Going For The Throat: Health Care Reform; A Patient-Centric, Non-Political Wish List
(Written by Robyn Davis Hahn, Editor-In-Chief, Health Care, Dear Thyroid. Column “Going For The Throat)
This past week was a hot one, both here on Dear Thyroid and in the U.S. Congress. As I write this, the big press is on to have this HCR bill passed. In the beginning, I thought anything, even if less than perfect, was better than nothing. Now I’m not so sure. When I read all the special provisions, and the “reconciliations” to those provisions, I realize that the HCR bill is not about health care at all, it’s about government perpetuation of itself.
Edited to add: Well, the historic bill did pass, and has been signed into law. However, my thoughts above still apply. I am not sure if we will look back on this law as a positive change, a necessary evil, a stepping stone, or a huge mistake. I’m cautiously optimistic that it will all shake out for the good of U.S. citizens, and only time will tell. I think, no matter where you lie on this issue, we probably agree that there is MUCH more to be done, so I hope the wheels keep turning to make this a “means to an end” rather than a final product.
Here’s what Health Care Reform should have, in my opinion:
- Access to health care from primary care physicians (including pediatricians) and emergency services should be free (as in included in every plan or available for no charge at every “free clinic”) and unrestricted to anyone.
- Health care coverage should be unlinked from employment/employers so that a loss or change in employment does not mean a loss or change in insurance.
- Health care insurance should be standardized, streamlined, and easy to understand. The sheer volume of different policies, different delivery systems, and complicated billing and payment systems can make basic health care a bureaucratic nightmare (leading to increased costs).
- It should be marketed, advertised, and sold similar to other insurances such as car and home insurance, so the consumer can decide what they need and want, and the direct competition would curb costs.
- Maybe doctors, hospitals, procedures, tests, hospitalization, etc. should be priced according to the “free market” idea. (If you call 5 veterinarians in the phone book, they all will have different exam costs, test costs, etc. based on their overhead, their “bells and whistles” the quality of their doctors and staff, etc. The “customer” can choose a clinic based on price alone, service, doctors, etc. depending on what is most important to them and know all the costs up front.)
- Providing health care and financing health care are separate issues and should be treated as such. Affordable means of coverage can be paid through any number of public and/or private funding source scenarios, even while allowing the providers to remain private.
For me, this list felt more like a good starting place than anything I’ve read or heard on TV about the current congressional debates. (I’m sure I’ve missed something essential, and I encourage you to add your ideas for health care reform in the comments.), When I wrote requirement (wish) #6, I realized that everything I had heard debated about health care reform was mainly geared toward financing health care, and not providing health care. When my mind made the leap that “affordable health careÃ¢â‚¬ would mean “better health careÃ¢â‚¬ for the U.S. I realized this was a gross miscalculation on my part. They’re not talking about taking care of all U.S. citizens, really reforming our health care–they just want us all under the current health insurance umbrella and are trying to figure out how to pay for it.
The Center on Social and Economic Rights (www.cesr.org) has written a short (20 page) document on the concept of health care as a basic human right (excerpt below). Amazingly, it highlights to me how the current health care reform debate is not actually working to change health care or it’s availability–it is just trying to find a way to maintain the current system but make it cheaper. Their idea hits the proverbial nail on the head. For our government, it’s all about the Benjamins and the status quo, not about helping Americans gain better, more appropriate, and ideally, more affordable health care. For perspective, this document was written in 2004, long before the current “push for reform” began.
THE RIGHT TO HEALTH IN THE UNITED STATES OF AMERICA
“Americans pay more per capita on health care than the population of any other country in the world, and receive less for the money. Under the current system, a tremendous amount of that money goes towards private-sector profits rather than building new rural care facilities, providing wider coverage, or implementing new quality control measures. Rights-based reform does not dictate funding structuresÃ¢â‚¬”any mixture of private and public funding may fail or meet human rights standardsÃ¢â‚¬”but it does require that all Americans enjoy the minimum standards of availability, accessibility, acceptability, and quality when it comes to their health care.
The international right to health sets out clear expectations for providing the best possible health care to all people. Health care must be physically and financially accessible, and no one may be deprived of health services because of income, location, race, or insurance status. Services must meet minimum standards of quality, and must be culturally appropriate. These elements of the right to health are already being discussed as problems requiring urgent attention, but they are too often considered in isolation rather than as interrelated and fundamental components of the human right to health…
Now, I’m not an idealist by any means. My head is not in the sand. I do know that health care is costly, especially since here in the U.S. we appear to be Hell-bent on destroying our health with our lifestyle and then looking for medicine to bail us out, rather than invest in good nutrition, health education, and preventive measures. So, while I would wish that we could fix the system from the ground up, I realize that my lofty dream needs to be filed for now and access to current health care is the paramount issue–which means money, essentially. Personally, I am intrigued by the single-payer system. I can envision a system in which our government is the sole insurer, yet the providers are the current mix of public, private, government, etc. and it doesn’t implode upon itself. And yes, I realize there are many single payer systems out there in other countries with plenty of problems. And yes, I also realize I could envision the perfect system financed by the government and doled out by our current medical establishment which sound great in theory and fail miserably in practice. But I really do believe there is a better solution out there, and that it looks nothing like anything Congress will ever put together.
So now that I have a wish list, what is the answer? I think all systems have their associated pitfalls. We will have problems with any system. Is there a system out there which maximizes benefit and health to U.S. citizens which is affordable, convenient, and efficient? The question reminds me of a saying my Nana used to use in reference to pretty much any service industry: “Good, cheap, fast. Pick two… Maybe it’s as simple as that.
Going For The Throat is going on a short sabbatical next week. I will be out of town for a 5-day, all expenses paid (by me!), vacation dressage competition with my horse, Bravo. Highlights will include: sweat (mine and his), cleaning up an unlimited supply of horse poop, searching for gluten-free food offerings at the on-site, uh, “eatery” more sweat, a good probability of mud, more poop, and a glorious lack of wifi and internet. I wish you all good health and will see you back here in 2 weeks!