Monday, July 13, 2009

The Health Care Debate

I am sure there will be no argument to the premise that the current health care system in the US is pretty screwed up. Its a no-brainer that there have to be changes to the system. But not all changes to the current system is bound to make it better. There are some things which could make things worse than it is in the current state, although the intentions of the change maybe to make things better, it very well could transpire on the contrary. Here I am going to try give my views on what is wrong and what I think should be done. And also, more importantly, what could go wrong with some of the changes being considered right now.

Problems with current system:

There are problems galore, but I am just going to mention a few main ones. I am no big expert on this (all I know is from reading and self-enlightenment) and so I might leave out a few other major problems. First things first .....its all about the money. Why is health insurance so expensive? Why is it not affordable to people with a less than substantial income? If you ever looked at the bills from a hospital (even if it is paid by your insurance) you would notice that the numbers on them are so high, you can even call it obscene. The reason is not just the "big" insurance corporations or the "unfair" pharmaceuticals or the "selfish" hospitals like we may have been made to believe. It goes a little deeper than that.

Its like a vicious circle. Why do insurance companies price their insurances so high? Its because they have to pay those high bills from hospitals when we are treated for anything (and sometimes nothing). It seems like the buck passes on to the hospitals, but if we try to understand why are their costs so escalated to bill insurances so much, its mind-boggling. You can find so many reasons, of which their selfishness or greediness is probably way down on the list (I do not contend that it is non-existent, but it is less significant considering the bigger picture).

One problem is the cost from pharmaceuticals. I do not mean to say big pharma is "evil" by any means. I strongly believe that one of the main reasons for the great quality of health care in this country (considering some contributions to medicine, it is to the whole world) is big pharma. The amount of research and money (through investments) thrown into them warrants more than But, there is so much of beurocracies involved in it including escalated costs due to patents etc. We are definitely indebted to these people not only for what they have contributed in saving lives but also in sustaining a great quality of life in this country. But sometimes, they really do get greedy, trying to patent some achievements which may not warrant a patent for the simple improvement in the product, thus increasing the length of the patent and hence the length of time when they can overcharge for that product. This is a real touchy area, and it is hard to control the patenting system in a generic way. And it is going to be too laborious to deal with this on a case by case basis. But at least you have to cater to this as an issue and do something about it.

Another less spoken about issue is Tort lawsuits. It is a well known fact that tort lawsuits is a big problem in the civil justice system. A lot of them pertain to the field of medicine. Doctors do not have immunity to these tort lawsuits, which is understandable, as the people have to be protected against negligence and malpractices. But the line has to be drawn somewhere to give more immunity to doctors and hospitals. Let me explain this with an example. Mr. X goes to a doctor complaining about chest pain. The doctor diagnoses it as being just gas and gives him medication without further tests. But Mr.X has a smart lawyer who knows how to work the loopholes in the justice system ( of those tort lawyers...or "Extortion" lawyers). So he sues the doctor / hospital saying that the doctor was negligent not to test his heart when he complains about chest pain. He argues that the doctor / hospital should have taken ECG nd other tests to make sure it was nothing else. The settlement is in the seven figures. So what do doctors/hospitals do to counter this (protect themselves). Mr. Y goes complaining chest pain. Now, although the doctor knows it is simple gas, he does all the tests possible on Mr.Y to avoid getting sued. Now who gets billed for all these tests? The insurance company of Mr.Y. Imagine the same happening to tens or maybe hundreds of people at each hospital everyday. That is quite some expense the insurance company has to spend. So who picks up the tab? We all do in the form of higher premiums for our insurances.... which is sometimes not even affordable to people at the lower income group.

Things that can be done (but wont be done) to improve:

This is where politics enters the picture. Either politicians (both democrats and republicans) do not identify these as the major problems or they just do not want to cater to them due to conflicting interests. I sincerely believe it is the latter. In the case of big pharma, they have lobbyists and donors in hoards lining outside all congressmen and senator's offices irrespective of party. It is hard to fathom that this does not imply clear conflict of interest when politicians have to satisfy all the special interest groups and donors who are responsible for getting them elected. When it comes to tort reform, politicians simply would not do it because it would seem to cast them in bad light in the view of voters. By granting more immunity to doctors or by limiting the avenues to sue hospitals, they would come off as supporting the rich and against the small person, which we all know they would never even go near.

So what is the fall out here? Trying to provide other solutions to the problem, which aren't real solutions (explained later in this post). All they are trying to do is hoodwink people into believing that they have identified the problem (which might be a problem, but has lesser significance) and try to propose alternatives that on the top seems like will make the system better, but in effect brings more control of government over the system, thus crippling it in the long run.

What is being proposed:

There are many proposals on the table right now for health care reform. The ones that seem to have the administration support and seems most likely to be legislated are all for public health care options (although they do not want to call it that). In essence, what is being proposed is that there is going to be a public insurance to be offered by the government. Its a tall order to try cover the 45 million or so who are estimated to be uninsured in this country. So how is it going to be paid? Do I hear tax increases? There are more to this proposal than just calling it a public option.

What is really in it and some consequences:

First, let me explain how this is in essence going to turn into a full fledged government controlled public health care system and not just an option. To begin with, to pay for the public option apart from general tax hikes, private insurances offered by employers are going to be taxed. So why would a company or any employer take the extra monetary burden? They would do one of the following: 1. pass on the extra tax to the employees (in effect more deductions in our paychecks) or 2. just outright stop offering a employer health insurance program. The second option would add more people into the public health insurance option raising it significantly from the estimated 45 million people under it, which again in turn increases cost and burden on tax payers.

Now another thing to keep in mind is the government is going to run the health care program. Unlike the private sector, they have no need to sustain profits year after year. And so are going to phase out private insurance providers one by one through unfair competitive advantages, starting with the small guys and eventually the big ones too. So over time, we will have only the government offered public option in the market. So there we are in the liberal euphoria of public health care system in the country. One example of such phasing out of competition by government can be found by just looking at the medicare system. Medicare was put in place with good intentions of helping the senior citizens of the country. But over time, the system has through unfair competitive advantage of not having to make profits has put away all competition for insurances for seniors, and so unless a senior citizen can afford a private insurance, they are tied to the mediocre services of Medicare facilities. We can expect the same to happen with the entire health care system all through.

Public health care system on the surface may appear to be a good idea. No doubt in theory, it should work like a charm. But in theory, so are a number of systems that should have worked, but were devastating like socialism or marxism. There are a number of reasons for my apprehensions with a public health care system. You can learn quite a few lessons from history and also looking at current state of affairs in countries with public health care systems right now. You may hear people who are proponents of a public health care system pointing out countries where it has been a success. But if you stop them and ask, mention a few, they will either stutter or try getting out mentioning countries like France and Canada, where its been well documented that the people there are unhappy with the system, in most cases even more unhappy than here.

The most scary thing about a public health care system is the rationing of health. The system has to take care of over 300 million people. It can easily get out of hand, as it has so often in even smaller countries, and the services offered to patients can wary demographically or according to age or on the basis of any other imaginable yardstick. (Here's a video depicting what could happen in the US based on the state of public health care in Canada) What ends up happening is rationing of health. To see proof of this, all you have to do is look at the public health system in Britain. If a person needs a minor ligament surgery on his leg, he cannot do it right away like here. There will be a waiting time, depending on the type of ailment, pushing people with minor ailments like a leg injury to wait of a few weeks before they can be worked on. Imagine having a color based alert system at hospitals like a security alert system. Hypothetically, If a hospital has a orange level alert, you can go there only for emergencies. A yellow level may allow a wider range of ailing patients, but you cannot go to get treatment for a minor sprain or migraines; you have to go hunting for a clinic with green level to get treatment for that. Those are the kind of hassles we maybe facing with a public health care system. Not to think of the frightening stories you hear about people rejected for treatment because they are too old for it. It happens in a lot, if not all, public health care systems worldwide. An older patient who needs a surgery may be denied because of limited resources, and priority given to younger people who have a longer lifespan at stake. Yup, the system can be as cold as it sounds.

Some of these things are not discussed publicly by people proposing the changes, as it is detrimental to their case of a public health care system. People are going to be taken by surprise, without warning. And it is bound to get worse with time and not better. In fact, there have been legislations in Canada, France and Britain to privatize some sectors of their health care systems. There is a push in lot of those countries to move away from a public care system. How ironic is it that we are going in the opposite direction. Why can't we learn from others' mistakes, before we commit a blunder?

Here are some interesting links about current health care proposal and recent developments in other countries with public health care systems:

Interesting funny video about public health care in Canada.

Canada switching to private health care?

State of public health care in European countries

Read about British Public Health care concerns: here and here

Interesting chart depicting the complexity of new bill

The (supposedly non-partisan) Congressional Budget Office has this to say about current health care plan on the table in the House

And it would make individual private medical insurance illegal

What about tax hikes to pay for it. Or Tax the wealthy to keep everyone healthy.

Talking about taxes, unrelated to health care, I thought I should post the link to this article too.

Friday, July 3, 2009

Wimbledon Finale!

Wow!! What can I say? ....time to eat my own words?? Although I subconciously knew any 2 of the four semi-finalists, I must admit, I didn't see Murray going down to Roddick.

On the face of it, looks like Federer is well on his way to no. 15. I have a feeling, it aint gonna be so easy. Roddick is playing some inspired tennis right now. To take out the local kid who kinda was my favorite to go all the way is no joke. He seems to be a different player than the young angry restless player who wanted to prove a point to people that he belonged in the big stage. But now, in his own words (paraphrased of course), he has reached a comfort level to his place in the tennis heirarchy. It may not seem to be a big deal. But it really is....think of all the pressure off his shoulders...albeit pressure he put on himself. He knows who he is, and you are not gonna see him trying too much on the court, trying to blow Federer off the court, which he has learnt the hard way is a futile strategy. He is gonna take his shots with that big forehand... but he isn't going to try too hard and give away too many unforced errors.

I probably lost my cred with my semi-final predictions. I'm gonna go main stream here and change my finals prediction (duh...I didn't even have the right 2 players). I am gonna go with the general consensus: Federer in 4 sets. But we might be sorry if we don't tune in. We could be in for a surprize!

UPDATE (July 7, 2009: after the finals): What an epic battle? I never thought any finals could top last years in terms on-court drama ..... i think this one just did. (Last years still is high up on off-court drama since it was Rafa vs Fed). I don't mean to gloat about this, but just as I had expected, Roddick showed up against Federer. The quality of tennis late into the 5th set is testament to the physical fitness of the 2 players ...... ridiculous! So now Fed has his 15th .... and hopefully Roddick can carry this form into the hard court season through to the US Open. And the debate about Federer's greatness (GOAT) still goes on ......

Thursday, July 2, 2009

Wimbledon Final Four Preview

The Championships at Wimbledon ..... this year I expect the semi-final match-ups and possibly the finals to be as intriguing as the feel for the mid-summer classic tournament itself. As a fan of tennis, I love watching the game being played on the green pastures (not so green now...towards the end of the 2nd week with all the wear and tear), especially what a sight it is on Hi-def. The red clay of Roland Garros comes a close second (talking just about the mystic view of the court ... not quality of tennis per se).

I am going to talk about only the men's side here. This year all of the four semi-finalists seem to have a chip on their shoulders. Not only is each one of them playing exceptional tennis heading into the final weekend of the Championships, but all of them have, what you may say unfinished business, especially cause its wimbledon.

Let me start with the dark horse of the 4 here - Tommy Haas. He is a 13-14 year vet who has many a times knocked at the door at the semi-final level of slams, but has never been able to take that next step. Not that he is'nt talented enough, for he can beat anybody when he is at his best (yes...including Federer). Add to this his consistent bouts of injuries all through his career, its fair to say he had a very limited window to really show off at slams. But this time, it might be different. Haas seems to be playing with a purpose now. He knows that window is fast closing on him to win a slam. Recently at the french open, he almost busted the fairy tale story of Federer winning the French...... leading him 2 sets to 0 in the quarters, only to see an epic comeback from the Fed. He was that close, and now he gets another chance....this time in the semis. Federer may be more comfortable on grass than clay (which is an understatemnt :)).... but the same goes with Haas. All I can say is out Fed!! Haas has always been a thorn on Federer's path, grabbing a set or 2 from Federer in slams, even when Federer was stream-rolling through his draws at his peak. Their head-to-head record may not tell you the whole story.

Talking about Federer, his quest of pocketing grand slams is just ridiculous....well on his way to No.15 and that too on his favorite surface. With every win, he is just bolstering the case to be annointed the "Greattest of all time" (GOAT). Some people have already made up their mind that he has reached that point, although I still think he has ways to go to be the undisputed GOAT. Right now, he seems to be at the top of his game. But one thing different now than in 2005-06 is that his opponents beleive in their heads that they have a chance. Back in 05-06, Federe won his games on paper...guys just pshyched out before they even played him. Rafa was probably the only one with immunity to that effect. Now guys do not have that fear. They think they can win everytime they take the court against Fed, especially Djokovic and Murray. So I think Federer has his hands full. But, hey....this is home....he is not gonna let anyone take it without a fight. If I had to bet on the number of sets for the Haas-Federer semi-final (considering the line being 4).....I confidently take the over. It could turn out to be a classic.

Andy Roddick has been exceptional this tournament. He had to sweat it out against Hewitt in the previous round, but getting through that just shows A-Rod is mentally ready. He has his own tryst with Wimbledon. Roddick's game is tailor-made for grass. But for a man named Federer, he may have won 3-4 slams here. Kind of like how Rafa was there at the french for Federer. Could the tables turn this time around? Just like Federer breaking through at the French, could this be Roddick's turn to return the favor? Well...he has to get through a bloke named Murray first.

Andy Murray..... never in my lifetime has a brit player had a legitimate credible chance at the wimbledon. This kid knows his way on the grass and he's been phenomenal the last 2 weeks. If he can get past Roddick, he should like his chances against Federer. After all he has owned Federer of late (Head to Head Murray is up 6-2). But its a whole different story playing at Federer's home (the center court at wimbledon). If it turns out to be a Murray - Federer final another angle to the story will have to be the crowd. We all know they love Federer. But will they root against their local kid?? Will be interesting to notice the crown sentiment if such a final pans out.

My Predictions:

Semi-final 1: Murray def. Roddick
Semi-final 2: Federer def. Haas

Final: Murray def. Federer

I know I'm going out on a limb here predicting an upset in the final ..... but hey it just feels that way!

I'll try update a final's preview if I can get to it before Sunday.