Tuesday, January 19, 2010

Can We Start Over in Health Care Reform?

Trying to solve Everyone's problems will necessarily infringe on rights and create new problems.  Diagnostically, it is most sensible to isolate and determine (understand) cause.  Then treat the cause. 

If I were to begin isolation I would start with significant costs of being sick:

1.  Intervening of Insurance (a middle man who takes profit out) and which causes secondary costs of claim disputes, heavy admin requirements on everyone, illogical & unnecessary procedures, errors from complexity,  incorrect care decisions, etc..  In other words, it managing by averages to maintain profits... a business model with a captive customer base (shared monopoly?).

2.  Intervening of Pharmaceuticals which is linked to Insurances 'allowed' treatments.  Any scrutiny on the Insurance-Pharma relationship?  High profit drugs replacing older low profit drugs or non-drug therapies.  There is a constant pressure for profit and no incentive to produce and distribute cheap drugs or herbs in favor of 'faster acting' or 'more powerful' or 'without a particular side affect'.  Although these often product many adverse reactions and then can in fact exacerbate dis-ease calling for more medical treatments.  The often dubious rationale of a 'better' drug appeals to society weakness for 'immediate relief' or 'not having to change'.  So, if one smokes, over eats, eats poorly,  eats things that aggravate, has stress, etc., they can get rid of the problem symptoms with a drug.  On some level this is unethical to pander to those needs.  That is why ethics versus  profit is so important in medicine.  People are vulnerable here.  There appears to be no advocate that promotes lifestyle changes to cure disease except Alternative Care.  And Alternative Care is predominately Not Covered by Insurance.

3.  Medical treatments and equipment.  I don't understand deeply this category but read that advances in procedures and equipment are very beneficial and often reduces pain and cost.  However, I have seen that the relationship between Insurance coverage and procedure is dubious and cloaked.  For example, Medicare won't commit to paying or not paying for an MRI until after the patient receives it.  So, this category introduces the fact that patients cannot have control or even understanding of what they are being charged medically nor what will be reimbursed.  This surely is the kiss of death to any cost containment process-- no control or knowledge.

4.  People who are now sick or at risk cost a lot.  From an insurance point of view these are not the kind of policy holders desired.  Why?  Because those who must be paid are bad, and those who have no claims are good-- because we need to make money to run a large company and for our investors who want to make lots of money- as much as possible-- whatever the market will bear!

The sick and at risk are minority and represent high cost patients.  Some of these people are in need and some are not.  Some are wealthy and some are indigent.  It is obvious, as a society we must be compassionate.  We must also be wise so as not to remove consequences that instruct human behavior toward happiness and away from pain or undesirable condition.

5.  Oh, I almost forgot the ballooned costs charged to those without health care insurance to pay for the artificially lowered prices insurance companies and Medicare have coerced from medical providers.

A non-cost consequence of our medical system I call the assembly line care.  It is de-humanizing and disrespectful.  It demeans the patient and the well-intended doctor.  It places selfish motive and profits between my self determination and my health, making it stressful and often inefficient or ineffective the cure.  It introduces First Doing Harm into what was sacred.

I'm getting old and my mind has let loose of some other points I wanted to make.  But, I can still say it doesn't seem necessary for us all to suffer hardship and loss of freedom to accommodate a universal answer to an ill-defined problem.  I've mentioned several problems.  It seems they can each be tackled with a right-minded attitude.  But, these can not be tackled with selfish-mindedness or greed.

Who among us can see with integrity-- without selfish motive (including me)?
LA Times Opinion, What does it mean to start over in healthcare? 

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