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 (yup...one 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?

UPDATE:
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.

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