Thursday, February 15, 2007
Crashing to Earth, and why it needn't happen......
(Paul issued this challenge to me, which I accepted. Thanks, Paul.)
Picture the Hindenburg (Oh, the Huge Manatee!!!) catching fire and descending to the ground, only in extreme slow motion. THAT, my friends, pretty much describes our health care system, if you can really call it that. While more and more Americans lose any kind of affordable insurance, the cost of providing health care of any caliber continues to skyrocket. As the treatment centers of last resort, emergency rooms are being overwhelmed, as the uninsured and those who don't understand what a medical emergency really is tax a system that threatens to melt down under the strain. In the ultimate paradox of the 21st century, the most advanced nation on this Earth in terms of medical technology isn't able to provide the most basic health care in a rational and cost effective manner to a large and growing segment of it's population.
I could be wrong about this since I THINK I heard this on the news or in some article, and please point it out if that's true, but there are only two nations on Earth that do not provide SOME level of state sponsored universal health care, those two being the United States, and Australia. The only two. Maybe they didn't include Somalia in this study, but perhaps that's because Somalia hasn't even had a government for some time now. If this IS a fact, it's a sad, and totally illogical fact.
Anyway, the monkeywrenchs stuck in the gears here are so glaringly obvious, I can't understand why they haven't been dealt with long before now. The first and worst fubar that's making all this possible is this long-held delusion that the free-market and health care can possibly have any relationship to each other, unless you are deliberately dreaming up a guaranteed way to bring down that zeppelin. Can you imagine what would happen if we turned over the entire government to Haliburton to run for us? Yea, that's right, Senators and Congressmen dragging down obscene CEO salaries while services are cut left and right in the name of "efficiency". Forget being poor, you wouldn't live long enough to file your tax return.
When operated on a non-profit basis, a hospital is adhering to the principle that you try and control your costs within reason, you charge what is necessary to deliver that care in the best manner possible, and tack on enough profit to maintain your infrastructure while upgrading your services as needed. You don't throw money at executives just to do their job, and yes, they are EXPECTED to earn what they do get. You don't concern yourself with stockholders, because patients and those who are charged with delivering healthcare to those patients ARE the stockholders, and they are not there to get rich, they are there because they are needed, and are paid a decent wage to do their jobs. Unfortunately, we here in the United States think EVERYTHING is a tree ripe for the picking, and thus you have "for-profit" hospital chains attempting to reward stockholders and greedy executives while at the same time understaffing their hospitals and refusing to use what profits they do generate to enhance their ability to do what they are mandated to do. Meantime, the insurance companies are balking at paying even what it honestly costs to deliver these services without hiking up the rates for their policies, so determined are they to suck out their share of the loot for the benefit of THEIR stockholders, becoming nothing but money sucking middlemen who skim off profits while making the problem worse. Yes, there are certain services within our society that can clearly benefit from competitive free enterprise, such as package delivery and other such straight-forward services, but health care is a much more complex monster that does not fit that model. Capitalism requires big losers outnumbering winners. In health care, that is the worst kind of model you should be wishing to embrace.
It has already been proven by economists in study after study that the Federal Social Security and Medicare system has been able to deliver it's services much more efficiently and at far less cost than any private enterprise could hope to match, since it deals directly with the consumer without having to pay delivery ransom to some middle man. The shortest distance between two points, even in capitalism, is a straight line uninterrupted by middle men serving no other purpose than to add bottlenecks and suck out more money from the stream.
Another major problem we face in this country is this sense of entitlement and unrealistic expectations that the health care system has created by being as good as it has been in extending lives, without a corresponding increase in the QUALITY of those lives. We have also used this system to interfere with nature's mechanism of strengthening our gene pool by weeding out the weak and non-productive amongst us. People who a hundred years ago would not be expected to live long enough to pass along those damaged genes are now living and reproducing and creating a whole new breed of human that otherwise would never have survived to place such strains on the rest of us. We value life so much, yet we seem blind to the horrible quality of life that we promote by extending life at all costs. We can't even seem to accept that some people simply are not designed to live to be a hundred, and go to great lengths to keep people alive no matter how horrible and empty that life might become when we warehouse them in nursing homes and tend to our guilt by periodic visits to these people who were once such vital forces in our lives, but whom we refuse to grant the dignity of a good death when their own personal physiology's say it's time to go. This only drains more money from the effort to keep the rest of us healthy in the face of injuries, disease, and more easily dealt with infirmities. It's no wonder that the more "primitive" a society is in relation to us, the hardier it's stock seems to be. How many of OUR women squat down in their cubicles, have their babies, and go back to work after cutting the cord? I don't suggest it's a good idea to promote that kind of maternity, but that's just how tough it is in some societies and humans there are built to deal with it when necessary.
We also have a pharmaceutical industry, in all it's free-market glory, that focuses most of it's energy on developing drugs that MANAGE disease rather than CURE it. There is no profit in curing a disease, but there is plenty of profit in keeping the sufferer of that disease alive as long as possible, paying for those drugs forever. What is the ratio of cure versus management type drugs in the last forty years? Do we need a study to point out the obvious? Imagine the Federal government taking over this job, rewarding bonuses to research teams who actually produce drugs that benefit consumers more than they do a drug company.......can ya wrap you head around THAT? Imagine getting a drug for diabetes or heart disease for slightly over what it costs to produce, rather than what it costs some drug company CEO to buy a new yacht. Yea, I know, I must be some pinko commie just to even imagine it.
Despite the complexity of modern health care, there are remarkably simple and straight forward fixes that can be applied, but probably won't because it would remove the profit motive and we simply can't have that can we? Here are my ideas (which I will not take credit for in their originality) that won't make it very far, due to their logic and the incredible PAIN it would inflict on such an entitled populace which wants all the rights but none of the responsibilities.......
Universal health care delivered straight from the Federal government much like Social Security and Medicare, taking the premiums straight out of everybody's paychecks just like the rest of all those terrible taxes, based on income level, of course. Based on the claim that the larger the "group", the more affordable it is to cover them, well, what "group" is larger than all of America?
Nationalize all hospitals, using the VA hospital model. Pay physicians handsome, but not outrageous, salaries based on their time in service, their expertise, and their ability to deliver quality care to their patients, rather than how many lippo-suctions they can get out the door in one half-day. Pay bonuses according to specialties and how onerous it is to become proficient in them. We also have to take into account how much sacrifice most physicians pay in their training years and in their day to day lives when they have to be available to their patients at all hours of the day and night. As far as bad doctors go, remove any incentive from the system for any one physician to protect another from bad practice. Shared peer responsibility can go far in weeding out bad doctors, before the civil and criminal law needs to step in and intervene, after the damage has been done.
Provide for another level of national service on par with military service. Pay for the nursing school tuition of those who wish to serve as nursing assistants in national hospitals for four years. If at the end of those four years they have decided they weren't cut out to be nurses or some other allied health occupation, they can be given tuition for any four year degree, but they will have provided a much needed service to this country in the meantime, and didn't have to pick up a rifle in order to serve their country.
Provide for doctor's training in the same model.
Finally come to grips with our growing epidemic of obesity and other self-inflicted ailments which are placing such an inordinate strain on our system. I really don't see any inalienable right to gain 400 pounds and expect the rest of us to deal with it. Everybody should be required to have a yearly physical in order to be covered for health care, and those who are gaining weight should be required to control that weight, through diet, exercise, and whatever medical intervention should prove to be necessary. Showing up with a hundred extra pounds over what your frame should be bearing should get you a ticket straight to a Federal "Fat Camp", where you are treated for your eating disorder or whatever metabolic problem that might be causing it. If you think this is some onerous attack on your personal freedoms, fine, keep stuffing your face or refusing to deal with your problem even though you are offered help in dealing with it, and you can forget getting any kind of health care unless you also happen to be rich and can fly to mexico for your next heart attack. I for one am tired of the unproportionate effects you are having on heath care overall, and I have an equal right not to have to pay for it.
Yes, other countries bit the bullet long ago and nationalized their health care systems, and yes, some of them have had to rely on some degree of rational rationing, and there are always going to be complaints, yet you do not see those same countries rushing to copy this messed-up system we are laboring under. I agree that we are better off in many areas of our lives utilizing free markets to provide us with products and services, but health care is not a product or a service that can prosper under a free-market system. Like I have said, capitalism cannot really function without two extremes, winners, and losers. If we are really the caring people we claim to be, then we should not be proud of making a buck at the expense of the basic health needs our our fellow citizens.
There are probably many other sane and rational approaches we can use to address the growing problems we have with health care in this wonderful country of ours, but I sincerely doubt that those answers will be found under the guise of the free-enterprise system. Yes, you can buy an hour's worth of time with a prostitute, but it's not love you're buying. All we really need right now is love, my friends. All we need is LOVE. Even if it includes TOUGH love.........