It’s Not That Simple

My title is an anticipation of the likely response to this post.  Okay.  Very few issues  are  so “simple” that they can be dealt with in a few paragraphs.  Still I persist:

Trump  better hire some genius medical economist to come up with a healthcare plan and simultaneously explain why Ocare did not work.  (Which it really hasnt) McConnell has said he’s not gonna help,  which swells the music of the Dems’ chorus:”They have no plan!”    We gotta get one.

I think we should go back to private insurance, but regulate it.  Make it  illegal, period, to deny coverage based on pre-existing conditions.  Make the insurance  market nationally competitive.  There: we’ve leveled the playing field, let the vying for customers begin.

Also would somebody break it to middle-aged America that Medicare is not free?   Maybe it is you’ve got nothing, but if you do have assets, you’re penalized and they’ll take it outta your social security.

But that isn’t even the biggest thing.  We should be concentrating on care, not insurance. Instead, Ocare has made it more difficult to even get to the actual hands-on treatment stage.  You can’t get into a clinic without photo ID.  You can go to an ER without it, but such “facilities” are authorized to  charge a “facilities fee” just for entering the door, exactly like a cover charge, in addition to and possibly in excess of the fee for treatment. (But independent practitioners cant impose such a fee.)  And, is it still possible for a medical school graduate to set up his/her independent office?  I doubt that.  When my husband left his practice as a family doctor in 1998  as we moved to my mountains, it had already become impossible to pay the overhead.  He was prohibited from performing most medical tests like EKGs and throat cultures and drawing blood in his office: patients had to make a separate trip to the hospital lab, pay for that, and w.a.i.t…both to undergo the test then to obtain the results.  He was prohibited  from charging more than insurance would pay for work injuries and car  accidents, regardless of the services he rendered beyond those remittances.  He was prohibited from charging for the total cost to him of immunizations.   Let those rich doctors just absorb the costs!

Yeah, so,let’s scrap all that and start selling medical students again on how great it is to exercise their professional skills in an environment where, yes: they are god.  (WTF was wrong with that?  If you have ever been through, or been terrified by th prospect of, a deadly illness, you know that what you want from your physician is, precisely, a god-like certainty and confident prognostication. ) Then they’ll compete for patients, who will flock to the ones with the best results, the most accommodations in services, and yes, the best bedside manners.

Such competition was fierce! we used to joke about our fellow residents who set up an office in some fairly remote area, and were instantly “busier ‘n’ a one-armed paperhahger” ( i dky, But thAt was  the invariable  cliché)— until one other doc moved in, and the new practice was instantaneously halved!   It was riskier and harder, but much better in the long run,  to go to an already saturated area and carve out a space.  If you could make it there, you’d make it anywhere.

People  had no idea what they used to get outta their doctors.  Oh, BC (before Clinton, Hilary I mean) they did respect and kinda idolize them.  But they didn’t know how much work docs  did FOR FREE.  Weekends “on call” where the doctor was tethered to his practice area, likely to be interrupted at all hours of the day and night.  Hours on the phone after office hours ended,  explaining lab results to patients, answering their questions, calming their fears.

They didn’t charge for all this time, and the cost of the office visit, what, like, $30-35? surely  didn’t begin to cover it. IF the patients paid even that, which many regulars just..never did.   But I never once heard of any of our peers asking a patient to leave his/her practice because of failure to pay.

Hilary, and then the era of the HMOs ( capitalized mecicine) convinced America that doctors weren’t on their side, they were just greedy,self-important charlatans in white coats.  Well, when you knock a profession off its pedestal,  don’t expect its members to keep up the monumental standard.

If Trump can’t win 2020 without a healthcare revamp, then come on!  Find the right architect, now!  The man who rebuilt lower Manhattan can handle that!

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13 thoughts on “It’s Not That Simple”

  1. Hypatia:
    Also would somebody break it to middle-aged America that Medicare is not free?   Maybe it is you’ve got nothing, but if you do have assets, you’re penalized and they’ll take it outta your social security.

    My husband was forced on Medicare because he’s in his sixties and we pay $250 a month for it which is annoying because he had at least 8% of his income taken for 40 years to fund it. That money could have been used to fund HSAs which make so much more sense and cost the general taxpayer so much less.

    I am contributing $7500/yr to fund my HSA and that income is tax free. The  U.S. government is incredibly ignorant financially. Don’t get me started on why we don’t allow people to buy private insurance on an interstate level.

    Anyone remember the concept of competition?

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  2. Hypatia:
    (WTF was wrong with that?  If you have ever been through, or been terrified by the prospect of, a deadly illness, you know that what you want from your physician is, precisely, a god-like certainty and confident prognostication. )

    You’re more than right; this comment acknowledges that the impressive advancements in medical science are all for naught if we don’t allow doctors to do their thing unencumbered.

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  3. I have a lot of sympathy for doctors now.  When I have an appointment, the doctors (and nurses) spend much more time entering data on the computer than examining or talking to me.  I agree it is nice to have web access to my medical records, but I think we have lost a lot to get to that point.  It is also depressing to see them try to sort out what ‘codes’ to use to justify a test that they think is necessary.

    I wonder how many children of doctors to into medicine.

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  4. No it’s not that simple.

    #1 Stop medical companies from advertising their wares on national television, radio and any sort of publication, billboards included. (do they advertise on radio?) (Take away their advertising budget and prices will fall.)

    #2 Prevent local hospitals from doing the same. (Take away their advertising budget and prices will fall.)

    #3 Prevent doctors and medical practitioners from doing the same. (Take away their advertising budget and prices will fall.)

    #4 Mandate price rollbacks on all medications especially those that had unheard of increases in the U.S.

    #5 After price rollbacks take effect, mandate insurance rollbacks.

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  5. Hypatia:
    Make it  illegal, period, to deny coverage based on pre-existing conditions.

    President Trump says this will be a feature of TrumpCare.

    It seems to me that this was the feature of ObamaCare that brought about the Individual Mandate.   Otherwise, young healthy people go without insurance until they need healthcare, and avoid paying into the system.

    I am thinking that the only way to fairly fund TrumpCare that has no exclusion for pre-existing conditions is to enact a healthcare tax to create a fund to use to pay for catastrophic care required by uninsured individuals.   There could be a tax exclusion for insured persons.   That is pretty much how ObamaCare ended up operating after the John Roberts tweak.

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  6. G.D.:
    #1 Stop medical companies from advertising their wares on national television, radio and any sort of publication, billboards included. (do they advertise on radio?) (Take away their advertising budget and prices will fall.)

    #2 Prevent local hospitals from doing the same. (Take away their advertising budget and prices will fall.)

    #3 Prevent doctors and medical practitioners from doing the same. (Take away their advertising budget and prices will fall.)

    This seems to me to amount to a sure-fire violation of the First Amendment rights of medical companies, hospitals and doctors and other medical practitioners.   I do not think this is going to fly.

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  7. One of the biggest problems with our current system is the way we have employers positioned in between their employees and the employees’ healthcare providers.   That is nuts.

    What happened was that we made the costs of employer-paid health insurance premiums deductible to the business.   But we did not make health insurance deductable on individual or family income tax.   This was done so that employers could reward employees and retain them without inflating wages.   The whole healthcare world readjusted to put businesses in between their employees and the healthcare providers.   That happened because everyone who had a higher than unskilled labor job could participate in the giant tax dodge.

    But the consequence is that patients are removed from the costs of healthcare.   Nobody pays attention to price; everyone simply either chooses for convenience or chooses from a network.   And the insurance industry has become so complex that most doctors do not know what is being paid for their services.

    I can remember conservatives in the Wall Street Journal writing on occasions for at least three decades that we could start a great reorganization to our messed-up healthcare system by making health insurance premiums tax deductible to individuals and families.   Why did that idea not gain traction during those times when Republicans held the House and Senate?

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  8. Ok, everybody will probably hate me for saying this, and I haven’t studied the medical system in Massachusetts, so there are things I am not aware of, but what we have in Mass seems to work pretty well: the state government insures those who can’t get insurance any other way, and everybody else is left alone. From what I can tell, most people on Masshealth hardly ever use it: it is just there in case of emergency or catastrophe. Or, maybe they go to a doctor once  a year. So what?

    Romney Care gets a bad rap, because Romney, and I dislike Romney as much as anybody else, but I am forced to admit: his health care plan seems to work pretty well, and has been working for some time now. Massachusetts has not gone broke, the medical system here has not collapsed. But, conservatives don’t like it because it’s too liberal and liberals don’t like it because it isn’t nearly leftist enough for their tastes. But it is one plan that has worked in one place for a number of years; obviously, that doesn’t necessarily mean it will work nationally or everywhere, but I don’t understand why people are so dismissive of it.

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  9. Judy Campbell:
    From what I can tell, most people on Masshealth hardly ever use it: it is just there in case of emergency or catastrophe.

    Here’s the problem with that. I had a minor emergency (shattered patella) and between surgery and physical therapy, my insurance company was billed $95k. Thank God I had insurance, but I have an additional month of PT to endure that is self-pay at $175 a session.

    We have to get interstate insurance so it’s affordable for all. Because of the age differential here in Florida from say, Kentucky, I’m paying extremely high premiums for 90 year olds to have hip replacements.

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  10. Massachusetts has about the same percentage of illegal alien residents as the national average (about 3.5%).

    There are fifteen or so states with higher percentages of illegal aliens.   Are they going to be covered for pre-existing conditions also?   Are those states going to get federal subsidies?

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  11. MJBubba:
    Massachusetts has about the same percentage of illegal alien residents as the national average (about 3.5%). There are fifteen or so states with higher percentages of illegal aliens.   Are they going to be covered for pre-existing conditions also?   Are those states going to get federal subsidies?

    I totally acknowledged that just because something works in Massachusetts doesn’t mean that it will work everywhere. I never tried to claim that Masshealth would work everywhere.

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  12. From what I’m reading today it looks like Trump has called in the A team, so…expect miracles!

    I think Trump will do his part, but I have also heard that the Republicans in the House and Senate are afraid to touch it because it might harm their chances in 2020.

    We need to convince them that once again sitting on their hands will really harm their chances.

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