The 1x Objective

I had a lively discussion today defending the “public option” component of health care reform.  Below is what transpired; I thought the different view points were quite interesting and well worth sharing.  Please contribute your own thoughts below! (Note: I am not personally committed to one side of the fence or other, but today I defend the ‘public option’.)

ME to MW: my understanding is that the public option is just that, an option. if you want to stay with your superior and therefore more expensive health care insurance provider you can. thats the beauty of the open market. and by providing a cheap alernative to everyone- that way everyone can have at least ok health care and your costs might go down in an effort to compete with the national option. ultimately you will always have the choice, or at least your employer will

also, “america provides the best health care” is a phrase totally misused.first, anti-reformists use it to stir nationalism in feeble-minded americans cuz america is just the best at everything… except for modesty and self-awareness second, we do have the best doctors, no doubt, but that’s cuz we pay them the most (which i am ok with). BUT. Third its the most bloated health care system- the throw money at a problem solution is bunk and wasteful. there are more MRI machines in seattle than in all of canada… srsly wtf.

Opening Statement: From CNN this morning – “Medicare overhead: 4%. Average private insurance company’s overhead: 30%” – and you don’t want a public option?

Person 1: No!  My friend’s uncle lives in Italy (public health care) and was in an accident recently. He broke his pelvis and both arms. His wife broke her hip and arm. They sat in the hospital for almost THREE weeks before they were even seen by a doctor! Absolutely NO!

Response: Do you know who has the public option right now in these very United States? Most retired folks and just about every war veteran. I can tell you from personal experience, that the folks at the VA get treated just as fast as anyone else does, and certainly not like your experience in Italy. People that are against health care reform are using scare tactics and are in some cases out-right lying about what would happen. So let me be clear again, a public option already exists in the VA health care plan and with medicare and what is being proposed would be an expansion of that, and would NOT be the complete rehashing of health care into an Italian (or Canadian for that matter) system.

Also, it should be noted, that with VA healthcare, the hospitals and clinics are also run by the government.  So this is different than just government-run health care, this is government-provided health care, which, obviously comes with its own set of issues.

Person 2: If politicians would BEGIN health care reform with TORT reform, we could immediately see a 30% plus decrease in rates. But, the vast majority of politicians ARE lawyers and lawyer make up the LARGEST lobbying bloc in Washington, I guess everyone BUT lawyers are going to be screwed by the rising costs of health care. What we need is the MY health care reform plan: Tort reform, portability of policies, competition across state lines, and an assignment pool for newcomers to the system based on the health of the individual and spread out proportionally over all insurance providers. Then, since no one can MAKE someone go to the Dr. for checkups and Preventive care (much cheaper than care once you are sick) I would give tax credits to those families and single users who provide proof hat they GO for physicals. My son fell and cut his head, (no swelling) and they gave him THREE MRI’s because they were afraid of lawsuits- ridiculous.

Response: I totally agree with you on all counts, except the last; I agree that tort reform is needed and is blocked by the lobby.

For me, portability is the SINGLE MOST IMPORTANT THING to the success of health care in America. I cannot stress that enough. The reason insurance companies don’t cover things like yoga and gym memberships but will pay for gastric bypass is because everyone is locked into the same insurance company that their job picks.  If they switch jobs, which most people will almost certainly do at some point, then that company has no reason to pay for primary prevention because they will never see the fruits of their labor.

The point of contention I have with your statement is this assigning of people to health insurances in a distributive manner. I think this may not be a good idea because that totally does away with competition all together, right?  We need competition to drive down costs.

Finally, as far as tax credits for going to check-ups is sticky issue. i agree that most people in America are not good at following up on things in general, and bribing them with tax credits might work, but I think that is a dangerous precedent to set (like paying kids to get A’s- it apparently works, but I feel is morally questionable).

Person 3: No, or at least not from what I hear. If we had this wonderful health care system when my daughter was sick, she wouldn’t be here today.  We wouldn’t have had to choice to go to A.I Dupont, nor have the pediatrician who saved her life.  It [the plan] would also fine small businesses if someone doesn’t have health insurance offered to them.  In addition, people are asking if they will be able to keep their doctor(s) and while Obama says, “yes”, he forgets to add in,  ”but only for 5 years”. Finally, yes it’s sickening re: how much private insurance companies make and what I have to pay out of pocket and that I have to fight with BCBS all the time and I have to pay more because of the people who don’t have insurance, but I want to have to choice to have the best  and not just what you get.  Things do need to change, but it’s within the insurance companies.

Response: My understanding is that the public option is just that, an option. If you want to stay with your superior, and therefore, conceivably more expensive health care insurance provider, you can. That’s the beauty of the open market. and by providing a cheap alernative to everyone, everyone can have at least OK health care, and your costs might go down in an effort to compete with the national option.  Ultimately, you will always have the choice, or at least your employer will, which is a different problem all together.

Also, I think it’s important to point out this: at the VA if someone can’t get the treatment they need THEY WILL ABSOLUTELY SEND YOU WHEREVER YOU NEED TO GO TO GET THE PROPER TREATMENT.  So, if things go as planned you’d have been fine still.  The public option does not mean AT ALL that you would not get the right treatment. That’s simply not true, and I’m basing that on 6 years of direct exposure to the currently established ‘public option’ type prototype at the VA.  Again, care for vetrans at VA hospitals is compounded by the fact that it is government-run provision as well.

Person 4: I honestly don’t know enough about the healthcare that Obama is proposing but, as a person who lives with public healthcare (in Ireland), I say, “no thanks”.  It’s not the doctors or nurses, it’s the way the health department is managed by the gov’t and, at least in Ireland, they are doing an awful job.

Response: It does depend on the gov’t NOT doing an awful job, but that’s why I posted the original comment: 4% overhead vs 30% overhead- who is doing the worse job? The VA and medicare system work really well over here for the most part, but, of course, we need to be cognizant of slipping into a faulty version of an European-style system.

And again, I will reiterate, that a single payer system is an AWFUL idea.  That would create a veritable monopoly, and we would wind up with the same problems as the Canadian system, which, if you ask many Canadians, is not good either.

Medical Student 1: Sigh.  I am doing a rotation at the NHS in S right now.  Their heatlhcare is miles ahead of what Americans receive.  Let’s clarify a few myths.  They don’t put you out to pasture at 70-years-old, you do have a choice of what doctor you want to go to.  You don’t have to wait months for medically urgent procedures (i.e.: breaking your pelvis and arms).  It’s sad how misinformed most Americans are about how health systems are run. Devaluing publicly funded (NOTE: not publicly run) systems and overvaluing our lack of system we have now.

As it goes for preventive care- I recognize that this will not reduce costs, but will make our population healthier for longer. Increasing our societal gain and for that I am for it.

Person 2 Post 2: [re: his personal experience with the VA] My father spent most of the last 18 months of his life in and out of the VA, and if that is an example of what “ObamaCare” will be, just shoot me like a dog first. IT WAS HORRIBLE.

Response: What was so bad about it? Here, in Albany, the VA is staffed by the same residents, features the same education/ conferences, the care is very evidence-based and, also, the VA has a well-developed EMR system in place, that’s arguably the best in the business.

Person 2 Post 3: But the public “option” will end up taking away everyone’s private insurance.  Why would companies want to waste their resources in HR and elsewhere dealing with insurance problems.  It’s like- a small raise to the employee with resulting expectation pay your own ins to the government is just the answer, and then everything else will be all right?

Also, the VA was awful in our experience. We made an appointment to see a doctor and who never showed up; we had things stolen or “misplaced” from the rooms. Can’t find our dad, because he was sent somewhere else without telling anyone… just, awful.

Response: I’m not sure I follow your logic in the first paragraph, but I will say this: if the public option causes private insurance companies to go out of business, because they refuse to remain competitive, then I say, “Good, screw them.”  As things stand now they are so bloated that they are truly having a negative impact on patient care. I’m not sure about this, but something like this is true: one of the HMO CEO’s is like the 6th richest man in the world, for doing essentially nothing to treat the patient.  I am all for private business and entrepreneurship, but you have to stop and say to yourself at some point, “enough is enough!” When 50 million Americans don’t have health care for whatever reason, this desparity has to at least raise an eyebrow.  In my opinion, the whole POINT of a public option is to foster competition which would in turn force insurance companies to tighten their waste-bands to compete; and, the glorious thing about competition is that, as in Person 3′s case above, you still have the option of paying for your expensive private health care that will give you yearly body scans and treat your brain cancer when you are a 100 years old… Go ahead, knock yourself out! lol.

BUT, as it stands, with the public option, your employer could choose it or could not.  If they do choose it because there is less paperwork (as you specifically mentioned) then, well, those other companies better cut down on the paper work. Health insurance, while it is meant to be good and behind-the-scenes, is, in practice, of questionable moral character and is overall bloated; It is viable competition that will force them to suck it up! That 30% overhead I mentioned before amounts to over a trillion dollars a year. Cutting that fat alone could pay for the whole proposed health care reform bill (in reality it wouldn’t work like that, but, the point remains valid). That money is going to people that don’t give you your care and no longer act as your advocate, IMHO.

I think your experience with the VA is unfortunate, but most doctors would agree: similar occurrences happen at every hospital, and those occurrences are the exception, not the rule at both public, private and VA hospitals.  Also, I am not really trying to defend a government-run facility.  If the government ran all the hospitals and clinics, I really do think that would negatively impact patient care in the long run, and also possibly dissuade doctors from coming to practice here in this system, and in the long run that could be quite detrimental to the health care system as a whole

Person 6: All I can say is that now being a UK citizen (as well as a US citizen) and having being made redundant recently, I thank God that I am living in the UK and have the right to the NHS.  The system is not perfect, but you do have the right to care without any cost which is pretty difficult for most Americans to believe.  Plus, if you are in an emergency, the emergency care is state of the art.  I still have the right to COBRA under the US system to extend my private health insurance but it is expensive.  I’m lucky that I can still afford it, but what if I could not? If I were in the US, I would be out of luck.  You hear often that “the US provides the best health care in the world”, which is simply not true.  You just need to look at the US system from an outside perspective to really understand this.

Response: your comments are well-received.

Cobra is for many people, even those with steady incomes, cost prohibitive. How anti-reform proponents cite that as a feasible an option seems unfair, and at the same time, its citing by proponents is also senseless.

Also, to respond to the “America provides the best health care” comment: it is a phrase totally misused, IMHO.  First, anti-reformists use it to stir nationalism, aka “America is just the best at everything” (except for modesty and self-awareness ). Second, we do have the best doctors, no doubt, but that is because we pay them the most (which, as a doctor, I can’t say that I am totally adverse to that ), and at the same time it’s the most bloated health care system around.   Does the fact that there are more MRI machines in Seattle than in all of Canada really improve the delivery of care, or health care outcomes? I seriously doubt that.