Good health care article

[TheTodd]

Op Ed piece (http://www.nytimes.com/2009/08/09/opinion/09rich.html?_r=1) that lead me to this article about health care from the New Yorker.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all


The Op Ed piece is kind of all over the place. Starts talking about Obama and the challenges he faces but then goes on to hit on the media and touches on these groups being used to lobby at these community meetings. Then it points out some issues with Democrats in some money they are getting as 'donations' from those in the medical industry. It did lead me to the article in the link above, which I though was a pretty good piece and it brings up some valid points about how some of the legislation being passed around won't really fix the healthcare issue of high costs.

[annarborgator]

Really interesting article. Thanks for passing that along. It certainly seems to me that we have massive overutilizaiton of health care in this country.

[G8rMom7]

I'm about half way through this...very good so far though!

[TheTodd]

yeah, it is really long. I read it in stages.

[G8rMom7]

A couple of comments about some things in this article...

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.

I don't see it like this at all...for instance we remodeled our home on our own...no real "contractor" but we had a friend helping us...we got three quotes on air conditioning and picked the one that gave us the most for the least amount (not the cheapest one). So NO, you wouldn't necessarily end up with outlets, faucets, etc. that you don't need. As the consumer you would need to aware of what you need and have the insight to make sure you get what you want. The problem of why this may not work with health care is that people are totally unaware of how much things cost these days. So many people pay their co-pay and have no idea what their doctors are charging their insurance companies. That is because we've gotten dependant on our insurance companies (as we would wether it changed to public or not). I think the free market system could totally work with medicine although I think Medicare and Medicaid have made it a lot harder to do so.

He gave me a quizzical look. We tried to imagine the scenario. A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they’re supposed to haggle over the price as if he were selling a rug in a souk? “I’ll do three vessels for thirty thousand, but if you take four I’ll throw in an extra night in the I.C.U.”—that sort of thing? Dyke shook his head. “Who comes up with this stuff?” he asked. “Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.”

I just don't see it like that...if you have a Health Savings Account that if not used earned you interest and you had more control, you're darn right you would be looking around for the best costs...and the scenario they presented was a catastrophic issue that would be covered under your catastrophic insurance which is required to have a Health Savings Account. But getting your preventative maintenance and regular medical coverage for your dental work etc. can or should be negotiated. You don't think I called around about finding a good pediatric dentist? And part of that was asking about cost since some of them aren't covered under my insurance. So this is where the doctors will have to be financially reasonable otherwise they will lose their business to other doctors who are. IMO.

Instead, McAllen and other cities like it have to be weaned away from their untenably fragmented, quantity-driven systems of health care, step by step. And that will mean rewarding doctors and hospitals if they band together to form Grand Junction-like accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering. Under one approach, insurers—whether public or private—would allow clinicians who formed such organizations and met quality goals to keep half the savings they generate. Government could also shift regulatory burdens, and even malpractice liability, from the doctors to the organization. Other, sterner, approaches would penalize those who don’t form these organizations.

I think the whole band together idea to share ideas and best practices is good. However, we have to ensure they follow basic rules of anti-trust and such. None of the ideas above would require a public option though.

Anyway, this is a great article and proves to me that the people who should be dealing with this issue are the people like the one who wrote this article...doctors, educators of doctors and people in the medical field. Not these lawyer politicians.

[TheTodd]

You would know how many outlets or faucets you need in your house. Unless you went to medical school, you don't know what procedures and tests are necessary or not.

[G8rMom7]

Like I said though...if you got more than one opinion, you would. And for the majority of health care we are talking about, you would have the time to make such decisions. Of course, if it's an emergency or catastrophic illness that would be covered by your health insurance.

Like with car insurance...oil changes, new tires, etc. are not covered in your insurance...what do you do? Take it to one place and pay whatever they ask just because they tell you that's what you need? No, you say thanks and ask someone else what they think.

[DocZaius]

I don't mean to step on Mom7's toes, but she posted an article to her Facebook that I read that seems pretty reasonable.

http://online.wsj.com/article/SB20001424052970204251404574342170072865070.html

The Whole Foods Alternative to ObamaCare [/size]

By JOHN MACKEY

“The problem with socialism is that eventually you run out
of other people’s money.”

—Margaret Thatcher

With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become eligible for both, we are rapidly running out of other people’s money. These deficits are simply not sustainable. They are either going to result in unprecedented new taxes and inflation, or they will bankrupt us.

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:

•?Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees’ Personal Wellness Accounts to spend as they choose on their own health and wellness.

Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan’s costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.

•?Equalize the tax laws so that that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

•?Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

•?Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

•?Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

•?Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor’s visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

•?Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

•?Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program.

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That’s because there isn’t any. This “right” has never existed in America

Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.

Although Canada has a population smaller than California, 830,000 Canadians are currently waiting to be admitted to a hospital or to get treatment, according to a report last month in Investor’s Business Daily. In England, the waiting list is 1.8 million.

At Whole Foods we allow our team members to vote on what benefits they most want the company to fund. Our Canadian and British employees express their benefit preferences very clearly—they want supplemental health-care dollars that they can control and spend themselves without permission from their governments. Why would they want such additional health-care benefit dollars if they already have an “intrinsic right to health care”? The answer is clear—no such right truly exists in either Canada or the U.K.—or in any other country.

Rather than increase government spending and control, we need to address the root causes of poor health. This begins with the realization that every American adult is responsible for his or her own health.

Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.

Recent scientific and medical evidence shows that a diet consisting of foods that are plant-based, nutrient dense and low-fat will help prevent and often reverse most degenerative diseases that kill us and are expensive to treat. We should be able to live largely disease-free lives until we are well into our 90s and even past 100 years of age.

Health-care reform is very important. Whatever reforms are enacted it is essential that they be financially responsible, and that we have the freedom to choose doctors and the health-care services that best suit our own unique set of lifestyle choices. We are all responsible for our own lives and our own health. We should take that responsibility very seriously and use our freedom to make wise lifestyle choices that will protect our health. Doing so will enrich our lives and will help create a vibrant and sustainable American society.

—Mr. Mackey is co-founder and CEO of Whole Foods Market Inc.

I think Whole Foods is overpriced, and full of snotty hipsters, but I can't say that I disagree with much of the above.

[TheTodd]

A couple left of center friends were wanting to boycott Whole Foods because of this. Personally, I think the guy has some good ideas and this is the kind of thinking we should be encouraging.

[MinGator]

I agree that this is the thinking that should be encouraged. We can all agree the system needs some help, but to burden the country with a plan that will become a huge tax liability with no realistic way to back out if it fails.
It's painfully obvious that systems like medicare and medicaide are not sustainable at the benefit levels that are now available and that system is failing. But you also know now at this point we can't just cut and run, we have created the dependency on them. That's not the fault of the folks relying on the system now, they were promised this, so why shouldn't they depend on it, but it shows the shortsighted nature of creating a program like that. It will have to be funded for years and years until we can cut back gradually enough not to shock the system. It will be like weening the country off of a back heroin addiction.

[DocZaius]

The incoming president of the Canadian Medical Association has described the Canadian health care system as "imploding"

"[Canadians] have to understand that the system that we have right now if it keeps on going without change is not sustainable," she said. "We all agree that the system is imploding. We all agree that things are more precarious than perhaps Canadians realize."

[MinGator]

Well then let's get that shit started here right away!

[G8rMom7]

A couple left of center friends were wanting to boycott Whole Foods because of this. Personally, I think the guy has some good ideas and this is the kind of thinking we should be encouraging.

You know what makes me laugh...all these left-of centers are usually the first ones to turn their nose up at the big evil Walmart empire, but what are they to do now? Walmart got together with the SEIU in favor of the whole overhaul thing and now a hippy type store like Whole Foods is getting their disdain? They must feel like they've entered Bizarro World. Hilarious.

And I love that Whole Foods approach. Some of these HSA's can earn you interest and if used properly wouldn't it be great if a whole generation who gets them may not have the need for medicare in the future? It's a pipe-dream I know...but a dream just the same.

[G8rMom7]

OOhhh...and I just got a tingle up my leg knowing that Doc read something I posted on my Facebook page! I'm all giddy now.

[MinGator]

That's not just a tingle. :ninja: