On US healthcare reform - sure to piss everyone off!

[stef_tm]

Not that anyone asked, but I thought I'd piss away time at work and offend my FL share my thoughts with you regarding US healthcare reform:

- Reform is mandatory
- Reform will need to take place in multiple steps over time. It's too large a system to overhaul at once.
- There is no perfect solution.
- We need to be candid about the leading causes of disease in the US: smoking, high sugar/fat diet, lack of exercise.
- Preventative care is much less expensive than critical care
- Stop extending life in the ICU; giving an unconscious 90 year old six weeks in the cardiac unit is not quality of life. That's right: I'm all about killing your Grandpa. NOT. It's about respecting the death process. Hey "deathers" - it's called Hospice. Go look it up on Wiki. No one is going to put your Nana on an iceflow so stop bitching.
- Doctors aren't G_d and hospitals/insurance companies aren't babysitters. You'll have to manage your own healthcare and be a savvy consumer.
- Bring back PE in schools.

My primary issue is - how to pay for healthcare?
- Stop subsidizing corn (i.e. make high fructose corn syrup expensive.) Once soda is more expensive than milk, you'll see a change in the American diet. When broccoli is cheaper than Doritos, people may think twice. Use that farm subsidy to provide healthy meals in public schools and senior centers.
- Adopt a model that works. Northern Californians will throw rocks at me, but I'll say it: Kaiser Permanente. Not for profit. Focused on preventative care. Brings down the cost of private health insurance in the communities where it is offered because Cigna and others have to be competitive with KP. Funny that they do that in Nor Cal and *still* turn a profit. Go figure.
- Legalize pot then tax it.
- Stop incarcerating drug offenses. Use the $ savings for drug and alcohol education and treatment. Oh wait, there's still $ left over? Great! Use that for health screenings in public schools and at local libraries.
- Increase the number of physicians assistants and nurse practitioners; get out of the doctor-only system for health management. In that way, preventative care can be offered at an hourly rate much less than an MD. Doctors should be for trauma and cutting. Nurses/PAs for everything else.

Which modules first?
- All children (under age 21) have 100% coverage.
- Tax credits for buying personal catastrophic health care insurance.
- Free nutrition counseling.
- Free diabetic management including testing equipment/strips.
- Free weight loss management.
- Free vaccinations (childhood and flu)

Your thoughts?

(ETA: I thought this was interesting: http://www.huffingtonpost.com/dr-mark-hyman/why-health-reform-will-fa_b_248986.html)

Comments

[jacflash.livejournal.com]

I'm with you.

I strongly encourage you to read this book. It makes a compelling case that the principal cause of chronic diseases (diabetes, heart disease, obesity, some cancers) in the US is refined carbs, full stop, while illustrating many of the current problems with the American health-nanny establishment. (Here's one spoiler: the American Heart Association sucks.)

[jacflash.livejournal.com]

So I guess what I'm saying is that if the "free nutrition counseling" is rooted, like most current nutrition counseling, in bad 1980s thinking, it'll probably do way more harm than good.

[nokomisjeff.livejournal.com]

Hey, I like corn subsidies. Any grain subsidies offer a floor on prices that enable one to find a bottom of the grain markets and that is tradeable and is a good thing.

My take on health care reform is to get the government completely out of it and allow free market forces to work their magic. Why should hospital beds and number of nurses and MD's be limited by fiat?

I remember the election of 1976 when Teddy Kennedy was vying for the Dem. position. Health care reform was the #1 issue back then, and if it hasn't been solved by our government in 33 years, I don't think it has a chance of being solved now.

I vote for maintaining the status quo....but I would like drugs legalized and taxed.

Just my 2 cents.

Jeff

[yaaresse.livejournal.com]

Not really a coherent thought, but an observation: I'm looking at the bill from LabCore where I had blood tests a couple weeks ago. The original bill was $784.97. The "discount" for being "in-service" made the final bill, paid by insurance, $82.63.

With that kind of "discount", I have o ask: What was the real cost for doing the blood tests, and how much of that $784.97 was pure bullshit?

Also, why not allow HSA's to be contributed to and used by all instead of limiting contributions to those with HDHPs? Maybe $2000 per person deductible isn't "high" for someone making six digits, but after paying in 12.78% (and increasing next quarter AGAIN) of M's gross home on insurance we seldom use only to be hit with a $2000 deductible and 20% co-pay the first time we DO have to go to the doctor is pretty damn high to us.

You won't get any complaints about Kaiser from me. What few experiences we had with them in NoCal were positive. It was all just checkups except for when I saw a retina specialist, so maybe it is different if one has a chronic condition.

[cjhm.livejournal.com]

Didn't offend me in the least - but then - I live with socialized health care - an imperfect system but a starting point.

I completely agree with you about legalization of some of the lesser vices - it's time that the heads and hookers start paying their share too. And you're right on - preventative care is less costly.

But good luck trying to sell it down there - I understand there's quite a bit of resistance. And personally I don't mind in the least the number of US born friends that have been coming up here for prescriptions and babies and stuff.

[editornia.livejournal.com]

Stop subsidizing corn (i.e. make high fructose corn syrup expensive.) Once soda is more expensive than milk, you'll see a change in the American diet. When broccoli is cheaper than Doritos, people may think twice. Use that farm subsidy to provide healthy meals in public schools and senior centers.

This is a good idea. They do that? I didn't know that (not being from the USA and all!).

[revdrmarsh.livejournal.com]

What about the sugar subsidy? Sure, we keep the price of sugar high for our producers, but that is why HFCS is in soda and candy manufacturers moved to Canada & Mexico.

Bring on the legalized marijuana and then bring on a few other drugs slowly over time. Not sure which ones, but hell, why spend the BILLIONS on fighting drug lords when we can tax it and make money! Plus, it helps farmers who lost their corn and/or sugar subsidies.

I WANT an HSA with a 5K deductible health policy. Sadly, I am too fat to qualify as an individual. If I got a job with a larger company, I could TOTALLY have coverage now.

When I had my motorcycle wreck in 2002, I thought I didn't have insurance at the time of the accident. Then a few days later, I learned the denial of COBRA forms hadn't been sent in yet, so I got it. Interesting to see a $16,000 hospital bill get knocked to $12,0000. Then they would only pay $10,500. The hospital took the money and never asked me for a dime. When I had cellulitis, my overnight stay in the hospital without insurance was $6,000, but they knocked it down to $3,000 with immediate pay. WTF? Like previously asked, what is the real cost here?

I want to see some reform, but I want it to be intelligent and compassionate care. I am all for a system that provides a certain level of care, "built in" and if you want more, then get an additional policy.

I have noticed the price of a 12 pack of soda has skyrocketed and may be what gets me off my soda kick!

Thanks for the forum :)

[apel.livejournal.com]

- Reform is mandatory
- Reform will need to take place in multiple steps over time. It's too large a system to overhaul at once.
- There is no perfect solution.
This is so important. In this case perfect really is the enemy of good enough. Or even, better than what we have right now. People going bankrupt because they had an accident -- not cool.

Aside from that, what bothers me the most about the debate in general is the element of blaming the victim that I see a lot of.

There are diseases and injuries that are self-inflicted, no doubt about it. But when I see (in other fora) that we should deny care to ill people who brought their illness on themselves, I get the chills. For one thing, there's the fat police that want to punish people for being fat. There are subtle overtones of racism and of hating poor people in many of those discussions.

I also wonder where it ends? If we deny care to those who slowly bring death on themselves, why not those who are self-violent? Cutters? Suicides? What about women who stay with abusers? At what age is an abused child old enough that if it doesn't run away from the abusive situation, we deny care?

What about other types of slow self-inflicted harm? Alcoholics? (Good luck drawing the line between an alcoholic and a heavy drinker.) Drug abusers? Prescription drug abusers? HIV-positive? There are so many shades of grey and judgment calls that it turns into a nightmare of arbitrariness for the person who needs care, or a quagmire of appeals that jams up the whole system.

The blame the victim mentality exists in other countries too. It's just that once you start looking into trying to enforce society's standards it becomes obvious very quickly that it's not workable so except for relatively easy, well-defined cases (no lung transplant unless you stop smoking, e.g.), it's very quickly abandoned.

[curiouseve.livejournal.com]

Ounce for ounce, isn't broccoli cheaper than Doritos? I didn't know broccoli was that expensive.

Whenever we talk about legalizing drugs, I must always say that pot is just in a different class than all the rest. It doesn't seem like such a good idea to me to legalize heroin, crack, or meth, but I am 98% supportive of legalizing marijuana. Real potheads generally don't get violent or desperate for money....

[6-bleen-7.livejournal.com]

I think all your ideas are good. In fact, a former CDC director gave a lecture here a while back in which her main point was that the most effective way to reduce health care costs was to get Americans to live healthier lifestyles.

It isn't just corn: meat, too, is heavily subsidized. In the Third World poor people are vegetarian because they can't afford meat; here, poor people can eat at McDonald's but can't afford fresh vegetables.