Saturday, February 28, 2009

To Your Health

So recently I watched Michael Moore's movie, "Sicko." Although I am not a big Michael Moore fan, I usually watch his movies--eventually. This movie is all about health insurance, universal health coverage/medical treatment in Western European countries, and in his view, all the problems of the American health system.

Here's my version of the deal, until we are ready to deal with insurance companies, there is no way out of a crumbling US health care system. I knew this before I watched the Michael Moore film by the way, just like I knew fast food is terrible for you before I watched "Super Size Me" by Morgan Spurlock. Plain and simple, there is a big difference between health care and health insurance. Don't be mad at your doctor. (Acknowledged, there are bad doctors out there who are implicit in fraud; it's okay to be mad at them.) Don't be mad at your hospital. (Acknowledged, sometimes hospitals have been found to do terrible things like put people on the street who can't pay; that's pretty bad too.) Don't be mad at your pharmacist. By and large, be mad at insurance companies. But don't be mad at insurance employees, who after all need their own job and insurance. Be mad at the policy makers--if you can find them. It's all smoke and mirrors as far as I can tell. If you don't have insurance, be mad at your Congressional leaders, they take more money from health insurance company lobbyists than any other lobbyists.

I have my own health insurance story. It's not sad like some, but it's enough to put me into a snit. My mother has a health insurance story. It's not beyond the pale, but it's pretty awful. My sister has a health insurance story. We all have a health insurance story, not to mention runaway premiums. Oh, and did I mention Blue Cross Blue Shield of TN is building a huge new "campus" with reflecting ponds and spa-like atmosphere up on the hill in Chattanooga to the tune of 300 million dollars? Every time I drive into town I am reminded of my anger and helpless rage at insurance companies.

We can talk all day about universal health insurance in this country. But here is the bottom line: until we make a health care system that focuses on prevention and treats everyone regardless of pre-existing condition AND returns medicine into the hands of doctors, the system will always be broken. Notice I said health care system, not health insurance coverage system. If we have a system that doesn't incentivize preventative care, how will we ever bring down the escalating cost of health care? If we maintain a system that keeps people away from doctors and hospitals until they cannot go on without seeking treatment, how will we ever cut it off at the pass? If we continue to use the emergency room as our outpatient clinic instead of for emergencies, how will we ever expect to rid ourselves of mounting debts?

Health insurance coverage is just that, insurance. It's a gamble that you won't need it. Like life insurance, home owners insurance, etc. etc. Remember Hurricane Katrina and all those reports of insurance companies denying claims left and right? They were overwhelmed with claims payouts that were never supposed to happen. Well, that's what has happened to health insurance in this country, except that insurance companies never planned to pay in the first place.

I see how universal health care is attractive. I see how it works (in theory and on camera) in places like Canada and England and France. The system they have there is health coverage not health insurance. It might be called health insurance, but it's not, it's actual services provided. Universal health services provided for free to everybody and taxes pay for it. Doctors practice the medicine they were trained to do. Everyone gets help when they are sick. Their medicines don't cost the mortgage payment. Staffing needs are actually based on patient need instead of paper pushing, insurance claim filing secretaries needed to send this form and that form and deal with this denial and that late check. I'd be down with that, if I thought it would work.

I'm no scientist, economist, medical doctor, or insurance analyst, but I see some big problems right off the start with universal health care. One, the sheer massive size of the United States. We can't even get a good bead on our current population if you stir immigration into the mix, which you ultimately will have to given our open border situation. Two, how are we ever going to make a system here that is based on health services and not health insurance? Do you really think Humana, Aetna, Blue Cross, Kaiser, and Cigna are just going to waltz off into the sunset? Any government subsidized/paid for system is not going to be passed in Congress without these guys getting their cut--and you can take your publicly traded shares to the bank and cash them over that. Three, who is going to run it and how? The Federal Government doesn't have a great track record--i.e. public education (a black hole), the Postal Service (going bankrupt), Social Security (going bankrupt). Four, let's not forget the drug companies. They're going to want their cut too.

And before we leave the issue entirely, let's not forget about litigation. One thing Michael Moore's interviewees in France got wrong is this--Americans are not afraid of the government, Americans are afraid of litigation. Don't get me wrong, lawyers are helpful to both wronged doctors and wronged patients on different days for different reasons. And in the end, it is people who decide to sue, not attorneys. Suing can't bring back your dead grandma, or make your child well. Science is science and miracles are miracles, and accidents are accidents, but doctors and nurses and EMTs and ambulance drivers are still people at the end of the day. No one is saying gross negligence shouldn't be prosecuted, but we all know a money seeking civil suit when we see one. I'm not sure we can reform health care without torte reform. The escalating costs of liability and malpractice insurance are a case in point. And torte reform my friends, will send Congress running for cover health care or no health care.

Health insurance guarantees neither treatment, payment, or health. Wake up people and smell the coffins. When insurance companies need a better profit margin, they cut the reimbursements to practitioners and hospitals and jack up premiums. Then doctors and hospitals have to increase the number of patients they see in order to cover expenses. Increasing this pressure on institutions and doctors that should be dedicated to providing health care causes mistakes. People are only human.

It's way past time for the American people to decide if health care is a universal right like education, social security, death, and taxes. If we are serious about reforming health care (again treatment not insurance) in this country--and if anything we should be serious--we have to start again. Let's not create a bigger black hole that allows insurance companies to make more money off the government too, or make a system that allows the government to make our health care decisions, or make a system that ties doctors up even further with useless paperwork ballooning overhead out of control. Let's make a system that makes sense.

I do need to pause for a moment to acknowledge a couple of other arguments I have not yet touched on. One, America was founded in part as the anti-government nation. People came here as a protest against taxation, government persecuted religion, etc. etc. etc. Call me crazy, but there is a holdover in many American minds that says, "My government doesn't have the right to tell me when and how and where to get my health care." What about the right to abuse your own body? Many people think it's their right to do what they want to their body. Are we going to be okay with treating every junkie, every alcoholic, every morbidly obese person, every smoker? These are serious questions folks. Everybody means everybody. There is also the argument that doctors don't want to be told what to charge, where to practice, what hours to keep, etc. etc. Unless you are going to pay their student loans and get rid of insurance reimbursement strategies that minimize payment and figure out a way to bring overhead to under 50%, I think doctors have a point. Then there are fiscally responsible questions to ask, "why does an MRI cost so much?" Let's also not forget the stigma that has been created in this country over medicaid. Alot of people consider medicaid a drain of the system. Regardless of how you qualify, walk in and say you're a medicaid patient and you get "the look."

It's way past time for some serious answers and some serious debate among regular people on this issue. Maybe we should all march on Kaiser Permanente and Humana? What about a million person march against health insurance? Maybe we should all fine tune our stock portfolios (and what better time since the market is in the toilet anyway) and divest ourselves from insurance companies. Would that send a signal? I don't know what the answers are, but I'm going to keep talking. At some point, I'll find somebody who has a great idea. When I find that person, I'm calling CNN, MSNBC, FOX, NPR, the BBC network, and Michael Moore.

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