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Going For The Throat: Health Care Reform; A Patient-Centric, Non-Political Wish List

Post Published: 24 March 2010
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Category: Column, Going for the Throat, Health Care and Health Care Reform Column
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(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:

  1. 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.
  2. 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.
  3. 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).
  4. 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.
  5. 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.)
  6. 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 care” would mean “better health care” 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 structures—any mixture of private and public funding may fail or meet human rights standards—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!

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16 Responses to “Going For The Throat: Health Care Reform; A Patient-Centric, Non-Political Wish List

  1. Melanie says:

    I wish I could be as positive as you but for me I’m just screwed either way because my husband and I make enough money where we will not qualify to get the aid of the government and now we will be taxed to high heaven. This will also put a burden on us now that it is mandatory to have health care or be fined. We as a family are barely making it now with the higher taxes and on top of health care we can barely afforded we have to let more things go in our life. This was not the system the country needed and I wished more people would of looked at the whole bill instead of the one issue(we have to be accepted no matter what our existing condition is). Now we are excepted but at what cost?

  2. Robyn says:

    Melanie,
    I don’t disagree with you at all. I had read the bill, all the provisions, but could never see “how much” taxes would raise. If taxes raise, but premiums go down, it’s a wash (probably not much hope of that, eh?).

    And then all the “well, I’ll only vote on it if you add….” made the bill pretty ridiculous. Even with some of the reconciliations, there is still stuff in it we don’t need, and things we need that needed to be left out. Government passage of bills/laws has gotten pretty ridiculous.

    But, I am being positive, because I am tired of being negative. It’s passed, now time to find the good and work with it. I’m gonna try to be optimistic while I “watch and wait” for how it personally affects me and my family/friends.

  3. Hypogirl says:

    Robyn,
    I haven’t had the time yet to really review what you wrote above and I plan on doing it later. But I agree with you comment regarding “I will vote yes if you add…” Why all the extras? Why do people throw things in bills that don’t have anything to do with it? Why was there so much bickering with this particular bill? Everyone was to worried about what “they” were doing over there to care. “

  4. HD inOregon says:

    Robyn,

    The things I like about the bill:

    1. If finally does away (in 2014) with the preexisting condition nonsense.

    2. It immediately lifts my life time $$$ cap

    3. It does a way with rescission (meaning they cannot drop me because in 1961 I forgot to tell them that I had a cold). As I said before, if there is criminal intend to defraud, then rescission of course should remain an option.

    4. It will (again in 2014) give me more choice on more plans. Hopefully one that is financially more affordable than the one I am on now.

    Is the bill perfect? Of course not. Congress is like Microsoft, they always need several iterations until they can get it workable.

    What remains on my wishlist:

    1. As you said on yours, uncouple health insurance from your job. Take it with you when you change or end your job.

    2. That healthcare indeed should become a “right” and not a privilege for those who can afford it.

    HD in Oregon

  5. HD inOregon says:

    HypoGirl,

    That habit of throwing all sorts of unrelated things into bills, is also a hot button of mine. It reeks of “bribery” to me, if leaders have to throw in “pork” favors in order to buy the vote of certain representatives or senators. Bad! Bad! Bad! — Stop it already!

    HD

  6. Hypogirl says:

    HD – It is crazy what representatives tend to add to a bill. I understand their reasoning – but with this particular bill were they already getting something for their district? In the form of health care? Why add extra spending in a bill if it isn’t necessary. It frustrates me to no end.

  7. Dear Thyroid says:

    Robyn – Really excellent article. You make so many wonderful points from the patient perspective. I appreciate where you’re coming from and have a greater understanding of how this will affect me as a patient.

    Additionally, I absolutely 100% LOVE and agree with your points regarding the health care wish list. Yes.Yes.Yes.

    Great column!

  8. Hypogirl says:

    Robyn, Your Nana was a very smart women! LOL! My grandma always had the best advice! She was a nurse in her earlier days and I would ask her a ton of medical questions. To bad she passed before I could be diagnosed with Thyroid Disease.

    I like all your options that you listed and I whole-heartedly agree with your last paragraph. I feel that at least we are moving in the right direction. Baby steps and we will all get there.

    Have a good vacation and I hope your horse does well!

    giddyup!

  9. Marcie says:

    I was asked to share this with you: I do now, thanks to being disabled and eligible for Medicare and thanks to my husbands military service. However, for aabout 6 years we could not afford to cover me. The VA covered my husband. Managing out of pocket expenses was very difficult, since we had to pay the full amount. I am a good person, I take care of my family–even when I don’t feel good, people like me.

  10. Theda Bolus says:

    The US Gov’t is killin’ us. Can’t the whole population get that the health care bill absolutely will increase taxes for everybody and even create brand new ones for everyone?

  11. Robyn says:

    Thanks all! (I would address everyone but I’m way behind on packing!!!)

    Hello, my name is Robyn, and I have a chronic disease. I wonder how many of us are out there, and if our numbers, coupled with those who seriously cannot afford any health care, would make any impact on the congress. I think the new law will have some good, and some bad, and I think it will be years before we know the full ramifications. My biggest disappointment is that our congress–left, right, and center–could not sit down and have a grown up conversation about what is right vs. what is gonna benefit them (and their election financiers). Anyway…

    For the record, my Nana was the shiz-nit. I miss her every day, and she’s been gone over 12 years now. When I think about her life, it puts a lot in perspective for me. My Nana was born in 1919 in Flounheim, Germany, where she lived until she moved to the US in 1964. She was a teenager and young adult through WWII. She was bombed out of 2 houses by the Allies during the war. She watched her father shoot all his dogs and then himself rather than give his police dogs and his service to the SS. She hid bread for Jewish families that were not yet displaced, but unable to buy anything in town. She got pregnant by a US GI, who “moved on” (he did come back years later to find her), leaving her with the stigma and the hardship of raising my mother on her own. When she left Germany, she left a cushy post office job, national health care, etc. to move here, where she worked in a factory, lived in HUD housing for years before “moving up” to a trailer park, and struggled to maintain her health on medicare/medicaid.

    Despite all this, she was a pretty rosy individual (OK, well that may be a little of an exaggeration, she was, after all, German!). My tax dollars help those like her now. Sure, they help other less deserving individuals as well. But despite my chronic disease, I know my life will never be as bad as hers was, and I am happy, therefore to do my part. I for one, do not mind paying taxes, even increased taxes, if I have something real and tangible to show for it. Remember, the only way to use any tax money for health care and have it be “fair” and “equitable” would be to have a national health service, which the majority of US citizens don’t want either. Concessions need to be made by ALL of us–there is no way to get more/better/etc. health care with no increase in resources. Well, unless you cut something else out like the insurance companies and their profits.

    This health care reform deal is a big tangled web. I am all for hearing folk’s complaints about what’s wrong with it, but then I would also like to hear the alternatives. In other words, how would YOU (the global “you”) fix it?

  12. Dear Thyroid says:

    Robyn;

    I absolutely love the proactive posture re: “How would YOU (THE GLOBAL YOU) FIX IT”. You’re so right. This is where advocating for ourselves as patients and Americans factors in on a global scale.

    Thank you for the reminder.

  13. Hypogirl says:

    Robyn, your nana’s story is incredible! I love it. A tough yet loving women. You must be very proud and she very proud of you.

  14. HD inOregon says:

    Robyn,

    Indeed an incredible and touching story about your Nana! Great woman!

    The other comment of yours that caught my eye was: “My biggest disappointment is that our congress—left, right, and center—could not sit down and have a grown up conversation about what is right vs. what is gonna benefit them (and their election financiers).” —- I fully share that disappointment.

    HD

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