Wednesday, July 22, 2009

An All Too Common Answer

The System Is Broken

While listening to an interview on amnesty once, it sounded as if the interviewee was a pull string doll. The answer to every question was "the system is broken". This was because there was no politically profitable answer to the questions he was being asked. I've begun to notice a trend here. I recently heard a repeat of that answer on the subject of health care.

1. Will the people who are so all fired in a hurry to revolutionize American health care be subjected to the same system?

The current system is broken.

2. What about medicaid, isn't it going broke? Won't this be like medicaid times 10?

The current system is broken.

3. How are we going to pay for this?

The current system is broken.

Now, while I understand that some questions can cause those with political agendas to say things about their agendas that they'd rather not be said, when the discussion concerns blowing up our current health care system, one would think that anyone in favor of such radical "change" ought to be able to answer some questions about it, or at least to give the nation time to understand and think about what is being foisted upon them. Is it too much to ask that a complete overhaul of something as important as the nation's health care be able to withstand a little reasonable scrutiny?

Hope against Hope

When I was young, I made several parachute jumps from an airplane. The thinking that led up to the decision to do such a thing didn't occur in a vacuum however. Rather it was based on reason derived from experience; that experience being the observation of the successful jumps of others, and a little training. When it was my turn to go, I didn't jump and hope. I jumped with faith based on reason that the system would operate as designed. One reason for that faith was that the ground wasn't littered with the bodies of previous jumpers. Had such been the case, needless to say, my decision to jump would have been based merely on "hope against hope", that is, "hope without any basis to expect fulfilment". With the world littered with broken health care systems, my guess is that "the system is broken" sounds much better than "we're going to do this and hope against hope that our experience will be different.

Yet there is a silver lining to this cloud. We don't have to worry ourselves about those like the president who are yelling that we need to go ahead and Jump, NOW! THE SYSTEM IS BROKEN, for their system is tried and true. And we could all use a little less to worry about during these times, don't you think?

9 comments:

Stan said...

Dan: "With the world littered with broken health care systems..."

Good point. When I ask, "So, can you show me an example of a system that works so I can see what you're talking about?", I typically get "Well, like Canada" ... except, of course, that one doesn't work very well and as many Canadians as can afford to do so are crossing the border away from their "free health care" to get quality ("broken") American health care. "No, no," they tell me, "look at Denmark! That's a great system!" And, indeed, the stats on Denmark's system are pretty good ... until you ask how it's being paid for and find out that it's costing about 50% of the income of each worker to have such a system. Wait ... is that the plan? 'Cause if that's the plan, I can understand why the President would say, "This won't increase the deficit at all!" That's because we're going to be paying massive taxes.

Is there an answer beyond, "The system is broken"?

Dan said...

Stan

Is there an answer beyond, "The system is broken"?"

No, because I don't believe that this is about compassion or health care, but about power. I'm of the same frame of mind of the framers of the constitution that man has a lust for power and will do what he can to amass it. This is a veiled attempt at just that.

That said, if someone's life was broken due to alcohol, what would you think if he talked of a fix with a fifth whisky in his hand? That's the way I see this "fix". There are ways and steps that could be taken to head down the road to a better health care system that would show good faith on their part. The first step would be to initiate tort reform. But that would mean giving up some sizable political donations from the trial lawyers, or perhaps better put, going cold turkey on trial lawyer money. This is one of the reasons I don't have faith in government fixes. They have to work around so many political issues that the final product will end up being... well... broken. We know that from the outset. But hey, it will be OUR broken system then, bought and paid for at twice the price. Then men will become angels, peace on earth will ensue, and government can quit and go home having worked themselves out of a job by writing the last needed law.

Beth said...

In response to the questions you raised:

1. When Hillary Clinton was running for President, her proposal for the public health insurance option was that everyone be offered the same plan offered to Congress. Whatever you may think of Hillary, I respected her for that.

2. Our health care system does not operate as a free market. I cannot freely choose any health plan (see above), but am restricted to what is offered to me as a private individual, since it was too expensive for me to stay on Cobre after I was laid off. Should health care depend upon one’s job? One may have reasonable health care now, but what if a job is lost? Good luck getting health care for a pre-existing condition. In addition, health care does not operate like a business because money is made by DENYING rather than providing services. I watched footage of a physician who used to work for an insurance company testify before Congress that she received promotion and bonuses based upon her rate of denying services, which saved the company money. Capitalism is a good system for operating business in a world full of fallen humans, but exploitation is still a big part of the equation. When a person needs non-elective medical attention, the first thought is often “what treatment can they afford at what hospital?” rather than “what treatment does this person need?”

3. I’ll get to this at the end of my post.

People are worried about health care rationing. I believe that we already have health care rationing in this country, it just takes a different form. Over 20% of Arizonans have no health insurance. The people who can afford it have it, and the people who are very poor who qualify for Medicaid (AHCCCS in AZ) have it. Who doesn’t have it? The working poor. Does such a system make sense or honor God? People get all excited about potentially longer waits to see a doctor or get medical care. Is my “right” to see a doctor within a certain period of time more important than another person’s “right” to get any medical care at all? The two may not be connected by a completely straight line, but there IS a relationship. We live in a society obsessed with immediate gratification, and I think this is just one more example. I believe that someone else’s need for emergency medical care SHOULD come before my less urgent need.

In my community health nursing class, we learned that 97% of medical costs are spent on treatment, while 3% is spent on prevention. Why is this? Treatment brings in income, but prevention doesn’t. However prevention is much more cost effective long term: medical treatment can prevent only about 10% of all early deaths, whereas prevention has the potential to prevent 70% of all early deaths. Therefore, the money to pay for a better health care system can come from cost savings realized by emphasizing prevention rather than just treatment.

Dan said...

Beth

The point of this post was not to defend the current system but to point out that there seems to be an extreme lack of debate, to the point of unwillingness to do so, on a very large matter.

That said I will respond to your answers to the questions posed, not from a heart of trying to be right, but in hopes of getting clarity on the issue.

1. Clinton didn't win the election. But if she had I doubt that congress would have ever agreed to giving everyone the same health care that they receive anyway because of the sheer expense.

2. My weakest area of knowledge. But my thinking is that it wouldn't operate as a free market system even if the government completely left it alone. The whole concept of "free" in a free market is based on a person basing the decision of a purchase on the price, hence as prices go down, demand goes up. I'd venture to say that most large "purchases" in health care are not based on weighing cost against want but on weighing life against death.

Still, all that said, it is dependant on an economy, that is, it is confined to the laws of economics in that it is in the end the allocation of scarce resources which have alternative uses. That is to say, all efforts, knowledge, expertise, and material that go into providing the health care system are not enough to provide everyone with congress type health care. This is a known. But of greater concern is that all those resources have alternative uses, that is to say that all of it will go with the money if it leaves, and I am convinced it will. A sad reality, but a reality all the same. This reality is further compounded by another reality. Health care that is freely chosen does amount to a market, that is to say, money is exchanged for services. (Some after weighing the cost, some not, it is relevant in this point.) Therefore, the laws of that apply to a market would begin to govern behavior in this one, meaning, that as prices are driven down, demand will go up. These two realities would have the cumulative effect in a "free" health care system of decreasing supply while increasing demand thus aggravating the problems we are now experiencing. The end result would be the necessity for rationing care. But as you pointed out, rationing is already occurring. This is true because it is an economy, and as such, by definition is rationed. But I would contend that the current rationing is nothing compared to the rationing that will occur for all except the very rich if the government succeeds in taking control of it.

This brings me to the government that will control it. It seem to me also counter intuitive to think that the same government that condones the slaughter of the yet born is going to somehow have a 180 degree change of heart once born. Once these reins are handed to them, they will not give them up. Furthermore, the government is a political entity. They have to convince fifty one percent of the people to put them into power. It is designed purposely with obstacles in place to slow it down. Backroom deals are made, votes are traded, backs are scratched, and money is exchanged for power. The people listening to the testimony you described are not any better or different than the person on which the testimony was given. The very nature of such a beast seems to me least suited for such a task as running the nations health care. There is evidence in this, as I mentioned earlier, in the fact that there is much that could be done to alleviate cost pressures by simply passing some kind of tort reform. This will not happen, and in fact is never brought up. Why is that? I know that some say that it doesn't amount to much but I believe it amounts to much more than can necessarily be counted because the cost are much larger than simply the money awarded by juries. It would be a good first good faith step. But don't hold your breath because there are boat loads of money involved, as mentioned in the testimony of that dastardly behavior by some non-government official.

Dan said...

3. This is a good point you make, but if the cost of prevention is so little why shouldn't the government simply take on that task alone as a first step. Also the 3% vs 97% seems logical since the prevention, I would think, by its nature is less expensive.

Where's God in all of this.

Even though I have focused on a narrow part of our human existence in this comment, I think that it would be a mistake for us to not pull back and look at it as it fits into a grander scheme of things. As Christians we should be asking ourselves how have we contributed to the fact that the working poor are uninsured? As the Salt of the earth, this shows more of a failing of us, the Church, than it does many of the other things we tend to blame. I know I have contributed to it. But also how much have we contributed to it in many other ways that on the surface have nothing to do with health care. Because our current president wants this, it is the current debate of the land. But there are so many other debates that have a direct and indirect impact on this issue. We need to be as shrewd as serpents and doves as we navigate these times just as those witnesses that have passed before us.

Beth I did very little proofing in this so if any of it doesn't make sense let me know. I'm anxious to hear your response.

Beth said...

It’s true that I did go off somewhat on a tangent by pointing out problems that I see with the current healthcare system, but I wanted to bring out points that I feel conservatives are missing or ignoring. My last and this post were thrown together quickly because I really need to be studying. Having started something by my original post, I want to reply in good faith, but this is the last post I can responsibly make. I’m not an expert on this issue and am not well informed about economics, but some of the things I have learned in my nursing classes have greatly influenced my thinking on this issue.

Conservatives tend to cast business as all good and government as all evil; that is a distortion. Both are run by fallen human beings. If the government had no heart, there would be no Medicaid; on the other hand examples of governmental abuse abound. At the same time, some businesses use godly practices and others exploit wherever possible. I trust neither business nor government to have the best interests of people at heart, but because of the nature of health care, I think government has the potential do a better job than private business, in which medical professionals are forced to focus on profits rather than helping people. I also think that the characterization of Canada as a poor health care system is extremely distorted. One can find actual and anecdotal evidence to support either point of view. I believe that Canada’s system of treating people based on need rather than profits is much superior, especially morally.

I maintain my contention that spending 97% on treatment vs. 3% on prevention is extremely inefficient and short sided. It is driven by the fact that health care is a business focusing on short term profits, another reason I think the government is better suited to manage it. I do not at all understand why you think universal health care run by the government would disproportionately benefit the rich.

I apologize for the fact that I cannot continue this debate. Thanks for your response and a valuable, thought-provoking blog.

Beth said...

One last thing (Ha! Obviously I am rather self serving in choosing the time that I spend on this). There is another important point that I want to make. A large majority of health problems are lifestyle related, including the ones that kill or disable people the most: cardiovascular disease, stroke, diabetes, obesity, etc. That is why only 10% of early deaths can be prevented by treatment, whereas 70% could potentially be averted through prevention. Each person, especially Christians whose bodies are the temples of the Holy Spirit, can do something RIGHT NOW to improve their health by forgiving others, eating right, exercising, etc. Perhaps we can both agree that people taking personal responsibility for their health is the best and least expensive solution.

Dan said...

OK I won't expect a reply, but I did want to respond. First this:

Conservatives tend to cast business as all good and government as all evil.

Where does this come from? Can you give me an example of a conservative that thinks this way? On the contrary, I would say that conservatives are sceptical of man, whether they be in business or government. So you, being sceptical of both qualifies you as a conservative, as I believe you are. But that's another story.

"I’m not an expert on this issue and am not well informed about economics, but some of the things I have learned in my nursing classes have greatly influenced my thinking on this issue."

I would only encourage you to consider the economics of this universal health care. Like it or not, this plan will have an impact that will not only have a negative impact on health care in general, but will also impact beyond the health care system. The laws of economics are going to apply... no matter how harsh those laws are and the end result will be a worse system for everyone except the rich. That doesn't mean the rich will benefit, for they certainly will not. They will simply have access to private care.

"I think government has the potential do a better job than private business, in which medical professionals are forced to focus on profits rather than helping people"

This sounds good in theory but I still contend that in the end the care will diminish for all. Again economics come into play. It has taken enormous amounts of money to refund the research upon which our current system was built. This money was the result of people like you and I saving for retirement and investing in mutual funds, as well as venture capitalist. We all invest with a hope of a return on our money. But in addition to that return, or profit, we also have made advancements in medical technology that has helped not only Americans but the world. By destroying the opportunity for profit, you destroy the motivation to invest, not only money, but energy. Sad I know but, such is our human existence.

This is why change should be the result of prudent reform, not some midnight fire sell. I am suspicious of this rush and the unwillingness to debate or answer questions with serious answers. We can do better than this, and the nation knows it. Why not try?

In the end however we must conclude that when the righteous thrive, the people rejoice;
when the wicked rule, the people groan.

To ask the wicked people that we elected to now reduce our groaning I'm afraid is going to be a fool's errand. But it will no doubt be an errand that we will not be able to resist.

I'd like to continue you know. You can wait till you have some time if you'd like to as well. I'll be here.

Beth said...

Dan, thanks for the offer, I would like to continue the discussion in a few weeks. But, I am very skeptical that the laws of supply and demand apply to health care. I am a very healthy person (partly by genetics, partly by lifestyle choices) and the only healthcare I need is preventative services - skin cancer screening (which I had done yesterday), and other cancer screenings, which save an exponential (not just by a ratio of 97:3 but far above that) amount of money compared to actually getting cancer. Were prices to go down, I would not want or need more health care. What for? Of course not everyone who wants a heart transplant can afford one. That's why our money is best spent preventing the need for a heart transplant. But business has no incentive for prevention, because there is not profit in it. You made a great point about profit motivating R&D that benefits the whole world. At the same time, Moses' brother in law told me that in Liberia, no one wants to know whether they are infected with the HIV virus because they have no access to antiretroviral drugs. So, the profit motive is also keeping people from having access to the wonderful technologies that profit allows to be discovered. Obviously prevention of HIV transmission is the best solution in that case. But no one is profiting from that. Obviously these are very complex issues. I put Thomas Sowell's book on economics on resevere in the library, maybe I will get a chance to read it during my break in a couple of weeks. Blessings, Beth