August 25, 2009

• The Franksabunch’s take on health care reform.

   

  AKA the most boring post evaaaar.

   

  Universal health care vs. public option

  ObamaCare’s “public option” is a federal insurance plan that aims to cover those standing in the gap, so that all Americans will have some sort of coverage.  This is the main fatal flaw of ObamaCare.  Not because it aims to give everyone health insurance, but rather because it will fail to do so.  Left out of this plan are the tens of millions of illegal immigrants residing in America.  The problems engendered by uninsured patients will continue to occur.  Adding another “public option” in addition to Medicare/Medicaid only serves to create another trough-feeding gov’t beast layered in bureaucracy while illegal immigrants continue to suffer and hospitals go unpaid for their services.  (Hospitals are required by law to provide care for anyone who comes to the ER.)

   

  America spends too much money on health care

  News flash: SAVING LIVES COSTS MONEY.  Health care is a victim of its own success.  Back in the days before angioplasty and cardiac bypass surgery, if you showed up with a heart attack, we’d give you an aspirin and hope you’d be alive in the morning.  Nowadays, many heart attack victims are staying alive…long enough to develop cancer.  Cancer victims, due to advances in chemotherapy and radiation therapy, are now living…long enough to develop kidney failure.  Kidney patients, because of dialysis, are now living…long enough to die of heart attacks, which brings us back to square one!  Mexico spends almost three times less of its GDP on health care than the United States and guess who had the higher death rates from swine flu?  The United States also has better cancer treatment success than other countries it outspends.  Coinkidinky? 

   

  Primary care physicians (PCPs) vs. specialists AKA what’s up with the Haterade?

  For some odd reason, proponents of ObamaCare have drawn a line in the sand between PCPs and specialists.  Every day you hear about how we do not have enough PCPs and how the evil, resource-sucking specialists are the reason why.  While it is true that preventive care is important, so are the services that specialists provide.  Having the best PCP in the world is not going to save your life if you have end-stage kidney disease and can’t find a nephrologist to give you dialysis.  We need more PCPs, but we also need more specialists.  In the coming decades we will be experiencing a shortage of oncologists, general surgeons and nephrologists, among others.  This is not a battle between PCPs and specialists…we need both.  In addition, preventive care/screening in America is not as bad as the doomsdayers would have you believe. 

   

  Universal health care is the best!

  Or is it?  The incoming president of the Canadian Medical Association feels that the Canadian system is in need of reform.  France is starting to employ the use of co-pays and fee-for-service and has women giving birth in firetrucks because it cannot afford to keep hospitals open in rural areas.  Cost-cutting measures in the U.K. led to a teenager being misdiagnosed over the phone and dying because she couldn’t see her PCP, while a midwife with no incentive to work harder let a minority woman give birth on the street because she didn’t want to send an ambulance.  (A first-year med student could tell you that forcing a woman in labor to exert herself can lead to problems.)  The issue, really, is not that UHC is better than the US system or vice versa.  There are pros and cons for both systems.  (The cons of the American system include medical decisions or denials based on greed and lack of coverage for millions.)  The issue is that the American public needs to be aware of and comfortable with what they are choosing.  Unfortunately, the current administration and Pelosi are disingenuous in not giving us realistic informed consent of what they are proposing.

   

  Tort reform, or a lack thereof

  ObamaCare does not include tort reform.  The practice of defensive medicine is an unfortunate, but necessary, byproduct of the litigious nature of American society.  There are times when you are pretty certain a certain disease is not present, but you must rule it out because it only takes one time to wipe out your entire career and family.  In addition, the costs of having 5-figure+ malpractice insurance premiums gets passed on to patients.  There is something wrong with a system that rewards lawyers and punishes patients with extra/unnecessary tests, procedures and costs.  If the cost of health care needs to be reduced, there has to be tort reform.  Of course, with the sitting president being a lawyer and Congress full of them, that will never happen.

   

  The art of medicine

  Medicine is a science.  But there is an art to it as well.  When my father was dying of pancreatic cancer, he opted to have a non-curative surgery to extend his life for what turned out to be an additional six months.  After that surgery he had respiratory failure and had to be intubated emergently and placed temporarily on a breathing machine.  In the eyes of an “expert gov’t panel” such actions would seem like bad medicine.  In the eyes of a society trying to ration out care so that every individual can have coverage, those were poorly spent health-care dollars.  But to my father and myself, those six months were everything.  Whether or not each of you would or should undergo that operation in the same situation is up to you…but do you want the government making that choice obsolete?

   

  Death panels and rationing

  Former VP candidate and Alaskan Gov. Palin was in error when she spoke about death panels.  End of life discussions are actually beneficial.  It allows people to choose for themselves how aggressive they want medical providers to be.  Do they want CPR?  Electrocardioversion?  Mechanical ventilation?  There is no shame or sin in wanting to die peacefully.  However misguided Palin’s comment was, death panels under Obamacare will exist in the guise of rationing.

  • Rationing will occur.  The belief that we can cover everyone (excluding illegals, per Obama) while remaining deficit neutral and providing the best care possible is naive at best and foolish at worst.  Proponents of universal coverage liken health care to food and shelter, things that humans cannot live without.  If the federal gov’t provided food for every man, woman and child but instead of handing out cabbage and bread treated everyone nightly to garlic rib eye with a side of truffle risotto (om nom nom nom!), do you think we could sustain it?  What about providing shelter?  Could the feds afford to build a 3 BR/2 BA/2 car garage house for every family unit in America that had wood floors, a jacuzzi and a wine cellar?  We are not a nation of limitless resources and cannot provide platinum coverage–no obstruction to seeing specialists, no generic medications, no waiting for elective procedures, etc.–for everyone.  Thus, rationing, in some way, shape or form, must occur. 
  • Still unconvinced?  Rationing is happening right now.  As of September 1st, the state of Hawaii will no longer be providing reimbursement for dialysis for Micronesians (non-citizens who are legally allowed to travel to and reside in America as part of a federal contract with their gov’ts) because the state has a budget shortfall.  Translation: we don’t have enough money, so you need to move somewhere else or die.  If it can happen here, it can happen anywhere.
  • Expert panels.  ObamaCare aims to create a gov’t panel that will come up with guidelines to advise physicians on what to do.  Sounds good, right?  However, guidelines already exist.  Organizations such as the American College of Cardiology, National Kidney Foundation, American College of OBGYN, etc. already create guidelines based on evidence-based medicine and opinions from leaders in their respective fields.  Knowing this, what purpose would an extra federal gov’t committee exist for but to make it difficult for physicians to orders tests/procedures?
  • Bundling.  Bundling is a practice were someone provides services A, B and C, but the insurance companies will reimbursed a single lump sum based on what they think is right, rather than paying for each service.  Imagine if you brought your car to the mechanic because you had a flat tire, needed your brakes changed, a crack in your windshield fixed and an oil leak, but GEICO would only give the mechanic a bundled fee that only was enough to pay for 3 out of the 4 problems.  What do you think the mechanic would do?  (Bundling already occurs in private insurance, but the gov’t is making a push to do this more with their plans.)
  • There’s more, but I don’t want you guys to commit hari-kiri out of boredom.

  Like I’ve said before, it’s not that universal health care (again, ObamaCare does not = UHC) is worse than a privatized industry or vice versa.  It simply more a matter of what the American public is willing to sacrifice for what it will gain.  I would ask that people be honest in their expectations.  Cash for clunkers sounded like a fabulous idea (save the environment! stimulate the economy) but delays in payment caused dealerships to pull out and shortly thereafter the gov’t canned the program.  Can the gov’t promise that the same won’t happen with ObamaCare?

  So my preference?  Believe it or not, I am a proponent of universal health care.  (Surprise, surprise!)  But it has to be done right. 

  • Universal coverage for ALL. That means rich and poor.  Citizens and illegal immigrants.
  • There must be tort reform.
  • Incentives for providers and hospitals/clinics (if there is no incentive to work harder, people will be lazy…it’s human nature).
  • Patients must be allowed to carry secondary insurance or pay more to get extra services/choice so that they can have the freedom to choose for themselves and not have to stand in line for non-emergent procedures and diagnostics.

  Peace out!  And let’s be civil.

  • 5:37 am
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