Thursday, July 30, 2009

Health Care Reform is Not Health Care Reform

Allow me to clarify the statement above. The legislation currently being hashed out by Congress, and the one discussed in the media and among the general populace is all about coverage reform. Health care reform, if we want to get into specifics, is the process of making changes to how hospitals and doctors treat and manage illness, how to preserve health through those appropriate professions (medical, dental, pharma, etc), and in the WHO's words, “preventive, curative, and palliative interventions, whether directed to individuals or populations.” Insurance certainly has to do with health care, but reforming coverage will not reform health care. The legislation in Congress will attempt to make health care accessible to everyone, but the issue that needs to be addressed is why it costs so much to provide care.

We live in a society where everyone expects the best health care because we have the technological ability to deliver the best health care. But the best is often the most expensive, and somebody has to pay for the cost. Enter the insurance company. Keep in mind that insurance companies, like all successful companies, are in the business of turning a profit. As more services, such as lab work, physical therapy, and surgery, are sought, expected, and provided, the costs of those services need to be covered.

High costs cannot be attributed to health insurance alone. Malpractice insurance is also a cause. There are currently no caps on the rewards from malpractice lawsuits, and so the insurance costs can be tremendous, though it differs from doctor to doctor depending on their practice. The cost of malpractice insurance is incorporated into fees charged by health professionals. Like health insurance companies, malpractice insurance providers need to cover their anticipated claims, plus a profit, by increasing premiums. The cost is passed from the professional to the patient.

So, the question at heart is how to reduce the cost of health care, but maintain the high standard of care. We have to realize that there are fixed costs that we can't do much about. These include equipment and staffing costs. Overall, the costs that we can reduce don't seem to fall much on the “delivery” side of health care. I say “overall” because in many cases there is an excess of supply, as far as hospitals are concerned. Often, in a town of 50,000 you can find two hospitals. Both hospitals are operating at 50 to 60% of their capacity. Generally, a ratio of 1.75 to 2 beds per 1000 people in a given population is optimal. So in a city like Madison, you want somewhere between 350 to 400 beds. There are over 1000, perhaps 1500, if you expand out just a bit beyond Meriter, St. Mary's, and the UW Hospital- and UW is expanding their hospital! This means that there are unnecessary building, equipment, and staffing costs. Of course, the question becomes, “which hospital do you close?”

Now, the advantages of universal coverage have been addressed and debated. Everyone pays in, the premiums go down, etc. etc. (Best-case scenario). So, how do we decrease the cost, if we don't want to close half-filled hospitals? Here's a couple of ideas.

1.Strong focus on preventive care. This isn't just check-ups and immunizations. Ad campaigns that seek to prevent or delay the use of alcohol, tobacco, and other drugs are a form of prevention. So are public smoking bans and worker drug testing. Pest control is prevention. Above all, public health codes should be carefully examined and followed, especially concerning areas like public pools, food preparation, and industrial hygiene inspections. Remember, the three leading causes of preventable death in the U.S. for 2008 were smoking, overweight/obesity, and alcohol consumption. We don't have to outlaw fatty foods, and we shouldn't. We just have to increase the education and awareness of the costs of overindulging in those delicious, delicious treats.

2.Following the doctor's orders. If an outpatient disobeys an order to rest after injury, and ends up requiring physical therapy, the costs go up. If a patient forgoes physical therapy, which would have provided relief, and as a result requires surgery, the costs goes up. This extends to prescriptions as well. I have heard stories where medicine has been prescribed, and the patient stops taking the drugs because the symptoms have subsided. Then the illness comes back worse than before, and drug-resistant, requiring something a little more potent, and a lot more expensive. Basically, your doctor knows medicine better than you. Do what he says.

Of course, there are plenty of other solutions to reducing overall costs out there, and I'd love to hear your ideas.

Wednesday, July 22, 2009

Alcohol Downtown

Alderman Eagon has already said everything that needs to be said, as far as I'm concerned. Give it a read.

Quick Pitch

Just a quick post right now.

Dan Seals is running again in the Illinois 10th Congressional District. I support him, and you should too. He's a good, intelligent man and would be an excellent addition to the House of Representatives.

Friday, July 17, 2009

In Memoriam

This evening, 7:42PM Eastern Time, Walter Cronkite passed away at the age of 92 after a long battle with cerebral vascular disease. Often regarded as the most trusted man in America, Cronkite delivered the news from 1937 to 1980, covering everything from World War II to the Iran hostage crisis.

In this era where to break news first is more important than to break news accurately, we forget how Cronkite waited until all the reports were gathered before giving the news to America straightforward, accurately, and concisely. Imagine how today's CNN or MSNBC would have covered the JFK assassination, and compare it how Cronkite presented it. It is that sort of journalism that creates an intelligent and informed democracy. For journalistic integrity, Walter Cronkite remains the gold standard. If we desire to have that back, then our newsmedia should remember Walter's words; that their "job is only to hold up the mirror - to tell and show the public what has happened."

We owe it to Walter Cronkite to strive for truth and accuracy above all, in all things. And though this blog primarily contains opinion, I will always try to be as accurate as I can, and as truthful as I can be. It's the least I can do for Uncle Walter.

And that's the way it is, July 17, 2009. Good night, Walter. You will be missed.

Saturday, July 11, 2009

Yes Virginia, I Am Alive.

Hello reader(s?). After a long period of absence, I have indeed returned to spread the gospel. Honestly, I've been fairly busy as of late, or I haven't really had the urge to write about something; you can believe whichever one you want.

In the Wisconsin State Journal on Friday there was an article about the possibility of increasing rent assistance payments for those who rely on Section 8 vouchers, with the major focus on how to do so. Even though I usually don't read the comments sections (and no one really should, it's so bad for your blood pressure), I came across this one statement:

"There is the answer,deplete all funds for these &%$*^ so we can raise city,county,state and federal taxes to enable these &^*%$ to continue to live off the hardworking citizenry,Good Choice councilmen."

I'd like to address something that bothers me, something that some of you may think about once in a while, but likely never realize. It's somewhat related to the comment above.

People who bitch about paying taxes to "enable these &^*%$ to continue to live off the hardworking citizenry" are often the same people that will turn around and bitch about the homeless and panhandlers (by the way, Alderman Bryon Eagon puts forward an interesting idea about panhandling here. With the right awareness campaign, it could work). Somoe people fail to realize that without these Section 8 payments, the number of homeless and panhandlers increases. I am bothered by people who bitch about both outcomes of a political choice; in this case, either providing rent assistance for people, or letting them go homeless. People who complain about when the government does something and when the government doesn't do something are idiots. You cannot have it both ways! Take, for example, the stimulus. If you're against it, fine. But I better not hear you gripe when the next economic catastrophe comes around and the government takes no action. Or here's one of my favorites (particularly in Wisconsin). A lot of people I know bitch about Illinois tolls, and boast about the lack of tolls in Wisconsin. Some of these people also gripe about road conditions in Wisconsin a few sentences later. Well, if you just had a few toll roads, the state might actually have some funds to spend on road repair, among other things.

People, you have to make a choice. You can either pay the tax to keep the poor off the stree, or you can deal with the poor on the street. For those that ask why the government has to get involved...it's the government. It's often the single entity capable of handling a widespread issue in a uniform and coherent fashion (even if you don't get their methods, the people running the programs do, and that's what counts). Not to mention, the government has an obligation to each and every one of its citizens, not just the well-off ones, or the ones who fortune has smiled upon. Personally, I would rather pay the tax to keep people off the street.

I am thankful that I have been born to a well-off family. My dad works very hard at what he does, and he's good at it. He and I disagree about taxation, mostly because he's the one that earns a lot of money, and I'm the one that doesn't. However, he's consistent about his views, particularly on welfare, and I respect him for it (I even change his mind once in a while). I don't think I will ever change my views on welfare, because I know that welfare primarily seeks to help those who have had a run of bad luck or fallen to circumstances beyond their control. Sure, bad apples get into the pool, but the system tries as much as it can to seek those out and remove them. If problems become serious, then reform is needed to weed out the bad apples, but allow those who need welfare to access it. Additionally, I know that if, God forbid, something should happen and I need to rely on the assistance of the state, that it will be there for me because I paid into it and the American people paid into it. Welfare is just a public insurance program. It is analogous to the money pool an extended family creates to support each other on hard times. Just because you never get sick doesn't mean you shouldn't have health insurance. When you pay for someone's unemployment insurance, you should take comfort in the fact that should you find yourself out of a job, someone else will pay for your unemployment checks.

In the end, we all must choose if we are to watch out for one another, or if we are all truly in it only for ourselves.

End of rant.