Saturday, October 24, 2009

Civis Valetudo (1 of 2)

In July of this year the Journal of the American Medical Association (JAMA) posted a study showing that 62 percent of the bankruptcies in America occurred due to high medical bills. The study also showed that most of those who filed for bankruptcy were middle-class, well-educated homeowners. The study further showed that of that 62 percent, 80 percent had medical insurance.
It is abundantly obvious that the current health care system in America simply does not work.

The reason health care in America does not work is not because of the quality of care, however. It is important to keep that in mind. Health care in America is incredibly effective at improving the health of the sick, easing the pain of the dying, and maintaining the health of the well. As long as you can afford it. The reason health care in America does not work is that nobody can afford it.
The cost of health care must go down, and it is impossible that the cost will ever drop to sustainable levels while for-profit businesses run health-care in America.

This is fact. You can argue about Democrats or Republicans or Socialism or anything else, but don't bother denying that for-profit business has ruined health care in America.

So, here's the tricky part: HOW?
How do you lower costs? Where?

All the health care plans in Congress right now deal with only one facet of the cost of health care: insurance.
Insurance reform is important. Costs are high, "Pre-existing conditions" jack those costs higher or serve as the excuse to deny coverage (did you know that domestic abuse is considered a pre-existing condition). Companies that provide health insurance do so because it makes them money. And like any business, they work hard at cutting costs and programs which do not maximize their profitability.
It should not strain your logic receptors to realize that sick people do not maximize their profitability.

So, a big part of insurance reform, then would be to minimize the ways insurance companies look at their customers as positive and negative dollars.
One way would be to put caps on the amount insurance companies can make as profit. This, essentially, is what regulation does. It's government oversight on an industry to make sure it is not taking unfair advantage of its customers. Health insurers need more than just a reform bill, they need regulation.
Another way to help could be reward programs. My auto insurance gives me a discount for being a good driver. Health insurance could give you discount incentives for being healthy. They penalize you for being a smoker, or for being older, or for being in a situation that would make you more likely to require health care. If you can manage going a full year without requiring more than preventative health care, shouldn't you be rewarded with a reduction of how much you have to pay?

Unfortunately, looking at health care customers as dollar signs does not start and stop with health insurance companies.

When a pharmaceutical company invents a new drug, you can't just call up the company and buy some. You go to your doctor, who fills out a prescription, and you pick up the scrip at a drug store or other pharmacy. The cost of the drug depends on your health-care, and not merely on whether or not you have any. The cost of the drug can change literally depending on which insurance company you have and which health-care provider you use.
You know how you can go to a car lot and get a quote on a car, and then go to a different lot and get a lower or higher quote on the exact same car? Pharmaceuticals work the exact same way depending on your health care plan.

As a matter of fact, most of your health care costs can vary between plans. There is no standardized price on most health care services. It's a contract system.
A hospital will actually give one health insurance company a better deal on x-rays, CT scans, etc. than another company, depending on how many customers that health insurance company can bring the hospital for those services.

Another problem with for-profit health care?
A former Pfizer sales representative filed suit against the company for its practices. "At Pfizer, I was expected to increase profits at all costs, even when sales meant endangering lives," he said, in a statement. "I couldn't do that."(Emphasis mine)
In September this year, Pfizer pleaded guilty to one count of illegal marketing of one of their products. The fine they paid was $2.3 billion, the highest fine ever levied against an American company (Pfizer can make $2.3 billion in about 2 weeks). No one went to jail.
In the lawsuit, Pfizer was shown to encourage doctors to prescribe their product for off-label uses, including for children. The product was Bextra, a pain killer for arthritis and and menstrual pain. Additionally, the company paid doctors to come to lavish "consultant meetings" with the goal of getting doctors to prescribe the drug more often.
Industry insiders say this sort of thing is pretty common. Remember how it seemed every child with more energy than someone in a coma was prescribed Ritalin? Did it help? Is it one of the reasons autism is on the rise? Are pharmaceutical companies to blame?

The health care bill in Congress does not address the price gouging of these companies. It provides no oversight.
The health care lobby is spending more than $1.4 million per day on Congress to protect its interests and if you compare earlier proposals to current plans in Congress, and then compare that to what will eventually pass, it'll be pretty easy to see Congress rolling over at every opportunity.

The absolute easiest way to reduce to exorbitantly high price tag on health care is creating a single payer universal health care system: expanding Medicare to include everybody, for example.

There is an incredible amount of either confusion or outright deception on this issue. In part 2 I will attempt to clarify what I mean, and why single payer health coverage is a necessity.
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