Burnt Offering: Common Sense Health Care Solutions From An Everyday American
by Robert DaviI am sick of speeches, I am sick of promises, I am sick of hearing the same old rhetoric: The State of the Union with all the applause and heads nodding in agreement or disagreement — the ping pong of politics, the white noise that drones on until we’re numbed and anesthetized with everything but the truth… Then there’s the opposition’s rebuttal — which is about as exciting as eating hot watermelon. I watch the good-old slaps on the back and think, “How can they all forget about Fannie and Freddie? The CRA? That THEIR policies created this mess!?!”
For too long the American people have been bamboozled and lulled into a false sense of This Is The Greatest Nation On Earth. Don’t get me wrong, I think it is, but my mother used to tell me as a kid, “Self-praise stinks.” When I asked her why, she explained that it can intoxicate you into laziness. I’m not saying the American people are lazy, but our elected officials get up, give a speech, and somewhere say, “Greatest Nation On Earth” and we all feel better and go on about our day not paying attention, enough attention, to what’s going on, and trusting that the latest line of shit we’ve been fed is the truth — no matter what side of the political spectrum you’re on.
Then the marketing machine starts selling to the public … a pile of dung. Haven’t you heard for years the same old issues over and over and over ad infinitum? Well, the patient is bleeding to death and we do not need a tourniquet, we need amputations: Get everyone out of office who does not have America’s and the American people’s best interests at heart.
Last week I had the privilege of meeting Congresswoman Michele Bachmann at a dinner hosted by my good friends Jon Voight, Kelsey Grammer and Jay Hoffman. I had been a fan of hers and what she stood for since first hearing her on the talk circuit and most recently on “Hannity” — and, of course when she called for people to gather on the steps of the Capital when it looked like the current health-care bill would pass. But what she said this evening should have been recorded for all to hear. Now I understand that at a dinner one is basically talking to the converted, but had this conversation been broadcast to the public conversions would have gone through the roof; much like when one hears Congressman Thaddeus McCotter go at it.
Let me just say that Bachmann is terrific! One of the dinner topics was health care and she and McCotter have great ideas, as I’m sure others do, as well (much better than the Pelosi- Reid Socialist Bankrupt America Bill). But one of the best ideas I’ve heard yet came from a plain ‘ole American citizen, my friend Jack Kavanaugh.
When I had dinner with Jack and his lovely wife Leslie, Jack told me that before the Presidential election he was contacting various politicians about a proposed health-care plan of his. He was shut out, not given a voice, and I know how frustrating it is to have something you feel strongly about and have none of our elected civil-servant officials listen. What happened to government of the people, by the people and for the people?!?
Our politicians act like feudal lords or movie stars who cannot be approached (I understand safety but not arrogance). Jack was a dentist, a doctor, a surgeon at UCLA, and an entrepreneur. He knows about health care and business. So I asked him to write down what he shared with me at dinner because it deserves to be heard.
I think this is a very interesting idea.
So read on my friends,
Robert Davi
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Dear Robert,
I very much appreciated your views on the health-care problem and health-care bill. Per our discussion, the following are some of my thoughts on the matter.
Firstly, there is no question that we as a nation can and need to do much better on the issue of health care. Debates can continue ad infinitum as to whether there are 12 million people or 50 million people in this country without health-care coverage. The 12 million number is calculated by including only those who are legal, are not eligible for health care but have not applied, or have selected not to have health care coverage because they can well afford the costs. The 40 to 50 million number we have heard includes all of the categories including illegals. Nevertheless, even though the United States has available, by far, the best health care in the world and emergency rooms treat patients even without health care, the current situation does require change.
Change needs to provide full health-care coverage, not just emergency treatment, for those uninsured and very importantly, the change must not lower the standard of care for everyone else. Unfortunately, the current health care bill would destroy the high quality of health care in this country and burden the country with immense health-care costs far beyond the projections of the budget office. In its inimitable way, Congress has taken the most complex road possible, based on politics and not on that which is best for this country. Unless Congress refocuses its efforts, the result will either be no action taken or a complete disaster for health care in this country.
Just one example of the absurdity of the bill is the assumption that Medicare reimbursements can be significantly reduced while providing care for more patients. Many doctors are already leaving the system. Further reductions will devastate the number of providers available, and make the provision of anything but cursory care impossible. Ezekiel Manuel, President Obama’s chief advisor for health care, has made statements directly indicative of the administration’s thoughts that health care for seniors needs to be controlled, which actually means limited. Does anyone really want to turn over their health-care decisions or those of their parents to government agencies who know that they control costs by limiting care?
Would it not be refreshingly simple to pass a single provision bill that clearly states its purpose. For example, one that would open state borders for competition among insurance providers? Just a simple bill, nothing more, no politics, just a yes or no vote – the passing of such a bill would result in billions of dollars saved in health insurance costs.
Let’s continue in that constructive mode. How simple – a single provision bill that revamps the medical malpractice issues and reduces the high cost of malpractice insurance as well as the overly defensive mode that the specter of malpractice has imposed on doctors and the resulting additional costly diagnostic procedures that would otherwise not be ordered. Those two bills alone would significantly reduce health-care costs.
What about two other single provision bills without any tag-ons or Nebraska type of bribes – one to eliminate “pre-existing conditions” limitations, and the other one that places a $1 tax on every pack of cigarettes and taxes every bottle and can of alcohol?
Alcohol and tobacco are directly responsible for highly significant health care costs both for insured patients as well as for uninsured patients that hospitals cannot turn away. If there are no tag-ons and special interest allocations, there would be two great direct benefits. Firstly, increasing the costs of alcohol and tobacco via a “health care tax” will reduce the consumption of both and therefore, in the long term, health-care costs resulting directly from their use. Secondly, the alcohol and tobacco tax revenue should be applied to independent health-care insurance for the uninsured population.
The above four measures taken together can fully address the health-care issues in this country. Any one of the four can have a direct and major positive impact. The President called for bipartisanship, clarity and openness in Washington, no tag-ons, no closed door sessions, no bribes, not increasing deficits. The terms and manner in which the current health care proposal has been conducted belie the President’s “comments.”
Let’s have clarity – four simple direct ways to resolve the health-care issues in this country; Let’s have openness — no confusing language buried in over 2000 pages subject to interpretation; Let’s have no tag-ons; Let’s have no closed door sessions; Let’s have no Nebraska, Florida or other type bribes; and let’s not increase the deficit. And, not the least of important of all, let’s not do two things — let’s not destroy the best quality health care in the world, and let’s not let the government encroach further and further into controlling the lives of private citizens and make decisions on who will and who will not receive health-care treatment.
Jack Kavanaugh, M.D., D.D.S., M.B.A.
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I believe the Republicans had bills last year and created yet another one this year which included the insurance across state lines and tort reform. The problem is that the Dems won't even consider them….especially tort reform since attorneys are (typically) huge Dem suppporters.
Also, I'm not sure about removing the pre-existing condition clause? Someone could wait until they have a serious illness (i.e. cancer) and then buy insurance……it seems like that would put insurers out of business. If somebody could explain this to me, I'd appreciate it. I'd like to learn more about it so I can then argue (ahem, discuss!) these issues better with Dems.
Hey Robert—-
Were you the narrator on the "Demon Sheep" political ad? It sounds like you!
teh Mob has it right. It isn't about health care, it isn't about health reform, it's about governmental power over people's lives. Control their or their children's health, and you have total domination.
Here's how to make health care affordable for everyone except for the very poor and to provide health care for them. (there's a difference, the latter is charity. We make the mistake of acting like getting the benefit of other people's money is entitled; it's not, it's charity!)
1. Enact Tort Reform. Immediately. Enact loser pays as every other country in the world but us has (they don't have any 50 million dollar John Edwardses either)
2. Portability. Who had insurance with what company on January 1, 2005 (the beginning of Bush's second term when the unemployment rate was around 5%)? Doesn't matter if you were a newborn, a child or working for a company and have since lost your job. THAT'S your insurance company if you want them. The only way they can unload you is you write them a letter saying you no longer wish to be covered.
3. Universal coverage. Combine the Public Health Service and the VA System. Pour some money in it if you have to. THAT is the public health service — wards, clinics, but every American CITIZEN can go and receive care gratis.
For the illegals, they can be treated, too, but upon recovery, they are escorted by ICE out of the country. Mothers who slipped into the country to give birth have a choice. Leave the child (an American citizen) or take him/her back to native country. Your decision. We don't give secondary citizenship. It's harsh, but the only way to stop this.
Where our mistake has been is we've forced our system to give private medical care to clinic patients. This did not happen in the past. And before the liberales start howling, in the days before government intervention, clinic patients received as good care as private patients, they just didn't receive it in a private room. That's what wards were for. In fact, that is what's gone wrong with the American experiment in a nutshell. We now demand equality of outcome, not equality of opportunity.
"Change needs to provide full health-care coverage, " While this is a presumably great idea, why did it become OK to think everybody should have the best healthcare? Everybody doesn't get to drive a Mercedes. Buy what you can afford. The wealthy guy affords better stuff. So get out there and make the most of your talents and make more money and you too can afford great healthcare. it's not mean-spirited, it's reality!
All common sense solutions. But that’s not the point of healthcare reform for the Democrats…power…is the real objective.
I disagree about the taxes on cigarettes and alcohol. These two products are already two of the most taxed products in existence, and everybody knows that tax dollars are fungible. No matter how much you say you're going to put all that tobacco money into a "lock box", it's going to end up in the general fund.
Chuckfan, you've got it right. Eliminating the exclusion for pre-existing conditions REQUIRES everyone to buy insurance (or have the gov't buy it for them). Otherwise it amounts to putting the insurance companies out of business. The current bill under consideration has a measly $95 fine for not purchasing insurance. (You can still go to the emergency room for free). What happens if you get sick and need major surgery that will cost $100,000? Buy insurance for $7500. The insurance company loses $92,500. They either fold up their tent and go out of business, or raise the rates for everybody else because some selfish bastards gamed the system.
The only way you can eliminate the pre-existing conditions clause is to have a SIGNIFICANT tax penalty for those who do not buy insurance. That tax money would have to be used to subsidize insurance purchase from an "assigned risk" pool, similar to that used in auto insurance.
Some people are born with a low IQ, no useful talent, and ugly. They're still entitled to really good health care
Not only are those two products the most heavily taxed, they are also the least stable in terms of being able to "depend" on for revenue. Every time the government hikes the taxes, they plan spending on projected increase of revenue based on current and sometimes even increased use of the products. The reality is that the use almost always declines as does the revenue. In the case of tobacco taxes, the revenue will even decline below the revenue generated prior to the tax increase. When the revenue doesn't bring in what was projected, we all have to listen to politicians whine about running out of money and endure higher taxes on everything else to pay for the spending they did based on poorly projected revenues on alcohol and tobacco.
Not only that, but using increased alcohol and tobacco taxes to both fund health care and reduce consumption creates a major moral hazard problem, as you will end up relying for funds on the very activity you are trying to discourage. Such tax increases will also result in increases in smuggling, so you end up with increased law enforcement costs, and loss of revenue from legitimate purchases.
Amen – Great article and great letter. We and the republicans have been saying these things to our congressional leaders, our neighbors, the administration, the Democrats. They don't listen. So we go to tea parties, and make ranting videos, and blog and scream! Thanks Thanks
Gammy Sparkles
PS You are lucky – you got to probably meet some of the F of A. Someday!!!!!
If the government wants to cover people with a pre-existing condition then THE GOVERNMENT should do it. The government is already in the health care insurance business with the 2 M's so just add those people to the 2 M's. For that matter how about eliminating the silly "pre-existing" condition limitations on auto, fire and flood insurance ? What is the difference ?
My grandfather used to say "Self-praise stinks!" too. And he and your mother were right. This morning I heard Pelosi on C-SPAN say, "Our stance on health care is predicated on the idea that the most privileged person in this country will have better health care if the poorest person in this country has health care." What a load of self-indulgent twaddle! The statement makes no sense but allows them to congratulate themselves on their greatness.
The whole " buying across state lines" angle is a canard. What would actually happen is that insurance companies seeking to do an end around on some states' regulations about things like price gouging would simply set up shop in a state that gave them the anything goes green light. Not only would prices not go down, some of the abuses in the insurance industry would amplify, and states would be utterly powerless to do anything.
If you think I'm wrong, see what happened to the credit card industry when the exact same deregulation was implemented. Did your rates and fees go up or down when deregulation and "competition" was put in?
The other possibility would be higher premiums for pre-existing conditions and partial payment (100% up to $X, then 75% up to $Y, and so on). It would still put those with pre-existing conditions ahead of having no insurance without breaking the bank when the inevitable services are required.
Powerful article, Robert.
What's every bit as bad is that there seems to be a growing number of people who want to give the government all that power, at the same time, surrendering freedom. Remember this: “(if Obama is elected) I won’t have to worry about putting gas in my car. I won’t have to worry about paying my mortgage.”
You're talking about congress?
You're right. Sin taxes are their own ponzi scheme.
She said what? It doesn't even make sense. Who votes for these short bus children?
And some people are born with an average IQ, ugly and no useful talent, yet they work their asses off to maximize what they do have. Why should those people foot the bill for the guy/gal who doesn't use what s/he does have?
I'm with you on everyone having a base line of health care provided by the taxpayers (the government has NO MONEY. It can only spend what it TAKES from us via taxes)? I favor the return of wards and clinics as outlined above with any American citizen or legal immigrant having access gratis, provided for them by doctors who are working off their school loans the way teachers work off theirs in Title I schools.
You're exactly right, it's a completely nonsensical and self-indulgent statement. The whole health care debate is irrelevant to "the most privileged person in this country", because they will receive the highest level of health care whatever happens
I like it.
I'd add this to the list of simple solutions:
Publish prices and success rates of procedures. Let the healthcare consumer make an informed choice about where he receives care. If Hospital A has a 95% success rate for Procedure X at a price tag of $10,000, and Hospital B offers it for $6000 but only has an 80% success rate, I want to be able to make that choice.
There's also a complex problem that doens't yet have a good solution. I work for an EMR software company, and our software give reminders to physicians when their patients are due for certain procedures–flu shots, mammograms, physicals, etc. One of our customers vaccinated over 90% of their pediatric patients for the flu. Later that year, they were starting to go in the red financially because hospital admissions were abnormally low. They then realized that they normally had a ton of flu patients in the hospital around now, and they weren't there because of the success with getting them vaccinated. The patients got better care, but the hospital didn't make any money.
What we need is a payment scheme that rewards doctors for providing better care, rather than rewarding them for more care.
Why can't we have a health ins. purchased like life insurance? When I was 35 I purchased a $500,000 policy that would stay the same payment for 20 years. If we could do the same for health insurance, and include portability, then we wouldn't have to worry as much about pre-exiting conditions. One could chose the slightly higher cost of a 20 year plan, or 10 years or 1 year and take their chances. As the term lowered, the cost would lower as well because of the lower risk to the ins. comp.
Question. How or who created the barriers to interstate health insurance.? Was it the Fed. gov't. or is it the states? Do the health ins. comps. want this, they seem to have nice little state monopolies or oligopolies and it limits competition? And if we aren't trading or purchasing health insurance across state lines, why the hell is the fed. gov't. involved in the first place?
While I do agree that with Jack's 4 ways to reform healthcare, I also see the flaws in his assumptions and with many assumptions about the healthcare system. I also see how much of a weasel Robert is co-opting his friend's words while oddly contradicting them.
Jack's comments that US has the best healthcare in the world (it's actually #12 but, hey) conflict brilliantly with Robert's charge against such jingoistic in his previous comments.
Anyway, both comments seem greatly misled with how the current healthcare bill was formed starting with the fact that Obama's comments about reducing cost comes with the knowledge that the industrialized European nations pay less for healthcare and yet with statistically get greater results. Sure, you could say that you could read statistics anyway but, you know you could talk about that later.
1…2…3…
But then it's not insurance. It's prepayment. I'm healthy enough, and my money goes just far enough that health insurance is something I'd rather not have. I haven't seen a doctor in years, and I've never been hospitalized. I dont' want to pay $2400 a year for a service I won't use. Taxing me $1200 (number pulled from my ass) because I don't want to spend $2400 is not good for me–the person the government is allegedly trying to help.
So, I don't buy insurance, I eat the 1200 bucks because 1200 bucks for nothing is better than 2400 for nothing. Then I get in a hit-and-run and have to be in a body cast for weeks. The hospital is required to care for me, and I can't possibly pay them.
So, instead of the insurance company eating the cost of my scam, the hospital eats the cost of my gamble. Which is better?
The free market (Capitalism) did not cause this crisis, the government (Socialism/Communism) did.
The free market did not create Fannie Mae, Freddie Mac, Ginnie Mae and Sallie Mae, the government did.
The free market did not pass laws that force banks to lend to those who do not qualify for a loan, the government did.
The free market did not take us off the gold standard, the government did.
The free market did not dump trillions of dollars of cheap money into the system causing the largest asset bubble in history, the government did.
The free market did not create multiple multi-trillion-dollar unfunded entitlement programs, the government did.
And I'd also add taxpayers should be able to take off FIRST DOLLAR for any established medical cost including insurance fees (no coffee enemas or Krebiazan treatments). Currently you have to be very poor or very sick to take advantage of the 7.5 deduction, i.e. the taxpayer has to spend 7.5 percent of his income before the NEXT DOLLAR can be deducted from the taxes. HUH! These are the people who want to GIVE everyone health care yet taxing people who buy health insurance, medicines, etc.
So far as listing prices and success rates of procedures, that wouldn't work without Tort Reform. In fact, nothing works without Tort Reform. We all need bumper stickers saying "Feelin' sick? Call a laywer.)
No one has mentioned reducing the cost of Provider (Doctors & Nurses) education.
Years ago, I had to take my son to his pediatrician in the morning. His condition worsened throughout the day, so I had to take him to “Pediatrics After Dark.” When the doctor came into the room, it was his doctor. She told us that she needed to work two jobs just to pay off her student loans to become a doctor.
Reducing the educational cost will hopefully attract more individuals into medicine. And, not to sound racist, but we have a lot of Indian doctors. Good doctors they are, but it seems unfair to their U.S. counterparts because they come here with no student loans hanging over their heads. They can charge less.
And, another suggestion, a personal one, at least, regarding me. Many hospitals accept volunteers. I volunteer for 4 hours per week at GBMC. Why? Because the bar thing wasn’t working out for me. I got beaten and rob and ended up in the hospital walking home from the bar. I sat there and looked around and said “hey, all the women are here.” So, all you guys hanging around at bars, I say change you tactic and volunteer. No, I don’t won’t to put union hospital workers out of a job, but every little thing that we can do to reduce the fix cost of a hospital should reduce the overall cost of healthcare.
Prior to Lyndon Johnson's "Great Society" (how'd that work out for the truly poor?) — physicians treated those truly poor gratis. Johnson came out with a statement that he didn't want people beholden to doctors. Nope, he wanted them beholden to the Government. And they are. Look at Medicare and Medicaid. Turn sixty five and retired and try NOT to have Medicare. You can't. Even if you can afford private insurance, you're stuck with Medicare. Yet physicians are not paid properly for treating Medicare (and Medicaid) patients and so it's difficult for patients on Medicare or Medicaid to find a doctor. Seniors either are not aware that they're receiving charity after all (when the Gov refuses to pay the going rate for their treatment) or they're in denial and don't want to believe they're charity cases. Either way, the doctors are getting screwed. Try going to college for four years, medical school for four years, serve an internship (one year), then residency training (3-6 years) only to be told you're a money grubbing exploiter by the likes of liberals like George C. Looney who makes twenty million for batting his eyes.
I'd say just use the Fair Tax, and not worry about that. But that'll never happen.
This notion that they "pay less for healthcare" is all in how you do the counting. European Nations pay a much, much larger percentage of their earnings to the government in exchange for services including healthcare. They do, however, eliminate not only the number of choices they have as a result, but also limit recourse if something doesn't go well. Also, the "statistically greater results" (of which you provide none) are often skewed by differences of how things are categorized and counted, such as infant mortality. On top of those differences, is the abysmal statistics for anyone with more serious diseases and/or complications, especially in the area of cancer.
Cancer Reference: http://www.ncpa.org/pub/ba596
I agree with you up until "don't want to put union workers out of a job." Unions are part of the problem.
Along with everything else correctly stated, its a fallacy that smokers are a burden on the countries health care. Smokers buy and large die earlier than non smokers, and that leads to years less of necessarry late life expensive health coverage. With taxes that are currently in place, smokers more than carry their burden on health expenses they create.
Pain:
Wow, the free market can do all that! That's amazing! Come on, Painesright, tell us how this magical free market can save us all by allow us to… trade stuff without government restriction. Hmm? Maybe your definition of free market differ from mine but, how exactly does allowing does removing taxes and restrictions benefit the deficit if the government isn't making money? Or do you suggest that the government should be abolish completely? In that case I suggest you live in the woods, and leave us poor simpletons with our poor hopeless society, you are obviously too good for us. We're trying to make a place where people actually live.
Sure, government incompetence has caused and will cause plenty of problems but hey, a government is ruled by incompetence of the best men the country has to offer and I would rather have that then to be ruled by the competence of the wealthiest men of the country.
Wait…tax my booze???
Agree ratcheting down reimbursement (we are being marked down, on sale) is untenable especially as us baby boomer docs decide to step aside and create a dramatic loss of providers. Taxing alcohol and cigarettes is targeting addicts. They have enough trouble. Higher costs for their drug will only make them more desperate to try to afford it. People don't stop using because of increased costs. The income generated would not be sufficient. My idea is to take this important humanitarian social justice issue directly to the people who are most vocal. They "know" what is best and with their media presence let us hear it day in and day out. All movie tickets, theater presentations, concerts should have a special health care tax of $1 per ticket. That would generate billions. I am sure the media moguls, stars, etc. would support such a personal sacrifice for the greater good. They might even embrace this and maybe even suggest $2. We may be able to provide health care for all Americans and even Central Americans – oh, wait, we already do.
Tort reform would help doctor's cost, yes, but would do nothing to help the cost to patients.
Opening state lines would indeed help ease cost of insurance as the market always does where competition thrives. I would venture you would see savings of 15 to 20%.
Getting rid of pre-exisiting conditions sounds all warm and fazzy but it's a horrible idea. The primary reason is simple, the government has no right to force a private company to do business with someone. Furthermore, if you eliminate pre-exisiting conditions you would have to mandate everyone has coverage otherwise people would simply exploit health insurance carriers which would drive cost up even further then you can imagine. Clearly mandating coverage is unconstitutional.
Yes…I am one of the heartless souls in the insurance industry.
You are absolutely correct. I believe the time is coming where every American Citizen is going to have to decide if they are merely a citizen or an American? I hope for our sake American wins.
The more common sense solution here is to create high risk pools for insured with pre-existing conditions wherein the government would simply provide either premium subsidy assistance for the members or tax breaks for the insurance carriers who buy into the risk pool or a combination thereof. Most people are no longer considered "high risk" or "uninsurable" after 6 months of insurance coverage anyway, in the majority of cases we only deem someone "high risk" or "pre-existing" if we are unable to determine their risk because of a lack of insurance. This is identical across all forms of insurance.
Furthermore we need to do away with employ sponsored insurance and attach it to the individual. Aside from being cheaper it is also portable. It has added benefits of saving emloyers money that they could put back into worker's salaries or hire addtional labor with. The premiums an individual pays could either be withdrawn pre-tax or simply be tax deductible like the interest on a home mortgage.
**CONTINUED**
**CONTINUED**
Our ultimate goal needs to be the abolition of Medicare and Medicaid through privatization. Both programs are financially unsustainable under the best of circumstances. Until we are able to do that we need to do away with the Medicare "Fee Schedule" (the amount Medicare pays providers) entirely and allow physicians to set their own prices based on their needs and cost.
These three simple steps would resolve our healthcare crisis.
I also heard a good idea about supplemental health insurance, I think they called it 'stop gap.'
Essentially its insurance on your insurance. When your primary insurance finally dries up do to extended health problems, this stuff kicks in to cover the difference.
You're right. The "Fair Tax" is a pipe dream, something that keeps a number of people and influential talkers occupied with overturning the US tax system. Ain't gonna happen but it keeps them busy.
Flat taxes, however, have been enacted in other countries — esp. formerly communist ones — and probably would be the answer. But that won't happen either. In 2003, Teresa Heinz Kerry paid 12.7% to the IRS on an INCOME of 5.5 MILLION dollars (while her husband was campaigning against "tax cuts for the rich"). A flat tax would have realized a lot more. The super rich have loopholes and enough money to "invest" in tax free municipals. What the "progressive income tax" addresses is the high income EARNER whose income comes through the system ergo can be snatched up to 40% by the greedy IRS. There is absolutely no reason for Kerry, Kennedy, Clinton, Pelosi, Geithner — you know how much HE paid –, Daschle (ibid), Soros, Gates and all the other super rich Democrats to ease the burden on the poor schlub who has to work (intellecutally or physically) to garner his daily bread.
Take a look at "Foundations" and who funds them. It ain't your local neurosurgeon, assembly line worker or tax accountant. It's just one more way to get money out of the greedy grasp of the IRS and into protected accounts (Foundations only have to pay 3% of general funds to their "charity". Maybe the 3% is higher now – perhaps Lawhawke can tell us, but it's still a way to shelter income for the very very rich).
The 2 "M's" are already in the financial tank and congress has been throwing iou's in the "SS" hopper for years, to pay for it, as a result (along with other entitlements). Translation: The government could not manage their way out of a wet paper bag.
Ironically, here in Indiana, Sallie Mae just started broadcasting an ad asking listeners to call their reps to get them to vote against the "govt control of college loans", saying that it would cost hundreds, if not thousands, of hoosier jobs, if passed. I guess "Hell hath no furry like a progressive program scorned".
Time to get out the ol' moonshine still, right?
Mine wen to zero. Due to the competition, I was able to pick and choose what kind of terms I wanted (no annual fees, high limits), and go somewhere else if I didn't like the company. And because I'm fiscally responsible, I don't care if the interest rate is 69%. I don't pay it. Why shouldn't I have the same freedom with my insurance?
Yeah, about the unions. If they know you are jeapordizing their "God-given" jobs, you might just get a worse beating their. So, ixnay about the chixay in the hospitalsay. It sounds like you found a good niche. One other word of advice… Make sure you check to see "why" they are in the hospital before you pounce. Otherwise, you might just go home with "crustaceous critters" in your pants, if you know what I mean ; o !!!!
Great article, Mr. Davi. I'm a big fan, and I'm wondering why it's taken you so long on making an appearance back on RedEye??!! I love that show! Make sure you're sitting at the table so I can hear you sing your opera, I remember you made that promise last time you were on there
2010 is right around the corner and I see common sense and free market solutions making a comeback!!
I think that reducing the amount of expensive and unnecessary tests performed simply to cover the doctor's ass would certainly help reduce costs to patients.
The existence of these CYA test is heavily overstated. We keep statistics on all of this fun stuff for purposes of cost containment and pretty much every industry study shows less than 5% of test our medically frivolous. Most of the needless testing occurs on Medicare patients since Medicare is less prone to deny testing. Private insurers have to authorize a test with a "pre-authorization" before the test is ran so we can assure it is medically necessary and this eliminates much of the over testing. For example we probably want to investigate the need for an MRI following a CT scan.
Don't misunderstand I'm all for legal reforms because doctors need relief on Malpractice Premiums I just do not want people to think this is a magic bullet that will ease medical cost. It's effect will be nearly invisible to us as patients. Medicare controls the cost of healthcare with Fee Schedules.
Wow do I hope you're right about common sense and the free market. We haven't seen them in so long that I'm not sure we'll even recognize them.
A good start but one that still fails to address to true costs of health care. People simply are ignorant and or apathetic when it comes to the care of their bodies and will simply carry those costs into whatever system you design. A majority of the people in this nation are literally killing themselves with their diets and lifestyles and until their is some sort of litmus test is required, what's the point?
I gotta agree. Everybody has to pull their own load. No free-loaders, except for the small percent of people who can't.
More taxes on alcohol and tobacco will not serve to 'greatly reduce their use', because they've already been taxed over and over, resulting only in the same thing that all tax hikes cause – less money for Americans. Taxing unhealthy choices has never worked, and further taxes burden the entire industries involved, resulting in job losses. Here's another unhealthy behavior that costs Americans far more in healthcare, and indeed all other expensive entitlements – promiscuity. That's right, STDs, AIDS, Unwanted Pregnancies, Poverty, Crime, [70% of all federal prison inmates come from single mother homes] cost Americans a fortune in more ways than just financial. Implementing Abstinence Emphasis programs in schools, welfare reforms, and strict limitations on abortion would make a noticeable difference for the better. Since 1970, the out-of-wedlock birthrates have risen 300% – so too has the health issues, poverty and crime that goes with it. The liberal experiment is over – it has failed miserably. Conservatism itself may once again reduce these massive costs all on its own – no taxes necessary.
Seems that if you get rid of the "pre-existing condition" bit, then we are not buying insurance, we are putting into a health care coop. Insurance works by you betting that you are going to get ill and the insurance company betting that you will not, more often they are right and they get to keep your unused payments as profit.
If you allow anyone to sign up at anytime, then they will not have that "profit" and they will go bust. What would stop someone from finding out that they have cancer, signing up, getting treated and then canceling? How would any of them make a profit. It just doesn't make sense and would not be sustainable (anyone that thinks so, is by definition a liberal).
Now, if you get cancer, pay your own costs, get treated and are "clean" then you should be able to pick up insurance going forward, but that is not what I hear when people talk about "preexisting", is it?
I like it, too.
I would add something else, but not sure how to word it. I have heard Dr. complaints about patients who go to the doctor for no good reason. They don't worry about the cost, becasue their insurance pays for it. This is another way health care costs rise.
If patients had to pay out-of-pocket for visits that weren't really neccessary, they might go less, and the congestion of the dr.s' offices would ease. I know this may sound harsh, but I remeber being a kid, and my mom didn't take me to the doc for scraped knees, a minor sore throat, a cold, or even the flu. We were vaccinated at school, along with the rest of our classmates. And a trip to the doctor meant something serious, like a broken bone or a deep cut from which the blood kept pouring. I was a tomboy, and remember quite a bit of my childhood being banged-up.
One dissent…
Private room is the way medicine is going for everyone…not because of luxury, but because of cross-contamination…too many wily bugs out there…
Better choice…finances and illness allows it, treat the patient at home…
Very nice. Problem is…HealthCare or HealthInsurance Reform, what the heck ever they are calling it this week, isn't about our health..it's about government power. Period. They will never do the common sense thing because what they want is power and the common sense things….rob them of it.
The same old rhetoric… how true is that…. that prties need to get together to pass something right or NOTHING at all. I lived overseas for over 1o years and was NOT in the military and I have to say being in ANY Nationalized health care systems REALLY SUCKS!!!! This nationalized plan will be the DEATH of our incredible health care system, our doctors and nurses are 2nd to none and will say this if Obama care is passed with Pelosi and Reid at the forefront our health NATIOWIDE will make a SUDDEN downturn. END RANT… I could go on for a hour or two about this but if any BAD BILL passes we are all in a world of SH*T
I disagree with the doctor's (or dentist's – I'm not sure what he practices) premise – that we have to provide full health care coverage and not just emergency treatment for uninsured. First of all, uninsured doesn't equal poor. I don't carry dental insurance. I pay out of pocket. And providing care to a larger number of people without reducing the standard of care (time on task) presumes that there will be an adequate number of health care professionals to go through the four years of college, four years of medical school and another 2-8 years of internship, residency, fellowship, enter their thirties with six figure debts, five figure malpractice premiums, operating costs that increase annually while the third party payer cuts reimbursements. Right now, there are areas of the country where master electricians and plumbing contractors make more than a primary care physician, and residency slots, once at a premium are going unfilled in several key areas. Medical school, and medical practice just isn't worth it anymore for the top tier student.
I think we have to stop looking upon health care as a right. We have accustomed ourselves to the best health care in the world and taken it for granted a little too long – and perhaps doctors were not as vocal as they should have been when the reimbursement game changed on them. I don't have a right to the goods and services of others without just compensation, and "just" means whatever is agreed upon between the provider and the client. If a doctor is content to earn 50 cents on the dollar, that's free choice; if he's compelled to settle for it, it's slavery.
I agree with most of what you ssaid except for one thing. A child born to an illegal alien mother IS NOT an American citizen. Read the 14th ammendment. It stated clearly that a child born to any person not under the jurisdiction of the U S Government (person entering country illegally) is not automatically a U S citizen. That is where we need to start.
Something for an actuary to explain….it sounds good but my guess is it couldn't work for health. If an actuary could explain so even I could understand it, it would be much appreciated!
The free market did not write a 60,000+ page tax code that punishes work, rewards sloth and buys the votes of special interest groups, the government did.
The free market did not destroy our public school system and graduate (or fail to graduate) generations of civically and financially illiterate citizens, the government did.
The free market did not drive our jobs overseas and kill our entrepreneurial spirit with over-taxation, over-regulation and frivolous lawsuits, the government did.
The free market did not ban drilling for oil, vilify coal and block the building of nuclear power plants in the United States, thereby transferring hundred of billions of dollars of American wealth and many thousands of energy-industry jobs to foreign countries, the government did.
This crisis is the result of a giant social engineering experiment and vote-buying scheme gone tragically wrong.
The free market does not try to engineer society or buy votes, the government does.
The government caused this crisis, the free market did not.
The government cannot fix the crisis, the free market can.
Did i miss something or do we already have "really good healthcare" in this country. It's the best and NO ONE is denied. I don't care how ugly, stupid or untalented you are, it's available. It should NOT, in any part, be free. If you have history, buy some insurance. If you want to risk it, you may be saddled with a ginormus hospital bill. Oh well! It's not anybody elses responsibility to pay for you, you should pay for you.
Other types of insurance goes across state lines. I don't see this horrible-ness of which you speak.
It's called EDUCATION my Man. Get some!
Farmer John and replies to his comment point out the basic flaw of sin taxes. A better policy, addressing both Dr. Kavanaugh's concerns and the critiques in the Farmer John thread, is a true self-insurance system for tobacco and alcohol. Create two independent funds, not accessible to the Congress and not invested in government securities, capturing all taxes on tobacco and alcohol respectively. Start from current tax levels and adjust for actuarial data over time to reimburse hospitals for the medical expenses of smoking or drinking caused illness/ injury. Each drink, each smoke, both pays its own way and tells the consumer the "true" cost of consumption.
I… Sorry, I was lighting up a smoke when I started typing… concur.
You're right. In the past we didn't go to the doctor for the small stuff.
Infected and infectious patients would not be put on an open ward — they would be isolated. I'd question also that unless the infection is airborne, the danger of cross contamination would not be all that much greater so long as personnel abided by strict sterile procedure protocols. Private rooms in my opinion make a lot more work for already overworked nurses and probably result in a lot more patients having complications that go unnoticed. On the old-fashioned open wards, one nurse could oversee rows of beds; today they have to trot from room to room to take vitals and check on the patients'. I'm not talking about monitored patients whose vitals are transmitted to the monitoring units. At home care is best, but in today's environment I don't see patients admitted to hospitals unless they're in need of more intensive care than can be provided at home. A daily visit by a nurse or doctor won't cut it. What if the patient crashes? Where's the cart? Are you going to have defibrillators in every house? Very expensive gadgets, those. And then there's the knotty problem of Medicare paying a doctor $35.00 for a house call (a plumber gets $65 just to diagnose the plumbing problem; then adds parts and labor). And don't forget sending a patient home and having him/her die on you – think of the John Edwards type law suit there! Nope, won't work. Does anybody know? Do VA Hospitals still have wards?
I will accept your premise in that I'm too lazy to look up the 14th amendment, however, I wonder then how come I keep reading about pregnant illegals coming here to have their babies in order that they can then stay in the USA because their child is a natural born citizen. There was also that case a few years back with the Mexican mother who was being deported while her son (born here) could not be — the pair hid out in a church.
The name of the game is going to be "keep the pressure on". It's nothing but constant work from here on out. These reps need 24/7 supervision.
My wife is a working nurse, I was a LPN in the Army…
Wards are not the way to treat anything anymore, and even the semi-private room is going away…its not just cross contamination by medical staff, (and that still happens), but everything and everyone in a room is a potential source of infection…even the hospital itself (MRSA) is a potential source of lethal infections…
The biggest burden of nursing nowadays is lack of staff…not patient care…
Home care is one of the largest growing sectors of patient care…because it costs less for everyone involved, patient to care team…one of the side benefits is the control of nosocomial infections, which is one of the biggest killers that lurks in those nice, clean halls…or so you think of them…
All health care entails risk, whether home or hospital, so you mitigate risk where you can… someone might drop an airplane on the patient, too…and that can happen at a hospital as well as at home…
Sorry, wards are NOT the way to do care anymore…they go into the box with snake oils and radium water….
All great ideas. Let's get the POS Dems out of office so we can get reps in who will be willing to consider some of these and maybe implement them.
Thank you Mr Davi for speaking up for for the rest of us. I don't want to be able to see a doctor, and neither should you. If I am poor, than that is God's judgment… end of story!!
I also am unsure about removing the pre-existing clause. Insurance companies can't insure against something that has already happened..However, I'd much rather have this issue debated in a single provision bill than with 1999 other pages of politics.
I'm a cynic. We had the Dems out of office, had a Republican president, House and Senate, and none of this was addressed. Seems to me both parties are guilty, just the GOP less guilty. Then, of course, there's the propaganda media which lands on the GOP every time they try to enact anything other than what the Dems' want — sort of like having the Colts owner and his family refereeing the Super Bowl this weekend. Until we destroy the Dems' propagandists, we'll just keep repeating the same tired old cycles — Dems get in office, screw up, we throw them out, Repubs get elected, try to do stuff, press then responds with unrelenting negativity until we vote the Repubs out and reelect Dems and then the Dems….
Until we get tort reform under control, home care will just become a new fertile field for the lawyers.
I can hear John Edwards channeling now — "Do you mean, Dr. So and So that you sent Mrs. Richards HOME knowing she has (fill in the blanks)?" He'd dig up some cases where patients with whatever didn't die in the hospital and next thing you know the doctor who discharged her would be looking at a million dollar lawsuit.
EVERYTHING hinges on tort reform.
Besides, infected patients SHOULD AND MUST BE isolated.
Don't the VAs still use open wards? Is their infection rate any greater than in non VA hospitals? I don't know the answer. Maybe somebody here does. Of course, I don't think lawsuits can be instigated against the VA (gov). Can they? Any lawyers?
I seem to remember a few years back where a cardiac surgeon working for the gov had hideous results but nothing could be done. Am I misremembering?
Back to the wards – A bed surrounded by curtains probably is a lot easier to sterilize than a pvt room. I seem to remember reading that back in the sixties, beds could be sterilized — the whole bed. I doubt that is ever done now save in isolation units.
The infection argument is used against wards, however, I'm not convinced yet.
I'm hopeful that the new "Tea Party" movement will use its clout (if any) to hold Republicans' feet to the fire.
One of the first items on the agenda of the Partiers, however, MUST be to inform those in the public who still rely on "mainstream" media they are not getting the whole story on anything that might be detrimental to THE MEDIA PARTY (Democrats).
I'm of the opinion that so long as the Courics, Gibson, CNNs et al present propaganda in the guise of "news" and use their considerable power to destroy candidates (as Couric and Gibson did to Palin and the NY Times tried to do to McCain), there will be a large number of voters who believe them. I was one in the past. People who have demanding careers don't have the time to go on the internet to dig out the truth on their own. They can tune in Fox, but the mainstream (propaganda) have joined full throat in demonizing Fox. I can't tell you how many people have insisted Fox is "biased for Republicans" when the truth is, Fox just allows Republicans and conservatives to speak and when they find something detrimental to the Dems, airs it. But even Fox won't touch some things. Witness how they ALL left the John Edwards affair totally alone and without the National Enquirer (whom the propaganda media demonizes as yellow journalism – a case of the pot calling the kettle black – think Larry Craig), then we'd have NEVER known about Edwards.
I was a CEO, CFO in Banking when the CRA was put into law and when Clinton's White house spurred the financial regulators on their witch hunts to make PC mortgages to people unable to finace buying a candy bar…I also screamed bloody hell when my own institution wamted to beef up our mortgage portfolios by selling guaranteed loans to Fannie Mae; which put a "bulls-eye" on my butt to be 'terminated' [opps!-not PC]-what they said was:…"we feel you do not fit into our plans going forward and suggest you resign"…The US Government was the direct cause of the meltdown…and they blamed everone else. Do you really want these bureaucrats handling your health insurance?…hell, just take cyanide…its quicker and cheaper.
The VA system is socialized medicine. The staff are paid a salary by the government, and paid well, kind of like the British system. I know people who work in our local VA hospital and people who have been treated there. No complaints from anybody. They treat every veteran who comes in. I'm with you on this, and it's refreshing to see someone on this site who supports socialized medicine. Woo Hooo!
As any Econ 101 professor would tell you when talking about insurance, the most efficient way to minimize risk to everyone in the aggregate is to increase the size of the pool. The larger the pool, the greater the risk is spread around. When I buy private insurance, if I don't get sick, my premiums pay for the care of someone else who did get sick and vice-versa if I do get sick. The point of having the insurance is to spread the risk.
Building on that, the ideal size for the pool would be everyone in the country, in other words a single insurer for everyone who might get sick or hurt. To be fair, premiums would either have to be uniform or based on ability to pay (depending on whether you are a believer in progressive taxation or not) What you get if you have a single insurer is, in other words, a single-payer system. Should that be the federal government or a large private corporation? Answer that question thusly, should the people who run the insurance system earn respectable government salaries or huge compensation packages based on how they are able to withhold treatment from the insured? More and more, the solution points to a single-payer system run by the government. Whether it is paid for by progressive taxation or a flat-rate as Medicare is depends on your personal philosophy. If you think single payer systems don't work well, find me statistics on how many seniors covered by Medicare lost their homes to high medical bills, and how many vets covered by the socialist VA lost their homes due to high medical bills. Compare your figures to the number of privately insured and uninsured people who are in that particular pickle.
I do not support socialized medicine as socialized medicine is rationed medicine and always ends up with a two tier system in which the well heeled have excellent care and everyone else waits en queue. If you read the post, you'd see that I support merging public health and the VA into a public health system which is a baseline which will take care of the few people who are not in the private health insurance system. Perhaps since you support socialized medicine, you can become one of the first patients and let the rest of us enjoy the best health care in the world.
Section 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
Thanks. I'm no lawyer but doesn't "born" in mean that the child of an illegal born in the USA is a natural citizen? Not being snide, just trying to understand since "Guest" above said the child born here to an illegal is NOT a citizen.
I remember getting a pretty bad gash on my head when I was about 10. My Grandma checked my eyes (for concussion), cleaned it up, and tied my hair in knots over the cut to keep it closed. Stitches? I dint need no stinkin' stitches. LOL
Having a system where insurers can price health insurance beyond the capabilities of those who need it, simply doesn't work. It just forces government to intervene. That's what happened with Medicare in the 60's and it's happening now.
Insurers have a perfect scam. Provide insurance for the healthy and young and then raise rates as people age and become ill to force them out of their coverage.
We pay twice as much for care as anywhere else in the world and obviously need reform. We need to work on malpractice but that's not the major cost problem. We need to have a system that favors efficiency, and works to temper both the profit motive and the patient's unrealistic expectation.
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