January 4 2010
Stupid promises and fixing the past....
Politically speaking, we're still fighting through the idea of health care reform in this country. I am, personally, no expert on the matter. I know that UPS claimed they spent nearly $10,000 to provide my medical insurance when I was with them, and that I now pay $8500 a year in premiums for my family, so that I can pay a co-pay and a deductible instead of the full medical bill. I've had a high-deductible plan with a savings account, I've had no insurance, and have had my children on Medicaid in times past. I grew up with the military medical system, and have never had a “family doctor.” A medical form is an issue for me applying to seminary, because I have to make an appointment with a doctor I've never seen, even though he's on my insurance card, to have him fill out a medical history form on someone he knows nothing about. It will cost me almost as much to have this appointment as my first class will cost, since it's not covered by my insurance.
I've known people stay sick for lack of insurance, people who go the doctor at every sniffle since they have insurance, and people that are still paying for medical bills from years ago when their insurance was inadequate. (which causes me a lot of questions about this “doctors lose money” issue. These folks are paying off bills from as long ago as 10 years. It's bad for the patient, but the doctor, hospital, provider is still getting paid. Are they having to wait on it? Yes, but they're still getting paid. I digress.) I do not doubt that the healthcare delivery system in the United States needs reformed.
I also do not doubt that the plan in Congress right now has the potential to be an unmitigated disaster. Why? Because it's Congress. “Pro” is the opposite of “con.” So, what's the opposite of “Progress”? CONGRESS! However, the disaster that looms even greater is what will happen in their midnight votes in December 2010, when we've voted most of them out for January 2011.
Do I have a plan? Not really. There are some good suggestions that are being sidelined, like tort reform and some consumer based systems. Tort reform, I think, is absolutely critical. On the one hand, I think patient satisfaction is a valid method for some of the compensation issues, but medicine has one guarantee: There are times a doctor can do exactly nothing. Sometimes, people get sick and die. You can treat, you can prolong, you can ease suffering, but you are still going to see a person die. How do you pay a doctor an outcome-based fee in those cases? As a Christian, I believe that certain people are going to heaven when they die and others are not. Do I well compensate the doctor that sent Great-granny to heaven but short the doctor who sent Uncle Skippy the other way? What if I think Skippy deserved it?
So, outcome-based needs some refining. I think it might help with the overbooking and bad scheduling that many doctor's offices do, but if the doctors believe they'll get paid better for making the patient or family think they're doing something, how much more extra and unnecessary medical events will take place?
Costs have to find a way to come down, so that individuals can get back to being in control of their own care. It will never be between a “patient and their doctor” when someone else is paying the bill. Decision making power follows the money in nearly everything. The solutions, though, are going to have to be local, because that alone will allow for the variety needed. One size may fit all in clothing, but not in hats or medicine.
Politically, more concerning, though, is a threat by the Republican Party that, if they return to the majority in that election, they will immediately repeal whatever has been passed.
Now, anyone should recognize that “ NO!” is a legitimate answer, even without an alternate plan, when the plan you're given is horrendous. I do not fault the stubborn elephant resistance to the current plan. However, if that plan becomes the law, you cannot simply plan to scrap it in 18 months. If it passes, businesses will begin to plan based on it. People will begin to plan based on it.
If you want to scrap it, you have to have something better to replace it. And just “going back to the old way” is not going to cut it. Not if the goal of the Republican Party is to stay in the majority in the next election. Have a plan, a real plan, even if your plan is to mandate that states come up with a plan. And no, you don't have to fund it, but you cannot obligate them to spend anything. A state's plan can be “you're on your own, turkey!” Then you can really compare the economic impacts...see what states draw employers and residents, the states with a provision plan or the states that intentionally don't do it.
You have to fix the past by providing the right direction for the future, not by just undoing what was recently done. Up, down, up, down, left, left, right, right, B, A, is the Konami code, but that's just to unlock goodies on a computer. It's not the directional chart for a nation. We need to see clearly articulated plans and allow the nation to choose which way they want to go. And then deal with how those of us who don't like that direction will handle it.
To the Democrats: stop and listen. Make a plan, not a kickback system. To the Republicans: 2009 was a great year as the Party of NO!. Now, you need a plan. To the irritated independents: keep notes. Short memories make for bad votes. Who has backed up their words? Who has followed through, who has betrayed? Who has shown they can be bought in other issues? They can be bought on anything....To all: Certain truths were known as self-evident 200 years ago, yet we've forgotten them. Those rights and truths are endowed by our Creator, not by our government. We will have a government that recognizes those rights and truths. The question to you, dear politicians, is: Will you be in it?