Health Care Facts August 28, 2009
The following summary from a colleague on LinkedIn concisely and emphatically resolves every major concern about having a health care system which includes a public option. Bravo and thank you David!!! ~Christine
By David Vernon, a Management Consulting Professional
1) Private insurers have almost a monopoly on employer plans, so there is now no competiton on price and service. Risk pools are regional, so inter-state private insurance will not change this. Federal jurisdiction does not extend to regulation of insurance policies written within States, but it does extend to plans receiving Federal funds. That is why we need a public option – so that Federally funded plans can offer features private insurers do not now offer, forcing all private insurers to compete on price and service (ignoring pre-existing conditions, eliminating “exclusions”, etc.)
2) 30% of current costs are accrued at municipal hospitals providing routine care for the uninsured in emergency rooms for ten times the cost of routine care in clinics and doctor’s offices. Providing Federal coverage for anyone, no questions asked, for routine care would allow these people to get care for one tenth what it costs now. A 90% reduction in 30% of costs saves 27% of current costs. That is the “indeterminate” savings from covering everybody, at Federal expense, at a cost of 1.4 trillion dollars over ten years. That is how expanding coverage could actually save money and lower overall costs.
3) 80% of lifetime expenses are accrued in the last six months of life for intensive care while dying. Absent clear instructions from the patient, medical ethics and current law require that no expense be spared to prolong life, at least unitl the $1 million lifetime insurance coverage is exhausted. Every patient who elects not to have intensive care while dying saves the system $500,000, $400,000 in insurance payments and $100,000 in copayments from the family of the patient. The cost of covering a living will conference is $100. Net savings is $499,900 per patient who makes a living will refusing intensive care while dying. Absent living wills, the 40 million Baby Boomers will incur $20 trillion in intensive care costs while dying over the next 25 years.
4) After end-of-life and routine care in ER, the next biggest cost item is 15% of current costs due to lack of proper medical information. These costs involve 98,000 excess deaths annually, duplicate diagnostic testing and imaging, and the care required to recover from mistakes in dosage and treatment. The existence of complete, accessible, lifetime electronic health records, such as now exist in the VA system, will eliminate this 15% of costs.
Bottom line = without a public option, it will not be reform. without mandatory living will coverage, it will not be reform. with electronic health records, the living will savings will not accrue because the doctor at the hospital will not know you have one, and it will not be reform. Costs can be nine times the CBO estimate and will still be half the $20 trillion that no reform will cost. Savings potential for living wills and guaranteed routine care for everyone are more than half of what we spend now.
5) Current costs of about $16 trillion annually amount to $8,000+ per capita. Results rank between 20th and 37th worldwide. The “best” results worldwide are achieved in France, which has a “public” option but not “national health.” Costs there are 30% lower than ours per capita, and private insurers continue to make profits, although not as huge as they do in the USA.
The only losers if the proposed reforms pass are the private insurers, who now reap most of the benefits of this system that lets 20,000 people a year die for lack of coverage and costs half again as much as the next most expensive national system in the world. ~~~
Health Care Coops part two August 25, 2009
The Policy-Speak Disaster by George Lakoff, Author and Professor of Cognitive Science and Linguistics at UC Berkeley, was referenced to me by colleague at LinkedIn in response to my previous post about health care policy. I enjoyed the article and heartily agree with the assertions.
For one thing, the quaility of the health care we afford ourselves does absolutely have a direct bearing on every other aspect of our aggregate life quality. Also, it is fact to me that people are not persuaded to change their inculcated preconceptions by reason or logic — at least not so long as their consciousness is ruled by inculcated preconceptions…
Are you much aware of the ‘pubic relations / social engineering’ work done by Bernaise (see: Century of the Self — 1 hour video) who demonstrated that people in general are not moved by logic, but by emotion…
Then, after they have made an emotional decision, they use logic to rationalize the ‘correctness’ of it.
And until this ‘knee-jerk’ reactionary cycle is understood as the compelling mechanism of behavior, we (individually) are the subjects of it. That is, we have little to no actual control over our own conduct tho we most adamantly fight to prove that we are in control by clamouring to gain power over others (aka: the ‘dominator paradigm’).
And one of the ways this is done is by fear mongering… which is the motivating force in the health care debate right now…
And the only (proven) way to proactively counter ‘fear’ is (not with reason, but) by cultivating (emotional) trust. Of course the (apparent) catch-22 is that the only way to cultivate trust is to be trustworthy…
On a related ‘just for the record’ follow-up, of the folks who responded to my post there was (as I understood it) 100% agreement that the ideal is to have a health care system where everyone has immediate access to the best possible health care practices without having to go bankrupt to pay for it. Also, the general consensus of the volunteered responses (most of which came to me privately) was that doing this — for a multitude of reasons — is simply not possible. About which I feel compelled to say two things:
#1 — We are the one’s who decide what is and what is not possible. Each one of us makes up our own mind and resonates it as our individual/independent attitude, which does in fact have a butterfly-effect on the well-being of our global community while at the same time having an immediate influence on our own quality of life.
#2 — We have the absolute power to choose where we put our resources. We can ‘afford’ to do whatever we set our mind to do and what with history repeating itself (until we learn from it) we have proven this to ourselves time and time again.
#3 — In light of the foregoing, all that needs be done is for us to hold true to our highest standards and most cherished ideals… stop settling for second best… and figure out how the optimum system of health care would work… then we figure out how to pay for it. Because until we know exactly what we want, there is NO WAY to even ballpark what it is going to cost!!!
Health Care Cooperatives August 19, 2009
Are you a member of a cooperative of any sort? Here in our region of the Ozarks, our electricity is provided by a utility cooperative. This type of ‘member owned electric coop’ origniated back in the 1940s or thereabouts, with government backing to assist people in rural communities to get plugged-in to the grid. To help them ‘catch up’ modern-convenience-wise with those who resided in urban communities where women like my uptown grandma were using electic washing machines and vacuum cleaners, and listening to the radio while her country cousins were still hauling laundry to the creek, or boiling it over open fires in big tubs in the backyard.
And it wasn’t that the country folks didn’t want the electric service. The problem was that the for-profit electricity generation & delivery industry was unwilling to bite the bullet to install the infrastructure to deliver the product because the investment/payback ratio didn’t serve the company’s profit margins. Thus the government, by and thru a process of awarding grants and making very low interest loans, made the installation of the conductive infrastructure possible by and thru the enabling of (a lot of) ‘member owned electric cooperatives’ which, at inception at least, seemed to be a very good thing.
Today however, and I base this upcoming opinion on my own personal experience with our local energy cooperative of which I have been a member in good standing for 20 years, our ‘member owned cooperative’ is little more than a localized mouthpiece for mandating multi-national ‘for profit’ energy policy which seeks NOT to deliver the ‘highest quality product at the lowest possible cost’ (which is the overarching mandate of every cooperative enterprise), but panders directly to (you guessed it) the dollar-driven bottom line.
Which is not to dismiss the potential for cooperatives to be ‘good things’ or to diminish the significance of money… which itself at botton line is simply a representative form of ‘energy’ with which I may purchase creative professional service or product from you, limited only by the amount of money/energy I have to trade. A statement of fact which itself goes to the heart of the whole health care reform issue: That at those times when folks are most requiring a significant infusion of ‘energy’ from health care professionals, it is generally at the same time that their own storehouses of energy at a low ebb and/or they are impaired in their ability to generate more.
Thus in terms of setting up health care cooperatives and in spite of the way our local electric cooperative now operates, the altruistic Pollyanna in me thinks that the system of egalitarian cooperation line-itemed for ‘cooperatives’ would be idyllic and sublime if applied to the health care paradigm. I as a member, by and thru payment of my dues, would be entitled to a certain range of health care services which would be purchased thru the cooperative at ‘the best possible’ price. My dues, combined with those of other members, could fund a full-time clinic and trauma center where members would be seen on an emergency, walk-in and appointment basis and either treated as outpatients or referred to a cooperative-owned hospital for specialist treatment and inpatient care — all the while knowing that there would be no gargantuan debt hanging over their heads when they were well enough to go back to work and hopefully pick-up life as at least no worse-off than they were before they got injured or sick.
Yet the real-world rational thinker portion of my intellect reasons that this would only work if the cooperative was unanimously nationalized, ie: the ONLY way for anyone to get health care and the only way for a doctor to practice medicine… because this is the only way to eliminate the ‘class structure’ which now regulates our health care system, wherein if one has sufficient of money one may purchase any manner of health care available in the world, but if one does not have monetary means the ‘for-profit death panel’ has already passed judgement.
Frankly, if we are to behave like full-fledged members of the cooperative society we all deserve to share (and that religiously many of us profess supplication to the ‘do unto others’ tenets thereof), then we as individuals must (not insure, but) ensure by and thru our own independent actions that each person in every community is able to get excellent, expedient and appropriate health care all of the time.
Respectfully, it is our own congnitive comprehension of the ovararching objective that must change: We must be unwilling to settle for anything less than the finest of the best for everyone as this is the ONLY way to guarantee that we get equal treatment ourselves.