Saturday, September 12, 2009

What's the logic in that?

A lot has been screamed at President Obama about his health care reform giving free health care to illegal aliens.

President Obama says no health care reform bill being considered includes any care available to anyone in this country illegally. One representative from the right side of the room called the president a liar for saying that.... ....

Is there really anybody in that screaming crowd unaware that hospitals are required to treat emergency cases without respect to ability to pay? Under the current system, this indigent care is paid for by the fees the hospital charges paying customers, whether through their insurance companies or from their pockets.

No hospital care is free, it's paid for!

Is there really anybody in that screaming crowd unaware that group insurance is less costly to the individual than individually purchased policies, and in fact, very few people can now afford individually purchased policies? The larger the group, the less expensive per individual. That's what groups are all about, so, screamers, would it not make sense to broaden the base of the group to make insurance more affordable?

You say that the government can't do anything efficiently, but if they were to compete with the free market by providing a single option, they'd run the efficient free market companies out of business? What's the logic in that?

Do you know that the government is "we the people", and if we don't like the government that we are, we have a vote to change it? If enough people agree on an issue, it becomes the will of the people. That's the way we make our wishes known. That's the way we MADE our wishes known last year.

You have a right to scream, but please use a little reason, and think about what it is you're screaming about, if it's not too much for you.


Mike K said...

"No hospital care is free, it's paid for!"

Indeed. And no health care insurance is free either, it is paid for. Of course, if it is paid for by the government, that means it is paid for by you and me. That is why people are upset and screaming. They understand that when something is given away for free, it will create an essentially unlimited demand that we will be expected to fund through our taxes.

What is the economic result of unlimited demand with no change in supply of a product or service? Sharply higher prices. So, the giveaway mentality actually worsens the problem it desires to solve. The way to reduce costs is to make people more directly responsible for their own health care spending.

Insurance is properly used to spread the risk of a catastrophic event over a large pool of consumers. The current trend in health care insurance plans insulates the consumer from the actual price of care by requiring only a small "co-pay". This removes the natural market forces that would influence prices in a downward direction, as consumers shop for affordable and necessary products and services. Imagine what would happen to the price of gas if car insurance worked the same way! If your insurance company was paying for your gas each time you fill up, less a $5 co-pay, would you pay any attention to the price of fuel? Of course not... and the price would skyrocket. This is what we have done to ourselves with health care.

The situation with pre-existing conditions does beg for effective regulation. The congress could make some meaningful legislation on that front, and if they limited their efforts to that arena, I think they could easily get something passed.

I agree with you that there has been too much screaming with regard to the issue. Let's hope that cooler heads prevail.

Willie C said...

Mike, you have a lot to say on this subject, and nothing you say needs rebuttal. I'm reading into your words that you agree that the current system is screwed up.

I spent the early years of my life at a time when the health care that was available to us was within reach.

All four of my kids were born without any form of insurance necessary. I had a hernia operation when I was 22 (paid for by my dad because I was in college and virtually a 'dependent'), and the to cost for hospital and surgeon was under $500.

For whatever reason, the cost of "health care" has outstripped the cost of living exponentially, and my desire is not nearly so much the "socialization" of medicine as it is to put a check on the unreasonable cost. For that reason, I'll continue to embrace the public option, because I think it has the best chance of anything that's been proposed to do what I think needs to be done.

I agree with you that insurance is not free either. Of course it isn't. I'm not nearly so adamant about denying that it is a public concern as the principle distractors seem to be. The system must be changed, or it will collapse, so I'll stick with my thoughts about it until a more viable solution is presented.

Willie C said...

This is a list of comments sent to me by my boyhood friend, Lew, who's been thinking on this subject for longer than I have.

I have his permission to post them here.

10/10/92 This is my first entry on the computer regarding medical matters.

The US medical scene is a complex situation with many problems. Among the problems are:

1. Lack of control over the medical profession's access to a nearly unlimited supply of funds (insurance and federal/state programs).
2. The recipient of the services doesn't have much to say about what is provided and what the cost will be.
3. The recipient isn't held accountable for the costs.
4. The primary provider (the doctor) has nearly unrestricted authority to expend funds, no matter what the source or utilization.
5. The providers (doctors, hospitals, drug companies and their ancillary operations) are profit making entities motivated to sell the most product at the highest mark up the market will bear.
6. A large percentage of the population cannot afford the cost of medical care.
7. The general population has a "fear" that publicly funded care providers will not deliver quality services on a timely, courteous and efficient basis.
8. The general population has been brain-washed by the medical profession to believe they are entitled to the best care money can buy, as long as the providers get paid the rates they desire.
9. There is no direct tie-in between the purchaser’s ability to pay and the cost of the desired product.
10. The medical profession has strong lobbies at all levels of government.
11. The medical profession is very skilled at public relations, advertising and marketing.
12. The medical profession plays on people's fears.
13. The medical profession is not open and frank regarding the cost, quality or need for services they desire to provide.
14. We use the existing high cost medical system to “care” for persons at the end of their lives.
15. Hypocrisy permeates the entire system.
16. What kind of systems do other “advanced” countries utilize?
17. The general population's thoughts and feelings (fear) re death are part of the problem.
18. The general population's expectations are excessive.

Willie C said...

ANOTHER ENTRY FROM LEW.....note that this is historical. Lew has studied this for some time.

12/19/92 The consumer will become a cost conscious purchaser of medical services only if he has to pay for such services. Considering the cost of such services is quite high he will probably have to utilize an insurance scheme. He should be held responsible for the cost of such services and should have to make choices re how he is going to spend his money, i.e., whether it is spent on cars, homes, medical care, boozing and chasing women, schooling, etc.

He should have a motivation to get the most services for his dollars. The insurance scheme should cover basic services only, similar to that provided by VA. Optional services should be at his personal expense, or by an insurance plan he purchases with the cost of such insurance not being tax deductible to either him or his employer. Childbirth coverage should be considered a basic service and should be fully covered, as should be basic pediatric services.

Coverage for catastrophic instances should be covered by government provided insurance carried as a separate program, perhaps in government supervised institutions.

We must apply the concept of competition to the provision of basic medical services.

How does he pay premiums for the basic coverage? They are deducted from his pay, much in the same fashion as Social Security and Medi-Care are deducted, with the premiums for basic coverage being deductible by the employer for income tax purposes. The program should be structured so that total deductions must cover the actual costs of providing the basic services.

The consumer should be motivated to shop around for medical services. This would tend to keep prices down since the consumer would theoretically want to keep his costs as low as possible, because he would be paying for “optional” costs out of his own pocket on a non-tax deductible basis.

The only way to bring medical costs under control is to make the consumer individually and personally responsible for paying the costs.

We must find a way to keep certain parties (attorneys, doctors, hospitals, drug companies, etc.) from raping the economy via publicly funded or quasi-publicly funded programs (insurance plans, workmen's comp, etc.).

12/29/92 It's been said that one of the marks of a decent culture is how they take care of their indigent citizens and this thought needs to be kept in mind when revising the medical care system. How do we provide for older people, AIDS victims, recent immigrants, etc.?

I suspect that at some point we will come to understand that care of the aged is not a medical problem and that other mechanisms and/or institutions need to handle this situation.

Re terminally ill patients perhaps we should provide publicly supported facilities, similar to hospice facilities, with it being understood (and written into law) that the facility is a place to die with dignity and not a place to fight death to the bitter end, at great expense to the public.

I suspect we should also give every person the right to end his own life at a time and in the fashion he desires. My own personal thoughts and feelings (at least at this time, at the age of 56) are that I would want to end my own life in my own fashion if I were terminally ill, a basket case or vegetable, or no longer able to live some sort of normal and satisfying life.

I wonder what a poll of very senior citizens would reveal. They certainly should have a say in the matter. I also wonder how West European nations address this question. I think some countries allow the medical profession to provide the means for a patient to end his own life, if he so desires.

Willie C said...

ENTRY FROM LEW. Maybe this one will conclude. If not, there will be one more. Lew has some very impressive ideas.

4/26/93 So far Clinton hasn't come up with a program that will reduce the "rape" of the economy being conducted by the medical professions. He's looking at funding sources and to broaden coverage so that every citizen is covered. All this means is that an even larger portion of the national gross product will be conveyed to the medical professions. Never underestimate the power and stroke of the lobbyists!

6/14/93 It seems like the business world has come up with a new method of reducing their contribution to the cost of insuring their employees for medical situations. They just change insurance companies from time to time which makes a lot of the employees medical questions fall in the "pre-existing" category which means the employee has no insurance coverage for such situations.

The solution to this manufactured "problem" is to take steps, via legislation, to delete this loophole. There is no moral reason why an employee who has faithfully performed his employment duties and commitments should be without effective insurance coverage. It is also not reasonable for a company who employed a person 10 years ago for a short time to pay more than a pro-rata amount (on a real time basis) for an employee's future medical expenses. This means we are probably looking at a national medical insurance pool, this pool funded the same way social security and Medicare are funded, perhaps with a provision that the medical tax is to be paid on non-earned income such as interest, capital gains, etc.

How do we prevent the pool from being "ripped off' by doctors and other medical providers? I really don't know. I suspect, however, that our expectations will have to be substantially reduced and that publically supported basic medical care will have to be taken out of the profit making arena.

What do we do with the existing high cost system? Here again, I don't know. I suspect the legislation, and cost reimbursement plan, will have to specify that nationally insured treatment will have to be performed in an approved facility. If the patient doesn't want to go to an approved facility he can pay for the “additional” himself. The national plan should not pay a single dollar toward the cost of any treatment provided by a non-approved facility. The elite can pay for their “eliteness” out of their own pockets.

When the demand for high cost, high profit medical care is reduced, the cost of medical care will fall. All of the specialists can't make a living treating the elite and many of them will have to treat patients under the national plan.

As far as the medical insurance companies are concerned, they can go out of business and the qualified people formerly employed in this field can find employment in the national plan.

We must have national medical coverage, and due to the cost factors the coverage will have to be middle of the road. In a sense we have to nationalize medical care.

Willie C said...

FINAL INSTALLMENT OF LEW'S COMMENTS...which he was thinking about long before the present Health Care Reform proposal.


Patients 65 and older account for 12% of the population and 33% of hospital admissions each year. (They probably account for more than 33% of hospital expenditures.)

Of all money spent on medical care over the course of a person’s life, two thirds of the total is spent in the final two weeks.

Nearly one-third of the budget of Medicare is spent on patients with less than one year to live.

The above comments are from page 258 of the book First, Do No Harm by Lisa Belkin, Ballantine Books, 1993.

These comments track with information I have received from other sources, primarily national periodicals.

When my mother was removed from ICU (at her request) and placed in Intermediate Care with a DNR order legally executed, she died of “natural causes” within 4 days.

The above comments indicate we are not handling medical care of the elderly and terminally ill on a rational basis. I don’t think the society and the economy can afford to continue this “insanity”.

We have to devise a more rational method of handling death since none of us are immortal, even if science has been able to artificially extend “mortality”.

Willie C said...

There's much to absorb in what you say, Lew. I'm looking over your email and responding to many items on a 'one at a time' basis. When I get through it, I'll send the attachment back with my notes, which, in large part agree with yours.

I think, as you've already implied in your emails, that the way for us "non-beltway" citizens to consolidate our random thoughts about the subject is through civil discourse, not through disruptive shouting matches.

Willie C

Anonymous said...

Still trying to learn how to jpost to your blog.

Lew said...

I finally learned how to post to your blog - I belatedly read the instructions.

Willie C said...

Looks as if you got it! Use the blogger one with your name on it. Anonymous is so impersonal....;^}

Lew said...

Doesn't the preamble to the U.S. Constitution include the phrase "...promote the general welfare,..."?

Further, I believe the last sentence of Lincoln's Gettysburg Address contains the phrase "...that the government of the people, by the people, for the people shall not perish fron the earth."

I have yet to find any basic document indicating the medical industry is entitled to bankrupt the country.

Willie C said...

Yes, Lew, and the part that says "We, the people, of the Unites States of America", seems to have gotten de-emphasized. "Of the people, by the people and for the people", gives emphasis to "the people". Many people interpret this differently, it seems. Some few say that the only obligation the Federal government has is to protect the states from foreign invasion.

I feel that "The people" applies to individuals. The Constitution authorizes the government to protect individual citizens from the unscrupulous acts of other citizens. I think that the oath taken by congress members which includes "enemies both foreign and domestic" means just what it says.

And, "promote the general welfare" should authorize health and fitness, for those who say that there's NOTHING in The Constitution that provides for health care.

When, sometime during the middle of 1008, President George W. Bush said, "We need a strong economy...a strong economy attracts capital", he led me to believe that he thought that was the purpose of a strong economy.

Mike K said...

The constitution puts many specific requirements on the federal government, most of them in the negative. For example, it prohibits unreasonable searches and seizures, prohibits the taking of private property, etc. Nowhere does it require that the federal government provide for the basic needs of every citizen. I think the founders would have found such a notion offensive in the extreme. But, one might entertain such a notion under the general welfare clause in a most imaginative reading.

I must wonder, however, if such basic needs are actually called for, even so loosely and ambiguously, in the constitution, why we are just now discovering it? Why did the founders not provide for the medical care of each citizen from the beginning of our great nation? Common sense would dictate that food and shelter be provided, as well. Why were they so negligent?

Perhaps the truth of the matter is not valid for all time. Perhaps the constitution does not mean today what id did then. I know there must be many who hold that view, even some on the highest court in the land. But I find such a notion intolerable. If it is the duty of the federal government to provide for the basic necessities, then it must always have been. If it has not been, then it certainly is not now!

Perhaps the whole matter is a simple misunderstanding. The left may simply be seeking such regulation as is necessary to prevent the rape of the common man by the powerful in the health care industry. If so, they are perceived by the other side as wanting much more, no less than making the lowly taxpayer responsible for feeding, clothing and medicating all comers. The "public option" raises the specter of a beast which must be perpetually fed, but will never be satisfied.

The other side may be similarly misunderstood. If they simply do not wish to be saddled with a burden that has no definable limit, they are perceived as not wanting to take on any burden at all. Their preference for incremental changes that take advantage of market forces rather than government mandates is viewed as stonewalling.

I am curious as to the opinions of anyone reading this. Do you really think that the constitution requires that I (Mike Krzywonski) should be responsible for paying for YOU (_your name here_) to have health care insurance? If so, why? Was this always so, or was it different in the days of our founding?

Mike K.

Willie C said...

Very well said, Mike! It's obvious that The Constitution has been interpreted differently during different periods of time, as witnessed by the amendments. The beauty of The Constitution, and the way in which it's written, is the basic reason for there being no more amendments than there have been.

The fallacy of any poll, Mike, is the way the question is presented. The answer will be geared to the question.

If I were to say, "Do you think that the constitution permits that I (Willie C) could have health care insurance as an option supported by The United States Government" The answers to the poll may or may not be different.

This is a case where we might both wrong (I doubt we could both be right).

Soon after I posted that last response to Lew (after, of course, not before), I checked on the oath, and found it had gone through three major revisions since the founding fathers, but they all include a promise by the members of congress to defend The Constitution, not the citizens. So, it comes down to how The Constitution is to be interpreted.

The Bible has been around for much, much longer than The Constitution, and in all that time, there's no consensus on what it says, nor will there ever be.

Willie C