Mar 152010

For the past several years, health care has dominated American politics. Many of us are exhausted, confused, disappointed, hopeful, or determined. Some of us are all of the above depending on the day. The debate rests right at a crossroads of ethics, macro-economics, survival, and personal finances. For portions of our population, religion is central to the debate and that is true for me, as well. I’ll be addressing the intersection of religion and health care as a series this week.

Although I hope the current health insurance Bill(s) before Congress doesn’t become law for various reasons, I have no serious opposition to instituting a National Health Service in the USA similar what is in SpainFrance or Australia. Nor do I have any strenuous objection to allowing more of a free-market in health care by reducing insurance down to catastrophic coverage only for all Americans. I can see the merits to any number of other ideas, such as what Safeway uses to cut costs by 40% by rewarding healthy behavior.  I’m open to these plans because they are all just methods of paying for health care and have little to do with health care itself. What I’m not open to is anything that interjects the government and politics in between the doctor-patient relationship.

The Epistates of Hellenion, in an off-hand way, related something profound she heard from a speaker at a graduation ceremony in the late 1980′s. The keynote speaker was one of the founders of Médecins Sans Frontières. He explained that while Zeus was about government, and his divine son Apollon addressed public health issues such as plagues, physicians belonged to Apollon’s mortal-born son Asclepios. The lessons to be learned from this are not only that doctors are mortal and only seem divine, but that government should be two steps removed from doctors. Governments should support public health, but the intimate relationship between Doctors and patients are beyond politics.

Other than minor areas such as licensing, doctors should be free to care for their patients without interference from the State. The Federal government shouldn’t outlaw abortion or prohibit funding of it (as in the Stupak-Pitts amendment), but also shouldn’t force doctors to recommend or perform abortions. I’m a supporter of doctor assisted suicide and disagree with the prosecution of those who help terminally ill persons to end their lives (even family members), but I don’t think doctors should ever be required to end a life. I’m all for birth control, but I don’t advocate laws requiring medical personnel to proscribe it. I’m as patriotic as the next person, but I refuse to label doctors who treat patients in “enemy” countries as traitors.

Regardless how you feel in respect to the health insurance Bills on the table in Congress or the current state of health care in this country, keeping government and doctors two steps removed from each other is a concept worth preserving.  Any changes we contemplate to our health care system or laws in the USA need to ensure this separation.  If that isn’t safe guarded, it won’t matter how we pay for it, our medical care will suffer.

  12 Responses to “Health Care Two Step”

  1. If the realm of medicine must be at a distance from government, I think that it must also be at a certain distance from the market. My mother was a doctor (she’s now retired), and I grew up with stories from the hospitals in which she worked. Many of these stories had to do with very poor people who couldn’t pay for regular, preventative medical care, and who therefore only came in when their problems were severe enough for tax-payers to foot the bill. Such a system is poorly wrought both in terms of public health and in terms of the fiscal impact.

    If the medical profession is going to do what it must in terms of protecting public health, it must itself be protected from the spirit of the marketplace which seeks to maximize profits. When hospitals are run like businesses, the “bottom line” can contend with the spirit of the Hippocratic Oath. Medicine is one of those public services (among others, like education) that should be expected to contribute to the public good without the additional burden of having to turn a profit.

    Certainly, money is needed to provide medical care, and it has to come from somewhere; although it is also true that the best care is not always the most expensive (healthy eating and frequent exercise cost less, and do more good, that heart transplants). It makes sense to me that public money (taxes) be used for the public good. I also understand, and share, your concerns of government oversight (and control) of medical care. Can those two be separated?

    I’d like to pose this question (to you, Cara, and to anyone else who might want to answer): suppose power was given to you to overhaul the current medical system. How would you change it?

    • I wasn’t planning to get into this yet (later in the series).

      I’ll give a short answer because I really want to hear from others. I think we are looking at things turned on their head. We are so focused on how to pay for health care that we neglect to have conversations about, you know, health care. We should be looking at what we want to accomplish and what we can do and what the results of certain initiatives are FIRST, then look at ways to fund it. Looking at our available funds will then let us know what on our wish list is doable or not. Make no mistake, if health care is funded through taxes or through private money – there will be a bottom line. There’s always a bottom line.

      If I were going to overhaul health care : “Healthy eating and frequent exercise cost less, and do more good, that heart transplants.” That’s the areas where I would start.

  2. I don’t think the larger debate going on is about health care at all, it’s about health insurance. The problem I have with what’s going on is the fact that it’s the Federal Government trying to involve itself. I think it is the business of the State Governments as per the 10th amendment. I see nowhere in our Constitution that the Fed is given this power. (Have you seen the language regarding educational loans IN the health care bill, BTW?) As we are all aware, state and local governments are at least marginally more efficient than the federal govt. They already operate the SRS, why is this such a leap? States negotiate with insurance companies to insure state employees, why not the citizenry at large?

  3. The capitalistic profit motive should never have strayed into the realm of health care to begin with. Yes, doctors and nurses need to be paid, and well, and the equipment and facilities that are needed don’t come free, but this idea of an “insurance” entity inserting itself between a patient and the health care system and performing no other function that to add to the cost of care, while interfering with the delivery of that care, is asinine at best, an apt demonstration of moral deficiency at it’s worst. Why is it that almost every country in the world treats at least basic heath care as a human right while we use it to bankrupt anyone lucky enough to survive an illness? Sure, it costs money, but so do roads and schools and our national defense and it’s only common sense that we all have to pay our fair share for it. If you spread the cost of care across the entire population and tamp down the idea of medical school as being a road to riches, then we can rid ourselves of the controversy. I’m really getting tired of so many Americans, mostly those who have yet to experience the horrors of our system, of screaming “SOCIALISM!!!!” every time it is suggested that not EVERYTHING on this planet has to create a profit, especially when the bulk of those profits are funneled into so few already fat pockets at the expense of the everyday working man. You don’t see very many people “fleeing” the “oppression” of the “socialist” Scandinavian countries in order to experience the “freedom” of our broken down “health care” system.

    • Indeed. Sorry, but I don’t believe that anyone’s life expectancy or health should ever be dictated by how much money they have. It’s such a Social Darwinist, 18th century concept that should have disappeared with the 7 day work week.

    • “I’m really getting tired of so many Americans, mostly those who have yet to experience the horrors of our system, of screaming “SOCIALISM!!!!” every time it is suggested that not EVERYTHING on this planet has to create a profit, especially when the bulk of those profits are funneled into so few already fat pockets at the expense of the everyday working man.”


    • Yes. Actually, I believe that the best economic systems are not “pure” anything. Capitalism, by its very nature, is not humane/humanistic. President Theodore Roosevelt knew this — and his was the first presidency to acknowledge that capitalism needs to be strictly regulated because the only thing that means anything in this system is money and profit, which is most usually gained from the exploitation of the majority of the population. In addition, Ethics/morals should always be above any economic system and not be subsumed because {GASP} no profit can be made. Who exactly needs compensation of 14 million per annum along with a whole of perks? No one, that’s who.

      • “Who exactly needs compensation of 14 million per annum along with a whole of perks?”

        If anyone is thinking about offering me compensation like that, I wouldn’t be offended.

  4. 1. Go to the doctors and other health care professionals who are saying that insurance companies and HMOs more or less force them to overtest, overmedicate, and overcharge, and ask them for data on how these can all be reduced without jeopardizing responsible care.

    2. Get hospital management out of the hands of the stockholders.

    3. Lose the concept of “pre-existing condition” as grounds for denial of care, and any means of making it retro-active for existing clients.

    4. Good health incentive discounts for people who don’t smoke, drink excessively, and can show regular exercise and healthier diet decisions. That last defined per the individual’s capacities.

    5. Fewer giant box stores and more locally grown farmer’s markets.

    6. Overhaul the pharmaceutical patent system.

    7. If anyone tries to regulate profit margins for insurance companies, they’re only going to find new ways to scalp people and deny coverage on a case by case basis. My vague base idea is to have every dollar withheld from a client’s refused claim that does not equal the amount they’ve paid in up till then returned to their account as credit.

    8. Or we could just launch all the insurance companies and HOMs into space on a trajectory with the sun. That would be cheaper than fighting them, and less paperwork.

  5. If government and hospitals shouldn’t be in bed together, neither should insurance companies and hospitals. I don’t see any benefits to the current affair between doctors and insurance companies versus the proposed arranged marriage of government and doctors; both stymie doctors from practicing medicine, ultimately to the disadvantage of the patient.

    It is again a problem of systems in place. All current systems are market-based and industrially-scaled, rather than people-based and human-scaled. Until a systems-shift takes place, little real change can possibly be affected, but curbing profits-greedy insurance companies sounds fine to me in the mean time.

  6. This is all smoke and mirrors, it’s not going to make much difference except that some people who aren’t insured, many of them working will have some insurance so they can go to the doctor and recieve the same lousy treatment just about everyone else does. Insurance companies, HBO’s, hospitals and clinic are all in bed together and the result is a pretty bad system all around. Here’s an example of what I mean, from real life.

    Last year I broke my ankle on the way to work. It was a closed fracture, no bones through skin, nothing like that, in fact I thought that I’d only badly sprained it. When it didn’t get better in four days I went to the clinic, (my normal clinic, not ER or Urgent Care, see I was trying to minimize costs and be responsible) My regular Dr. palpated it and my knee, (which I’d also hurt) and ordered x-rays. The x-rays showed that my knee was sprained/twisted but my ankle was broken, like I said a simple stress fracture. But because the HBO group that owns this clinic, (and about a 1/3 of the ones in Minneapolis/St.Paul) has a policy that all their Drs. have to see a certain number of patients per day, (they spend on average 15-20 minutes per patient, a fact I know from a friend who worked for them and saw the memos outlining the policy) I had to then go to Urgent Care to have the temporary cast put on. At twice the cost to me and to my insurance company. I also couldn’t go back to my normal clinic or even to the same hospital for the permanent cast, (although that turned out to be a brace not a cast) But to a third clinic this one a clinic that specializes in Ortho stuff for an even higher price tag, because the Drs. there are all Ortho surgeons and get paid as such even if all they do is the exact same examine as my Internal Medicine regular Dr.

    So here’s how the costs added up: for the Internal Medicine Dr. 200+ for 6 x-rays and about 15 minutes
    for the Urgent Care, $700+ never saw a Dr. But a Nurse Practioner, no x-rays done, and a temp cast put on, and a walker. Ortho clinic: $800+ for 2 x-rays and 5 minutes of seeing an ortho surgeon.

    All in all I got worse care than any of my dogs has ever recieved from their vet, for a whole lot more money, (btw those prices were my share of the bills with deductible and 20% co-pay).

    The other side of this is that my insurance company of course only paid about 70% of the bill, which as a friend who used to work in hospital collections explained is normal for them to pay. The other 30% will be passed along eventually to everyone by the clinics and hospital increasing the costs period.

    Many of my friends work in health care and have for a long time, as I did; we are of the opinion that the entire system is so broken that no laws can fix it. That the best thing is to let it completly fall apart and then rebuild it anew. This time remembering that care givers are supposed to be taking care of people, not be good investments in rich folks portfolios, (and some are) Drug companies need to be stopped from marketing bogus products that do more harm than good. Another thing is that Drs. need to be taught that people die, it’s normal, it’s natural; keeping people alive just because they can when that person’s quality of life sucks is just plain madness.

    If I remember the myth correctly, Zeus killed Ascelpius for bringing people back and interfering with Hades domain. We all go to Hades eventually, and it should be a gentle proud going, not some of the horrors I’ve witnessed while working in health care. For me that is my own one concern, to make sure that my wishes on this issue are followed and if the current health care bill see to that, then okay. I don’t hold out much hope for anything more.