Despite the obvious, they repeated the Republican Health Care talking points verbatim. The conversation went somethink like this....
We (Meaning the US) Have The Best Health Care In The World.
I looked over at my husband...he was concentrating on the multiple predicaments facing Harry Potter and the Deathly Hallows.
So, I took a deep breath......
...but we don't have the best health care in the world. The US is ranked last by the Common Wealth Fund's report released this spring and The World Health Organization ranks us 37th in the world.
The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds.
The really remarkable thing brought out by SICKO! was that Cuba is ranked 39th in the world just a couple slots behind the US and they spend only about $235 per person per year while the US spends about $7,900 per person. We don't get good value for what we spend.
I dearly love my brother and his wife and know them well, so I wasn't too surprised when my sister-n-law said: "I don't believe that. That has to be wrong." I shrugged and said that I didn't see what ax the WHO has to grind and the Common Wealth Fund's reports are peer reviewed prior to publication. They were uncertain, but unconvinced and I let it go. (We still had a couple more hours on the road and didn't want to push it.
Then my brother pitches:
Socialized Medicine Would Be a Mistake
We aren't talking about socialized medicine, we're talking about socialized insurance. Physicians will still be privately employed. Single-payer just means socialized insurance. The providers will still be able to choose who they work for, when their office hours are and where they work; which will only be affected by market forces. In fact the US already pays for about 50% of the health care delivered in the US through the various government plans or through the health insurance offered to government workers. It seems to me that the only people not covered by a government plan are the people paying for it.
Still unconvinced, my sister-in-law says"
I Don't Want the Government Limiting My Health Care Choices.
Our choices are already limited. Our private insurance companies drastically limit our choice of physicians and facilities. They decide what drugs we are allowed to take and what ones aren't covered at all. Insurers decide which medical laboratories can process our lab tests. For-profit insurers are only interested in profits and profits are maximized by contracting for the lowest bidders. The ideal customer in the insurer's eyes is one who pays for an insurance policy, but never uses it.
Worse off is the Medicaid recipient who can't find a doctor, because the reimbursements are so low. Of course, that's better than the uninsured person where your choices are only limited by your ability to pay.
My brother says, "Ok, those are limits that we've dealt with for years, but...."
I Don't Want Health Care Rationing
Rationing is already happening, too. Ever tried to get a prescription refill done more than a week before your pills were due to run out? If you lose a bottle of pills by some mishap; you have to pay for the replacements yourself. Your policy won't cover it.
Referral and pre-authorization requirements ration care. These mechanisms slow down the cue toward obtaining care. Sometimes these requirements are so difficult that the insured gives up - all these things slow down or stop health care delivery and allow insurers to collect addtional premium payments before they have to pay out a claim.
Now, I have no idea how my last comment led to this next one by my sister-in-law; but there it was:
I Don't Want a System With Long Waiting Periods to Get the Care I Need.
Waiting periods are already part of US health care. The Commonwealth Fund's report said:
The U.S. and Canada rank lowest on the prompt accessibility of appointments with physicians, with patients more likely to report waiting six or more days for an appointment when needing care.
That would be for something like bursitis in the shoulder. Waiting 6 days for pain relief could drive someone crazy. The only other option is to go to the emergency department at a hospital where you would have to wait 12-14 hours - maybe more - because a very sore joint is less urgent than just about any other case in the ED waiting room.
Then there's waiting times for non-urgent care or regularly scheduled preventive care. For instance, I called last May to make an appointment for my mammogram. I didn't get it until last week. That's a 3 month wait for a test that I'm supposed to get every year. They wouldn't let me schedule next year's appointment because I didn't have a prescription for the test. Prescriptions expire, so if I get one from my regular doctor, it will be too old to use it next year...a catch 22. ...and remember when your insurance company made you wait and jump through hoops for a year before they did your gastric bypass?
My brother reasonably commented,
...well, those kind of waits don't happen with serious health problems.
Yes, they do if you have no insurance or junk insurance. A friend of mine had to wait 6 weeks for an urgent endoscopy that eventually detected a stomach ulcer, because they had to put together a couple thousand dollars first. ...and remember when Uncle Jim couldn't get EPO between chemo treatments because that was before Medicare Part D (not that MC Part D would help that much)? ...That slowed down the treatment plan and probably led to his earlier death.
My brother changed focus, "You know,...."
The Private Sector Will Do a More Efficient Health Care System, The Government Will Screw It All UP!
Efficiency is in the eye of the beholder. If you are a stockholder, WellPoint is an efficient health insurer, but I don't think the government will screw people as much as Wellpoint has since acquiring Blue Cross Blue Shield of California. Finally, California regulators stepped up scrutiny of this firm because of retroactive policy cancellations triggered by people who actually thought they could use their insurance. These people had policies cancelled and claims arbitrarily denied for no good reason other than WellPoint wanted to preserve their profit structure.
The Department of Insurance, another California regulator, last week issued a report of an investigation that found BC Life & Health, another WellPoint unit, had revoked 1,880 individual health insurance policies in California in 2004 and 2005, and a review of 83 sample cases cited more than half for alleged violations of fair claims handling laws.
My sister-in-law nodded knowingly, and said something like:
Health Care Wouldn't Cost So Much If We Get Rid of the Fraud in the System And Make People More Responsible For Their Health Care.
Yes, fraud and abuse is a problem, so is gaming the system to maximize reimbursements. Disability recipients that exaggerate their injuries, Patient churning, unnecessary care and futile care all bloat the system plus malpractice law suits and defensive medicine- all of these contribute to the problem.
Then there is the perception that people who smoke, drink too much and are obese deserve to pay more for their care - maybe so; but then do we want to eliminate care for all self-inflicted injury? If we take that to an extreme that would mean whoever is at fault for a car crash would have to pay for the medical care required for everyone involved. No treatment for suicide attempts unless you could pay for them. Anyone who has unprotected sex would have to pay for STD treatment on their own. This could create a counterproductive public health nightmare.
Will there be changes? Probably. We already have a system that makes people responsible for their healthcare. Medicaid recipients are afraid to work because they'll lose Medicaid. People have job lock. People have to double and triple check referreals to be sure they are on "the list". Then we have people who lose their health care insurance and responsible for all of their care and they have to get it without the protections of limiting fees.
By now we were done with healthcare....my husband turned the page and started a new chapter in Harry Potter's life, but he piped up,
"You think the Dolphins are going to do anything with Trent Green as the new quarterback this year?"
...and the subject changed to a less controversial subject.
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