Monday, June 8, 2009

If You Kill the Government Health Care Option I Will Make it My Mission in Life to Run You Out of Government

Let me start by saying my health care plan sucks. It's a joke. For example, I need to have ankle surgery, but it doesn't cover rehab. Of course, anyone who has surgery needs rehab, but it's not covered. Moreover, the surgeon recommended trying rehab first, which I did, but stopped when I found out it wasn't covered.

The reason I have such a terrible plan is twofold: (1) It's cheap, and (2) I didn't have a better choice. Let me explain. For five years, I saw a doctor in his late 70s as my primary care physician. He was a decent man who genuinely cared about his patients, but in retrospect, I believe he was getting slightly senile. (He retired a couple years ago). I believe this doctor (in retrospect) was a bit panicky about certain harmless symptoms I had and wanted to put me on statins and other harmful medications I didn't need, which I refused. Except that when I went to change to a more comprehensive plan, they downgraded my status to Tier 4, based largely on that doctor's diagnoses. I appealed and lost, and so I had the choice of paying $500 a month for myself (I was 36 at the time with no known health problems other than torn ligaments in my ankle), or $79 dollars for a terrible plan (Tier 1 price). I chose the former, as I didn't want to give up my tier 1 status.

Now that I have a few other health problems, thyroid, adrenal glands, pre-diabetes, and still the chronically sprained ankle for which I am going to shell out $6000 in out of pocket costs for the surgery, I realize how meager the scope of my coverage is.

While there are many factors as to why health insurance is a joke in this country (from drug company lobbyists, to our poisonous food supply to the lack of preventative care), there's little doubt that the bloated infrastructure and big CEO paychecks of health insurance companies are a major one. If one is sick, one needs someone with knowledge (a doctor or nurse) and the best materials/medicine/technology for treatment. The costs of those two things are unavoidable. Throw in the rent for the doctor's office, the salary of the receptionists - that's all fine.

But why the fuck are we paying the salaries of the incompetent health care customer service, their office overhead, their marketing and advertising costs, their adjusters, their lawyers, their lobbyists, their management, including their wealthy CEOs? How did this slippery middleman weasel and connive his way into a huge piece of our paychecks in an area we have but no choice in?

It is quite easy to find doctors online. One does not need Blue Shield of California to provide a directory of doctors these days - one merely needs a bank of sorts, a pooler of risk that charges a very small vig for administration and processing.

That is why we need a government option - one that simply costs some taxpayer money and the only function of which is to pool risk, so that those with financially catastrophic problems are covered.

And if one wants still to keep his piece of shit private insurance, that's fine - keep it and continue as you were. Being foolish in your financial choices should always remain legal. But let's see how well these useless and outdated middlemen fare when they are no longer the only choice we really have. We will see the costs of insurance go down dramatically.

But the spineless "Blue Dog" democrats are now opposing the government option saying they will only support it if and after insurers fail to meet a particular set of goals. In other words, they will delay any real reform until after the insurance companies - the same ones under whom health costs have skyrocketed - get another chance to meet some benchmarks, which no doubt they are currently lobbying to set low. Only then should we consider giving people another option these "Blue Dog" dems argue.

Sorry, the time for those companies to provide a solution for us was in the last 15 years, and they have not. They had their chance, and the state and cost of health care have gotten substantially more expensive, more complex and arcane and flat-out worse. No one fucking likes our health care system. Not the patients, not the doctors and certainly not anyone with an eye on our long-term fiscal situation. It's over.

So you cowardly, unprincipled piece of shit representatives who have taken so much money from the health care industry

Jason Altmire: $405,279

Michael Arcuri: $103,547

Joe Baca: $159,250

Marion Berry: $536,917

Sanford Bishop: $356,496

Leonard Boswell: $304,680

Chris Carney: $167,664

Ben Chandler: $223,300

Jim Cooper: $894,414

Jane Harman: $292,694

Stephanie Herseth Sandlin: $323,924

Tim Holden: $386,278

Frank Kratovil: $86,556

Mike Ross: $833,670

Loretta Sanchez: $183,162

Adam Schiff: $380,708

Zach Space: $144,125

Charlie Wilson: $138,724

Mike Thompson: $631, 532 (His take from the health care industry, was second only to beer/wine/liquor business, which gave him $1,009,370)

if you stand in the way of an alternative to the status quo, I will make it my fucking mission in life to be absolutely sure you are removed from office and never work anywhere ever again until you repent and do something useful rather than destroy the well being of the very people whom you purport to represent.

And by the way, the next phase of health care reform will be to go after the drug company-funded studies that skew the results and help them sell billions of dollars worth of useless and often harmful drugs. There needs to be a truly independent board that puts the kibosh on that deeply corrupt and harmful practice. And finally, it needs to be made illegal - to the point of sanctions and the threat of losing one's medical license - for doctors to accept lunches and paid trips by these drug companies. Every doctor should take the time at least a few times a year to read up independently on new developments in his or her field (just like everyone does at every other job) and not rely on for profit salespeople to tell them what the latest and greatest medicines they're selling are while bribing them with gifts, meals and travel. It's a fucking disgrace that a person whose job it is to help other people heal from illnesses would ever be involved in that kind of transparently obvious corruption. But far from being the exception this is now the norm - as even doctors on the Harvard Medical School faculty are being paid to turn their students into pushers of product.

The bottom line, our current medical establishment is by and large as morally bankrupt and grossly incompetent as we recently discovered our financial one to be. The reason for the corruption is the same - that greed and short-term profit have caused systemic blindness to the facts and a callous indifference to the damage it does to the citizen that lives with it. While the financial sector, with a massive assist from the banking lobby which corrupted government, first created a great disparity in wealth between the rich and poor, then destroyed the pensions, home equity and the job security of millions while saddling everyone with a massive debt, the health care lobby is destroying what little we have left while giving us inferior and unaffordable treatment, resulting in avoidable illness and death. It, too, is our greatest long-term fiscal liability.

So getting a government option is mandatory now. And if you people on this list - you who purport to represent us - stand in the way, I will personally see to it that you're finished in government and that your reputation is permanently and irrevocably destroyed


Jonah Keri said...

Excellent post. It's a tricky debate, and one I often engage in with family members, who swear by Canada's system. Having both private and public options seems the way to go--even if it means a slightly higher tax burden.

I weighed in on this too:

Angele said...

Jonah didn't specifically mention that health care is the most frequent debate in our house. Having worked in health care, I have all sorts of real-world examples of how people's lives have been completely destroyed by our system but in another country everything would have been totally fine.

Can I be exempt from your proposed sanctions if I can't prescribe and if my drug company swag was obtained for irony purposes? There is room in this world for careful reading of the scientific literature and for Viagra coffee mugs.

Chris Liss said...

I'd allow an exception for Viagra coffee mugs. But not Lipitor ones as Viagra (allegedly) works, but there's no link between elevated cholesterol and heart disease, and statins deplete your CoQ10.

Doug said...

I agree that the current system is broken.

But really, exactly what federal government program works as you're describing? Streamlined, low overhead, highly competent, capable of dealing with exceedingly complex and ever-changing research and information, with interested and caring workers (paid at government wages) to deal with questions posed by its users, immune from abuse either by its users or its administrators...

I could go on, but I'm already belaboring the point.

I don't know if the feds could do it any better than private industry, but I do know that the profit motive is behind an awful lot of the advancement and innovation that has gone on in the world. Why smaller insurers with lower costs haven't stepped in to do what the big folks do poorly is an interesting question for which I don't have the answer. But perhaps its indicative of the complexity of the problem.

Now I'll let my own libertarian side show through here, but I'm HIGHLY skeptical that the federal government wields the sword that can cut through the massive knot of trouble that is our health care system.

Chris Liss said...

I think the doctors could decide what procedures were necessary (within basic guidelines, but with plenty of latitude), and that would be that. There would be oversight - just as there's oversight by the IRS - random enforcement when there are red flags to catch tax cheats, but otherwise, they could trust the doctors to prescribe the proper care and procedures. All they would need is a system of payment for the doctors that rewards outcomes more than procedures - easier said than done, but that's a problem for private insurance as much as it is for the government, and one that if you read the New Yorker article linked on Jonah's site, they haven't nearly solved, either. Certain government entities work pretty well - the post office delivers your mail anywhere in the US unfailingly for 42 cents. But the bottom line is that the government can't solve this problem alone. The doctors have to stop being such scumbags, and that will start happening when the industry isn't run exclusively by for-profit insurers. The whole ethos has changed in the last 20 years, and that's a by-product of our broken system. Once you get the corruption of the drug companies and insurers out of it, doctors can be doctors, and they'll do a far better job and get paid enough to be comfortable. As for innovation, much of it is bogus. The cholesterol drugs that rake in billions of dollars do lower it, but the drug-company funded study that concluded there's any significant relationship between cholesterol and heart disease has been debunked many times. A lot of innovation is like that - the solution to a problem of their own creation that generates massive profits. Real innovation should still be profitable, but honestly, creating life-saving drugs and devices is motive enough for many. The power of money to motivate is overestimated. It motivated bankers to create the out-of-control derivatives that nearly broke our system and put us all into indentured servitude - all the while they contributed nothing of value. Many of the drugs and innovations are like that, too. New, complex and expensive machines and chemicals to treat you so that you don't need to eat healthy and exercise. Much of it is unnecessary and actually harms people who would otherwise have no choice but to make changes to their lifestyle.

Doug said...

I know this is going to sound argumentative, so I'll put the disclaimers right up front.
1) I DO agree that the current system is flawed.
2) I DON'T intend any personal attack by my comments, though there a few things you say that are so outrageous, that I'm going to say mean things about your statements.

If the best example you have of a highly-functioning Federal Agency is the Post Office, I think you're radically underestimating the complexity of the medical field (or vastly over-rating the complexity of the mail). Medicine is complicated - solutions that work well for one patient don't work for others - people have different side effect from drugs, etc. Medical technology and drugs change, evolve, and new ones are created. All of these things may or may not interact with other drugs, treatments, OTC medicines/herbs, etc. The post office, well, it just doesn't have that kind of complexity. Their logic is as simple as: IF "Address Exists in database" THEN "Deliver there by lowest cost routing" ELSE "Return to Sender".

To "reward doctors for outcomes" is, well, risky and short-sighted are the first two descriptors which come to mind. You've now created a system where doctors SHOULD avoid treating very sick patients. Furthermore, because of the complexity of medicine, you're de facto arguing for the lowest-common-denominator standard of care. This isn't how medicine, or any other field of human endeavor, evolves and improves.

The rest of your argument seems to be that, by replacing private insurers with a federal agency, then everyone will just be smarter, healthier, and less greedy:

"The doctors have to stop being such scumbags, and that will start happening when the industry isn't run exclusively by for-profit insurers". Let me have one of my friends call with his stories about Medicare/Medicaid fraud, or use your favorite search engine. That's just not going to happen.

"A lot of innovation is like that - the solution to a problem of their own creation that generates massive profits" & "As for innovation, much of it is bogus." Your personal situation aside, this is just ridiculous, and borders on ignorant.

"Real innovation should still be profitable, but honestly, creating life-saving drugs and devices is motive enough for many" Sure, there are dedicated, selfless researchers for who finding a cure for cancer/diabetes/etc. would be reward enough in itself. But where are the resources going to come from, given that most research goes nowhere, and really effective solutions only come along once in awhile?

"The power of money to motivate is overestimated" You have it exactly backwards, if you think about it. The power of money to motivate CANNOT BE overestimated. It has motivated countless people to exceed their means, commit either intentional or systemic fraud, ignore warning signals that trouble was coming, and this is all just as it relates to the US's currently messed-up economy.

"New, complex and expensive machines and chemicals to treat you so that you don't need to eat healthy and exercise" If there's a person whose thought process goes - 'Should I eat this donut/bowl of ice cream/pound of french fries, or an organically grown salad? Well, since medicine will take care of me, I'll opt for the bad stuff.' - even indirectly, I'd like to meet him.

Should everyone eat well, exercise, be motivated by altruistic goals, without regard for reward? Sure, of course. But it isn't happening. And creating yet another government agency to solve absurdly complicated problems, well, it just isn't the right tool for the job.

Since it isn't, I'd much rather the broken system be a private one, that I can choose not to have anyting to do with, than be a non-functioning system that I (and you, and everyone) have to both pay for and navigate.

Chris Liss said...

I think you're reading rewarding outcomes too narrowly if you're arguing that doctors would stop treating the very sick. A very sick person has a spectrum of outcomes which are more bleak than a healthy one, but that doesn't mean we can't adjust the scale for that. The idea that rewarding outcomes would necessarily be a one-size fits all renders it meaningless. And second, sure the post office is easier than health care, but you asked for an example of something that works, and it does. At the city government level, we have clean water and if you're parked illegally for 10 minutes, you will surely get a ticket - at least in LA. And obviously a government option won't turn the doctors into saints overnight, but you vastly underestimate what's happened systemically throughout our culture from Wall Street to the medical establishment with crony capitalism run amuck. Wall street stopped existing as a industry that greased the wheels of commerce and became a massive casino that gambled with investors money and took a huge vig. The drug companies similarly are there to maximize profits first and foremost - not cure illnesses. The cholesterol drugs, some of the biggest money makers of them all, do lower cholesterol, but don't address heart disease which is not significantly correlated with cholesterol levels. So that's the kind of innovation this culture of money being the raison d'etre for being a doctor or a researcher has wrought. Yes, it motivates - it motivates people to steal from their investors and to make money off the sick. This culture needs to be unraveled, and the government option is a good start because it will prevent the insurance companies from stealing from us. They will have to compete, and it will be difficult for them. There premiums will need to go down, and they'll have to cover more treatments. The CEOs will get less money. I mean how can you possibly have any faith in the private insurers given their performance the last 20 years? We're 37th in outcomes, far and away 1st in costs. We're a laughingstock, and our corporations can't even compete overseas, and our own government is facing long-term bankruptcy. How can you possibly argue that private insurance is the solution without massive pressure from a government option? It's not really that complicated. Other countries do it and far better than us. The problem is (1) the current system isn't capitalism - it's crony capitalism, and (2) health care isn't something that capitalism is particularly good at because the customer doesn't have the choice not to buy it. If you're sick you need it, so it's not like a transaction involving an iphone which you can do without. Also, unlike when you're going to buy an iphone, you are not even qualified in many cases to assess whether you need a particular treatment or procedure. So it's beyond foolish that we've trusted companies trying to make money off of us to manage that process.