Friday, April 10, 2009

Putting you in charge of your own health care

Americans are ready for change in the way they receive and pay for health care. Surprisingly, it may not be the changes that most politicians, big businesses, insurance companies and special interests are pushing. Americans are ready to take back control of their health care. They are ready for a change from unaffordable insurance that comes only from an employer they may prefer to leave -- insurance that seems to provide more of a hassle than convenient protection from unexpected expenses. They are sick of sitting for an hour to see a doctor, then seeing a nurse for 10 minutes and the doctor for three and often left to wonder about what happened. They are burdened by high taxes for government programs that seem to provide health benefits for everyone but them while the same government clamors to cover even more in financially unsustainable programs. They have heard enough of empty promises from politicians who care only about getting re-elected and having more power. Yet even with all these and other problems, many Americans have given up and figure that it is up to the government to solve the problem. They wonder if the government solution will still allow them rapid access to high quality health care they deserve.

The current proposals for reform are cloaked as big changes, but as it turns out, they are actually more of the same. They can be summed up in this way: turn more control over to the government and insurance companies while politicians and special interests jockey for credit and work behind the scenes to benefit -- at the expense of individual Americans. Albert Einstein once defined insanity as doing the same thing over and over and expecting different results -- but that is what is being proposed today. While most American want more individual control over their own lives, the health reform proposals will expand the control over health care held by third party payers (insurance companies and government). This would make matters worse for Americans.

The story of how we got to where we are today is long but has its roots in the World War II era policy that stated that a tax deduction could only be applied to health insurance provided through a job. That lead to employers control of health insurance purchase and removed the consumer from the decision -- decisions they make every day for auto, homeowners and life insurance (products that are affordable). Insurance companies then sold to employers -- not to consumers. Insurance products then began to expand from "accident and sickness" policies, to "health" insurance. Thus they cover every minor expense except for a token deductible from patients.

While this seems desirable on the surface, in the end it leads to little control over demand for medical tests and treatments and drives up the cost of health care and insurance for all. Instead of asking your doctor, "Do I really need another pill" or an MRI, or a surgery, consumers take the "free" benefit. Unfortunately, doctors often do more tests and treatments to survive government-fixed prices through high volume services and to protect themselves from lawsuits. This leads to what the government and insurance companies call "over-utilization", the boogeyman they seek to kill by having more control over what kind of care every patient can be authorized to receive. Authorized by someone else besides the patient through cookbook medicine and rationing of care. That is the same thing that happens in socialized medicine in other countries.

There are many other problems created by government: requiring that young and healthy people pay the same high insurance rate as older and sicker patients, allowing anyone to buy insurance (even after they are sick or injured!), mandating that every insurance policy cover some things that not everyone wants to buy insurance for (like hair prosthesis, acupuncture, chiropractic care, maternity care for men and Viagra for women).

So what solutions do politicians like Barack Obama, Senator Max Baucus, Tom Daschle, and groups like the AARP, Families USA, big insurance and big business propose? They want to mandate that everyone buy the same expensive insurance that many can't afford (with a tax if you don't buy) - a plan that is failing in Massachusetts. They would create a "Health Care Fed" that would create cookbook medicine and rationing protocols and force your doctor to follow them under the threat of lower pay or a phony report card score that has nothing to do with quality and has everything to do with how much third-party money was being "wasted" on actual patient care. This would be enforced through a mandate to enter your health data into a computer that would be forward to the government where it would be subject to loss or accidental exposure of private health information. They would expand the Medicare program, which is scheduled to bankrupt its own trust fund next decade, to people who are 55 years old. They would put more children in government health programs even though such a plan failed in Hawaii after only 7 months -- leaving many children previously insured privately without coverage!

The way we pay for health care must change. It is clear that the politicians are making more promises that they can't keep and will resort to "bailout" mode with high taxes and lower quality health care when it fails. The good news is that there is a better way. Instead of expanding control of third party payers -- the same parties responsible for our current mess -- we can put the control of health care financing right where it belongs: into your hands.

Right now, you can buy a low cost health insurance package and fund your own private health savings account with tax free money. You can use that account to bargain for lower prices from hospitals and demand that your doctor spend more time with you and explain how you can be managed without every test and treatment they can provide. Your insurance will provide 100% coverage for preventive care and for true medical catastrophes that occur rarely in our lives. You can ask for your right to have a tax break when you buy insurance on your own (outside your employer). You can demand that the government stay out of the patient-physician relationship and not institute cookbook medicine and rationing. You can require that your politicians reserve government assistance for the poor and those who have no other means for health care -- not expand that care to everyone merely to get re-elected on an empty promise.

There are reform plans that will put you back in the driver's seat with your doctor at your side as your advisor and partner. They are proposed by people like Senator Tom Coburn, Representative Tom Price, Representative Tom Shadegg and Representative Paul Ryan. However, they will be very difficult to pass through Congress. It will require that you demand changes that empower you economically as individuals. Demand that you be able to have an individual tax benefit when you purchase insurance outside of employment. Demand that you be able to purchase insurance from another state. Ensure that Health Savings Accounts remain an option and grow in scope and size. Fight against expanded public saving for health care. Make sure that Government committees like the Comparative Effectiveness Coordinating Council don't create rationing protocols. In short, demand that you be in charge of your own health care financing and decision making. When you are in charge of your own health care, the politicians will not decide what kind of medical care you receive. Only you will.


Britain: Hospitals have never needed Chaplains more

A&E departments are a war zone. There could not be a worse time to get rid of their chaplains

There is no way of telling how many prospective doctors and medical students watched The Hospital on Tuesday night, but we should, for all our sakes, pray it was a low number. The first part of Channel 4's fly-on-the-wall series, which runs for another two weeks, looked into the modern world of emergency medicine. This wasn't ER or Scrubs, this was ugly reality - wave upon wave of young people, drunk, regardless, violent and rude, brought in with various terrible injuries as a result of intoxication.

It was some of the most powerful documentary television I've seen: the young people were both victims and propagators of alcoholic mayhem; the doctors were dead-eyed, high-pay-grade streetsweepers.

We would be sensible to regard it as a modern morality play, especially in a week when the National Secular Society called for the NHS to stop funding hospital chaplains. The society estimates that £40 million a year is spent on giving religious groups a presence in hospitals. In many areas secularism has much to recommend it. In this instance they are wrong and mean-spirited. There has never been a greater need for a spiritual presence in hospitals.

What was so interesting about The Hospital, apart from its shock appeal, was the moral landscape it painted of our society. Here was a stage, you realised, where everyone had become brutalised. The patients showed a total lack of responsibility for their actions. They swore at staff, they smirked, they were abusive, complaining, obstructive, hysterical and completely unapologetic. As for gratitude, why, it's a free service, isn't it? What's to be grateful for? There was an almost total lack of the embarrassment or thanks that former generations would have displayed.

Even when approached, sober, for their reflections they were not given to remorse. Rather they were insouciant. Danielle, a 19-year-old mother of two, who had arrived at A&E after being trapped under a taxi, her shattered legs bent up over her shoulder, was oblivious of any moral subtext. After she had spent a month in hospital she was asked if she had paid a high price for her drinking. Nah, she joked, I only spent £20 and got a free taxi.

Equally you could see the impact on the battle-fatigued staff. Like military mercenaries, their moral values had either ceased to exist or they had been buttoned away for fear of revealing disgust.

I've encountered exactly the same dead eyes in big city A&E departments. Once, at one of these hospitals, notorious for dealing with relentless violence and knife crime, I attended my child who had been rushed there with a suspected neck injury. Fortunately it turned out just to be a torn muscle, but I found it an unnerving experience, and not for the obvious reason.

The doctor, a young man with empty eyes and a hard-drinking face, did not engage with us. He spoke as if we were five miles away. For all he was utterly professional and faultless, I felt as if something had died inside him. He was almost like an addict: I wondered if he was so hooked on the adrenalin of coping with stab wounds and fights that nothing less than that stirred him.

You see the same look in abbatoir workers' eyes. They shut down all feeling, all judgment. The patients, deserving or not, have become lumps of meat to them. Monica Garnsey, the maker of the documentaries, believes that what patients want most is the sense that their doctor is sympathetic. But their patience has been stretched too far.

So maybe a little moral panic would be a good thing; maybe we need more chaplains, if only to check the growth in this new amoral, compassion-neutral transaction, where the drunk and feckless not only waste billions of pounds but leave hospital as ignorant and unreformed as they went in. Maybe we need to be a bit more judgmental, for all our sakes.

In a world sometimes scarily lacking in values, chaplains have a vital symbolic role as well as a practical one. Chaplains, in my experience, do not proselytise; they simply afford patients the kind of time, care and compassion that medical staff can no longer give them. No, they cannot cure binge drinking, but they do stand for something resolutely good and wise.

The secularists have missed the point completely. They contacted 233 acute and mental health trusts, which spent £26.72 million on chaplains. This money, they say, could be used to employ 1,300 nurses or 2,645 cleaners, which is as facile as saying that we could save £3 billion plus in A&E budgets by banning booze. Terry Sanderson, the president of the society, even claimed that people in hospital should seek visits from their own vicar, priest, rabbi or imam if they needed religious support.

What an arrogant man he sounds. It is non-religious people, lost in a crisis, who need chaplains the most. Look at Jade Goody, married and blessed as she was dying. Look at the tragic, chaotic lives of some of the young people lying in A&E with no family to phone. It is the injured, the dying and the bereaved, who seek, not necessarily God, but a little kindness and succour at their time of greatest need.


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