well made points. IMHO Obama's way is not the correct way. It smacks of Canadian healthcare style where everyone becomes covered in a socialistic fashion. The cost of this sytem that Obama wishes to create cannot sustain itself and will ultimately implode as it is doing in Canada. Higher taxes will be necessary to pay for it. California for instance has a sales tax of a whopping 8 3/4 %. In the province of Ontario they pay both a PST (provincial sales tax) and a federal GST (goods and services tax) that is over 15% !!! Mark makes good points that are right on. Medical malpractice needs to be reined in. When I finally retired in 2007 my annual premium was $50,000/year and this was for someone who in 35 years of practice was never involved in a law suit.

Doctors are now looking to alternate means of income as the proverbial slice of the health care pie becomes thinner and thinner, so much so that doctors are now failing to meet their obligations and are leaving medicine by the droves. After 35 years of private practice I retired in 2007 but I continue to follow the notion of healthcare reform as it will affect all of us in some way sooner or later.

Nicely written article Mark. As my mother would say "sei gesund"

 

[jazdoc]

Steve,

Thanks for the support. I still find the practice of medicine a noble and intellectually challenging avocation. Like all professions, medicine has its share of frustrations. I find more and more physicians and nurses becoming increasingly frustrated by the non-medical facets of the profession that come between them and providing patient care. I fear that the talent pool in our profession will be diluted with profound consequences for the patients. A key principle for any reform should be reconnect the cost of services provided to the actual consumer. Unfortunately Obamacare takes us further in the other direction.

Mark

 

[Steve williams]

Mark

you are spot on with all of your comments.

 

[Gregadd]

We need to rein in malpractice!
We need to deal more effectively with preventable diseases.
We need return medicine to a healing art instead of a cash cow.
W have a growing population with shrinking opputunities to make money.
Good luck with that.

 

[Steve williams]

Medicine is far from being a "cash cow" Greg. Just my opinion of course.

 

[Gregadd]

Medicine is far from being a "cash cow" Greg. Just my opinion of course.

BTW in DC the government was paying $8 million in year in malpractice insurance to keep Obgyn in the city.


Not for you Steve. The money is going somewhere besides patient care. That's my point.

 

[Steve williams]

I agree with you there Greg. One can only cut the healthcare pie into so many thin slices.

 

[Ron Party]

Get rid of the middleman. It's a hugh *slice*, and for what?

 

[FrantzM]

We need to rein in malpractice!
We need to deal more effectively with preventable diseases.
We need return medicine to a healing art instead of a cash cow.
W have a growing population with shrinking opputunities to make money.
Good luck with that.

I agree with most of what you're saying but disagree with your parting shot ... I must say that my experience with the American Health System is scant. I am extremely proactive about my health taking it to almost an obsession. eating right,exercising every day and on paper seems to have reaped the benefit of this asceticism. I must say however that my few encounters with the American Health System were to say the least sobering. A very brief sojourn to the Hospital for an insured person is a ticket to Bankruptcy, even with Insurance, bankruptcy lurks around for most family. Contrast that to the derided Canadian system or the infinitely (with respect to the American model) more humane models you find in most Europeans countries where health is not seen as a business but as a social imperative.

For these and other reasons Health Care in the US needed to be addressed. The present solution is faulty but what where the proposed alternatives? Do nothing? Cave in and let the "business" side of the equation run amok with people lives? Or go ahead with an imperfect solution , a work in progress that could be tweaked and tinkered to provide better care... In the USA we spend the most for a system that doesn't provide that great a care.. True some people can get some ultra advanced care they can't get anywhere else in the world ... The cost of it is so high that most folk will never be able to pay for it or and if they were to summons all they can to pay for it will be broke until they die of other causes ....

 

[jazdoc]

Frantz raises some excellent points. I think the key here is health insurance should be exactly that; INSURANCE against catastrophe. Unfortunately, we have become accustomed to third party payers covering essentially all of our medical expenses, to the point where >85% of payments come from a third party. Believe it or not, this was rare prior to the federal government providing the tax incentives I discussed above. To understand how this system distorts the system, imagine if you had some amount of money withheld from your paycheck to provide for transportation. By paying this fee, you were then allowed to purchase any transportation you desired for a small percentage of the actual cost. The result would be a huge increase in the number of Porches and Ferrari's with a concommittent decrease in used Pintos and public transportation.

To extend the car analogy, consider car insurance. The insurance is there to cover significant damage to the vehicle and any liability you may incur as the driver of a vehicle. No one expects their care insurance to pay for routine maintence, gas, etc. Indeed, providing this type of insurance would be very costly and would almost certainly result in more careless driving and decreased car maintenance. (Hence the say "no one washes a rental car".) Yet this is exactly how most 3rd party health insurance has functioned in our society, although the plans are becoming less generous as the economics become more apparent. In actuality, health insurance should function as all other types of insurance; to provide a backstop and risk pool for rare occurances of higher cost medical needs. That is why many folks advocate high deductible plans in conjuntion with medical savings accounts. For those who can not afford these types of policies, tax incentives similar to the earned income tax credit could be utilized to pay for the insurance and deductible expenses. This would serve to re-connect the consumer to the provider and provide incentives for cost savings in the system.

 

[amirm]

Why don't the insurance companies provide that kind of insurance now? What is stopping them? The current system they have with deductible amounts doesn't work. Even if you increase the amount, your premium does not substantially reduce to the level of car or home insurance. Nor do they ever offer to remove all caps.

 

[Ron Party]

Those are rhetorical questions, now, aren't they? Like any other capitalistic endeavor, insurance companies are in business to make a profit. Period. I will restate my question: that profit is a huge slice, and for what?

 

[jazdoc]

Amir and Ron -- excellent questions...

First of all, states regulate insurance. In most states, you can only purchase health insurance from a small number of state regulated companies. One proposal to reduce insurance costs is to allow health insurers provide services across state lines -- like home and auto insurance! For example, in my home state of Washington, the insurance commision essentially allows only 4 companies to dominant >90% of the market. Why shouldn't I be able to purchase a policy from a lower cost provider in Indiana?

Additionally many states require mandated coverages. For example, the cost of my policy covers breast implants, fertility treatments, chiropractic and alternative medicine...all of which I pay for but never use. I would gladly pay less to delete these coverages. In Washington state, there are over 50(!) of these mandates. If you can pick and choose cable TV packages and your iTunes, I really think you should be able to decide what coverages are extraneous. You do the same when you choose your car insurance deductible.

Some reform advocates of insurance reform have suggested a form of 'no fault' insurance. The idea being that people could save 20+% on their policy if they were willing to forgo the medico-legal lottery and instead participate in a malpractice claims pool. Guess which lobby is not particularly enthused about this?

As to profits, the health insurance business is not particularly lucrative...http://mjperry.blogspot.com/2009/08/health-insurance-industry-ranks-86-by.html. And if we allow food, water, and electricity providers to make a profit...

 

[Ron Party]

That is an interesting link, as are the comments therein. FWIW, I work with and against insurance companies on a daily basis. I strongly disagree with many of the comments set forth in justification of the existence and propriety of insurance companies, but I will stop here so as to avoid turning this thread into a political, Democrat vs. Republican, liberal vs. conservative, flame fest. Instead, I will reiterate what I as a Moderator here posted on page 1:

Political discussions ought to be taboo here in order to keep the peace.

 

[Phelonious Ponk]

Catastrophic health insurance, what we used to call "hospitalization," sounds like a good idea, but the truth is that healthcare has outgrown that concept. Hospital stays have become extremely short. Outpatient procedures have become the norm. Drug therapies have replaced surgeries and outpatient care and convalescence has replaced hospital care. There isn't much wrong with all of that. It is progress, for the most part. But it has changed the game. The average person, as a result of serious illness or accident, could easily go bankrupt paying medical bills, even if the "catastrophic" part were paid in full. A lot of people could go bankrupt just paying their monthly pharmacy bill. I'm not sure what the answer is, but I know we haven't found it yet and I know that healthcare will never be driven by the kinds of market forces we are reaching for with these kinds of ideas, and it is incredibly naive to expect it to. When your child/spouse/parent's life is on the line, you don't go shopping for the best price. If necessary, you go broke, but you don't go looking for bargains. Costs will have to be controlled another way.

Tim