What's Wrong With Free Market Healthcare?

Epinephrine is a medicine used to treat severe allergic reactions, which may be life-threatening.   Analphylactic shock is an allergic reaction which can cause death within minutes.  People with allergies to certain substances, such as wasp venom, are supposed to carry an epinephrine pen with them whenever they are in environments in which they might be exposed to the substance.   These pens enable you to administer an emergency dose of the drug to counteract the allergen, after which you're supposed to get to an emergency room as quickly as possible.  The pens come with an expiration date, so if you haven't used them in a year, you have to throw the pen away and get a new one.   That's not so unusual with medicines and medical devices.  

A few years ago, I had a severe allergic response to two wasp stings within a couple weeks, and as a result, I have been getting allergy shots to desensitize me to the venom, and I'm supposed to carry an epinephrine pen with me when I might be exposed to wasps (like being outside anywhere). 

Having to carry an epinephrine pen around is bad enough, but I recently discovered that these pens (sold under the name Epipen) are made by one company (Dey Pharma) which apparently has found an effective way to pad their bottom line at consumer expense.  Sometime in the past 6 months or so, the company decided to only package these pens in two packs (at twice the cost, of course).  So now, patients who need to carry an Epipen have to buy a two-pack, both of which have the same expiration date.  If all goes well and I avoid any wasp stings, I have to throw away two Epipens, not just one.   Since I try to avoid sharing space with wasps, the odds of me having two severe allergic reactions within the next year are extremely slim.

The packaging/marketing of these devices by Dey Pharma results in waste of both consumer and health insurance resources.   I don't know if the FDA has the authority or even considers trying to halt horrible marketing decisions like this, but it would be nice if the Federal government and/or the insurance industry could do something productive.  I resent being forced to waste limited resources on guaranteed waste. 

This strikes me as an excellent example of what's wrong with our "free market" approach to health care and why we need a good single-payer insurance system (which could conceivably control skyrocketing costs).  

If you know someone who needs an Epipen, I'd be happy to sell him/her one of mine.

Don't Want To Pay For Certain Government Spending? Too Bad.

Jon Stewart says it all so well it doesn't need elaboration.   Don't like paying for some part of government spending?   Quit whining and get used to it.

On his 3/5/2012 Daily Show, Stewart commented on "conservatives' reaction to Rush Limbaugh's incendiary remarks about Sandra Fluke and her congressional testimony on birth control coverage."  Another example of why Stewart's considered our "greatest public intellectual" by a Loyola University bioethicist.

It's about an insurance mandate from the government covering contraceptive medications as part of overall health care.  It's not your tax money that pays for it.  I'm not even going to get into your round-about argument about how somehow money is taken out of your pocket to pay for Georgetown's private insurance plan...

I'm just saying to the people who are upset about their hard-earned tax money going to things they don't like: Welcome to the $%&#* club.  Everyone pays for $%&#* they don't want to all the time.   You know what?  Reimburse me for the Iraq War and oil subsidies, and guess what, then diaphragms are on me.  Prophylactics are on the house.

Indeed.   We're not talking about tax dollars here, we're talking about health insurance.  Let me know when we all get to exclude various government activities and spending from our personal tax dollars.  I can put my list together pretty quickly, how about you?

Quantity or Quality?

During the national health care debate (and I hesitate calling what we had an actual debate, as opposed to shouting epithets at each other), one of the topics that briefly surfaced was end of life counseling.   There was a short-lived attempt to allocate Medicare funds to provide for comprehensive counseling on end of life issues, such as whether to continue treatments.  This devolved into the shouting over "death committees," among other untruths.  

Some health policy groups say cancer patients, as well as people with failing hearts or terminal dementia, should get better end-of-life counseling. Last year, a plan that would have let Medicare pay for doctors to talk about things like living wills was labeled "death panels" and was dropped.

This Associated Press article is an interesting report on the state of affairs with end of life treatment in the U.S.  What it says is that despite our "rational" desires to accept a terminal illness with some measure of grace, the facts show that we are not entering hospice care until way too late, and in many cases, desperately choosing very expensive experimental treatments to prolong "life."   The result can be a few more weeks, but at a horrible cost in quality of life.  A couple of sad facts:

—The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late. In 2008, one-third of people who received hospice care had it for a week or less, says the National Hospice and Palliative Care Organization.
—Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars.

The denial that Americans seem to undergo (although you might choose to call it "hope") is a good part of the reason that "health care costs" are continuing to skyrocket.  If you don't have insurance, you probably don't have the opportunity to consume multiple, experimental chemotherapy treatments for terminal cancer.   If you do have insurance, you might be able to get those $10,000 treatments, but the rest of us are paying for it.

What this comes down to is a tug of war between acceptance of the inevitable versus the good old American "never give up" reliance on "hope."  It's difficult to pick one side in this debate.  Even simply leaving it up to the individual and his/her family isn't a clear solution; if they opt to continue treatments indefinitely, the individual isn't the one footing the bill, we are.

We should really try to have a rational, calm discussion in this country about quality vs. quantity when it comes to end of life treatment.  Before we truly do go bankrupt.

Groceries and Politics - and Euthanasia?

A strange thing happened to me a couple months ago while I was grocery shopping.   This was before the Federal health insurance bill was passed.  I was approached by a elderly man (elderly meaning older than me) who commented on my Iowa T-shirt.   The commenting wasn't the strange part.  The discussion that ensued was, at least to me, the strange part.  It started benignly, with "How are things in Iowa?"   I responded that things were pretty good in Iowa (where I used to live), especially as compared with the political chaos in Illinois (where I've lived for the past 22+ years).   

In case you haven't heard, Illinois is drowning under a $13 billion (maybe more) deficit and politicians who don't have the courage to raise taxes to pay for the services the public has come to expect.   So we're laying off teachers because the State owes money to local school districts for last school year.   But I digress.  

I made some remark about Illinois government, and the man launched into a passionate dissertation on how the Federal government wants to ration health care to the elderly.   I was startled initially, but tried to say something about how health care costs are out of control and too many people have no insurance.  His response was that the government wants to set up "death panels" to save money.   I was flabbergasted that this guy was actually convinced that his country wants him dead.

As I listened to this man, who was convinced that any effort to reduce health care costs would be tantamount to executing the elderly, I realized that he wasn't really interested in discussion, but simply wanted to convince me that his view was correct.  I don't feel like I know all the answers to lots of topics, but I wasn't about to buy into this conspiracy theory.  It seemed advisable to extricate myself from the "chat" and finish my grocery shopping, which I did.   But the encounter bothered me a lot.

I had suggested to the man that our current for-profit health insurance system is designed to make profits for the corporations, and that lots of people are denied coverage for various treatments by the insurance companies.  He told me his fate was more secure in the hands of corporate interests rather than government, another consequence of Ronald Reagen's anti-government philosophy.  

I find such a belief truly incredible, given how badly many large corporations treat employees, the environment, and anything else that doesn't directly pad their profits.  

And I'd also suggest that when it comes to something as overtly nefarious as euthanasia, our government is the last place to look for efficient implementation.

No, I don't believe anyone in the current Administration was promoting "death panels" or euthanasia in order to curb health care costs.   I also believe that we Americans expect miracle cures for everything, from "ED" to sleeplessness to terminal cancer.  And we simply can't afford to consider unlimited expensive cures (paid for by someone else) to delay the inevitable.   As usual, there has to be a middle ground and we have to find some way to discuss what that might be.

Taking the Pledge?

I received a fairly clever email recently in which the unknown author (if you know who wrote it, I'll be happy to attribute it) deflates the Right-wing rhetoric which disparagingly refers to the recent health care reform as "socialized medicine."  The email is in the form of a pledge to avoid a lengthy list of other "socialist" services (the email is at the end of this post).

In the US, the term "socialized medicine" came into common use in the late 1940s as part of the American Medical Association's opposition to President Harry Truman's health-care initiative. The original use of the term referred to health care systems in which the government operates health care facilities and employs health care providers, such as the British National Health Service.  More recently, the term has been expanded to refer to virtually any publicly funded health care system.  It's clearly used as a derogatory term, playing on the irrational fear of "socialism" in the US.  And it was part of the successful defeat of efforts to expand health care to a broader segment of the US population for decades.

I found the email humorous because it pokes holes in the socialist "boogie man" -  as pointed out by Wikipedia:  "Most industrialized countries, and many developing countries, operate some form of publicly-funded health care with universal coverage as the goal. According to the Institute of Medicine and others, the United States is the only wealthy, industrialized nation that does not provide universal health care."   The term "socialized medicine" has become a ridiculous pejorative because it considers that shared responsibility and shared support is somehow bad.   That is, public funding of health care is bad because it is based on some sort of "socialist" model in which citizens pool resources (taxes) to provide health care to all citizens, rather than the capitalist approach of "every man for himself."

The fact is, shared resources and shared benefits are part of daily life of most Americans, but we don't think of them that way and we don't call them socialist. It seems clear that most Americans wouldn't consider such shared benefits as indoor plumbing attached to working public water and sewer systems a bad thing.   And Medicare.   And products of National Public Television like Sesame Street.  And highway rest areas.  And police, fire, and emergency services.

At any rate, here's the text of the email; see how many of these shared activities and benefits you're willing to forego.

I, ________________________________, do solemnly swear to uphold the principles of a socialism-free society and heretofore pledge my word that I shall strictly adhere to the following:
I pledge to eliminate all government intervention in my life. I will abstain from the use of and participation in any socialist goods and services including but not limited to the following:

Social Security
Medicare/Medicaid
State Children's Health Insurance Programs (SCHIP)
Police, Fire, and Emergency Services
US Postal Service
Roads and Highways
Air Travel (regulated by the socialist FAA)
The US Railway System
Public Subways and Metro Systems
Public Bus and Lightrail Systems
Rest Areas on Highways
Sidewalks
All Government-Funded Local/State Projects. This means every single road that is not a toll road is off limits to my use.
Public Drinking Water and Sewer Services (goodbye socialist toilet, shower, dishwasher, kitchen sink, outdoor hose!)
Public and State Universities and Colleges
Public Primary and Secondary Schools
Sesame Street
Publicly Funded Anti-Drug Use Education for Children
Public Museums
Libraries
Public Parks and Beaches
State and National Parks
Public Zoos
Unemployment Insurance
Municipal Garbage and Recycling Services
Treatment at Any Hospital or Clinic That Ever Received Funding From Local, State or Federal Government (pretty much all of them)
Medical Services and Medications That Were Created or Derived From Any Government grant or research Funding (again, pretty much all of them)
Socialist Byproducts of Government Investment Such as Duct Tape, heart monitors/defibrillators and Velcro (Nazi-NASA Inventions)
Use of the Internet, email, and networked computers, as the DoD's ARPANET was the basis for subsequent computer networking
Foodstuffs, Meats, Produce and Crops that were grown with, fed with, raised with or that contain inputs from crops grown with government subsidies.
If a veteran of the government-run socialist US military, I will forgo my VA benefits and insist on paying for my own medical care.
I will not tour socialist government buildings like the Capitol in Washington, D.C.
I pledge to never take myself, my family, or my children on a tour of the following types of free-admission/taxpayer subsidized socialist locations, including but not limited to:
Smithsonian Museums such as the Air and Space Museum or Museum of American History
The socialist Washington, Lincoln, FDR, and Jefferson Monuments
The government-operated Statue of Liberty
The Grand Canyon and all national/state/regional/local parks, forests and monuments
The socialist World War II, Korean and Vietnam Veterans Memorials in every town
The government-run socialist-propaganda location known as Arlington National Cemetery
All other public-funded socialist sites, whether it be in my state or in Washington, DC. This also includes Post Offices, fire departments, police departments, public schools, libraries and zoos.

SWORN ON A BIBLE AND SIGNED THIS DAY OF ____________ IN THE YEAR 2010

SIGNATURE:

Break Up Insurance Monopolies

Well, as long as I'm talking petitions today, here's another one worthy of consideration: the insurance anti-trust exemption that the industry has enjoyed since 1945. This online petition is from Senator Pat Leahy of Vermont and urges the Senate to follow the House of Representatives action in bringing this out of control industry under anti-trust regulation.

America's health insurance companies have had a pretty sweet deal for decades.

They can pick and choose their customers and deny coverage to anyone with any sort of pre-existing condition -- even acne.  They can get away with dropping your coverage when you get sick.

And since 1945 they have been exempt from the antitrust regulations that apply to nearly every other industry, rules that protect consumers from anti-competitive business practices
like price-fixing.

That's why I just sent a letter to my Senators, supporting the Health Insurance Industry Antitrust Enforcement Act, which will eliminate the outdated insurance industry antitrust exemption, and force health insurance companies to compete fairly -- like virtually every other business in America.

Please join me by sending a letter to your Senators as well: click here

Ban For-Profit Health Insurance Companies?

Here's a thought: why can't we have not-for-profit health insurance companies? Why are we forever stuck with companies whose primary objective is to make a profit? And since they are for-profit entities (in the USA), should it really be any surprise that their executives make millions and millions of dollars each year? Why would a for-profit health insurance company behave any differently than, say, a oil corporation or telecommunications company?

It wouldn't, and that's the root of our current problem with health care, IMHO. In any for-profit insurance company, the business model is 1) you bet the company you're going to die, get sick, or have a housefire and 2) the company bets you that you're going to live, be fine, and be careful with those matches. So the goal is that the company will minimize their risk by limiting what behaviors you may choose. No using a charcoal grill in your living room. No smoking or your life insurance rates will go much higher.

The difference between life or house insurance and health insurance is that you can, theoretically at least, live without life or house insurance. Let's forget for a moment that your bank will insist you buy homeowner's insurance if you want a mortgage loan. Health insurance is something different. Most people, at some point, will get sick or injured and require medical treatment. And in most cases, you can't accurately predict when you're going to get sick or injured. And in most cases, a serious illness or injury will cost big bucks. Furthermore, in many parts of the USA, you can't see a doctor without insurance. So if you don't have health insurance or suitcases of cash, many people in the USA can't get even basic health care.

That's a huge difference between health insurance and other types of insurance. And that's why the debate that seems to be missing in our current health care shouting match is for-profit insurance companies. I don't see how we reform any aspect of the completely out of control health care costs in this country without doing what much of the rest of the world has already done: outlawed for-profit health insurance for basic coverage. I referred to this Washington Post article by T.R. Reid in my 9/3/09 post:

Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. "Our customers love it," the group's chief executive told me. The corollary is that everyone is mandated to buy insurance, to give the plans an adequate pool of rate-payers.

The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

The current argument over whether we should have a "public option" is little more than a meaningless distraction. To really effect change in the way Americans get access to decent health care, we should be pursuing the establishment of a universal, not-for-profit health insurance system.

As long as we continue the fiction that we can have a for-profit health insurance system that will act in citizen's best interests, we're doomed to continue the mess we're now in.

Maria Bartiromo Going Down In Flames?

If you haven't watched CNBC's Maria Bartiromo displaying her ignorance about our health system on camera, you ought to check the Youtube video or here. It's just fascinating how some public people are so supremely self-confident they can make such utter fools of themselves and keep smiling. I wonder if any little tiny alarm bells were ringing in her head as she made fun of the 44 year old Congressman for not "using" Medicare. Probably not, just like they still aren't ringing for former Governor Blago, who's still blaming everyone else for his downfall.

Maybe Maria's angling for a job with Fox?

Consensus? We Don't Need No Stinkin' Consensus

There comes a time, after much effort to reach a consensus decision, when a group may conclude that consensus is not possible, because one of the parties to the "discussion" clearly is not interested in the objective and not willing to compromise or modify it's position in a meaningful way. This happens in all aspects of life. The conclusion in such a case is that consensus is not possible. The question becomes "what now?"

In the case of reform of the American health insurance system, the objective for many of us remains to provide all Americans with health insurance so they can obtain necessary health care. The Democratic Party has clear majorities in both the House of Representatives and the Senate. The Republican Party has made it clear that it is more interested in protecting the monied interests in the insurance industry and is not interested in a consensus decision.

The answer for me to the "what now?" question, is move forward. No reform of our insurance system is possible without a real public option. This country is the only industrialized nation that even allows for-profit health insurance companies. (For more info about how other nations provide health care, listen to the "Fresh Air" interview of TR Reid or read it.) A public option is the only way to break the strangle-hold that private insurance has on our health care system. It's wrong for the President to back off a public option and we should all tell him that, loudly and clearly. You can do that by clicking here and signing a petition to the President.

The Democrats control the House and Senate and should stop wasting time and energy trying to reach a "consensus" plan with the GOP. The House and Senate should draft a true reform bill and vote on it before the end of September, 2009. As Froma Harrop says, what voters will remember in November 2010 is whether the Democrats passed reform, or did not:

Democrats: Don't worry about November 2010 at the moment. Voters gave you the White House and commanding majorities in Congress to fix America's long-festering problems. Let Republicans go to their corner and holler, afraid that Democrats might get credit.

Democrats have the power to reform health care now and to do it right. They should use it.

It's time for President Obama and the Democratic Party to tell the GOP to take their fear elsewhere and pass health insurance reform with a government option now, without the GOP.

Is The GOP Marching Off Another Cliff?

There apparently is some hope for those of us who are dismayed by the screaming and yelling from the Right and disruption of town hall meetings about health care reform. Froma Harrop has some observations on why this is just another example of the GOP's penchant for "red faced crusades":

The right wing has launched another of its red-faced crusades. When that happens, the loser is ultimately the Republican Party. Sure, obnoxious behavior gets a lot of attention. So do car wrecks.

Harrop goes on to recite a litany of examples starting in 1998 with the GOP attempts to remove Bill Clinton from office and up to 2005 when "Republicans tried to make hay out of the Terri Schiavo tragedy." In each case, she goes on to highlight how out of touch the GOP was with voters and how that translated into losses in the House of Representatives and US Senate.

Read her column and take heart. One can only hope the GOP's influence in Congress is further diminished.