Tag Archive for single-payer at Zeal For Truth

Tag Archive for 'single-payer'

Health Care Is Already Socialized. The Real Question: Should It Be Expanded?

Published by Atanamis February 24, 2010 in Current Events. 28 Comments

The argument over the health care reform package being pushed by Democrats has been over whether it would make health care in the US socialized, and whether US government control over health care would reduce costs, increase coverage, and increase quality of care. The most fundamental flaw in the logic is that the government already pays 46% of all health care spending in the United States. The question really doesn’t seem to be whether we should have socialized health care, but if we should expand it. (And yes, I would agree we have socialized national defense and law enforcement, and personally don’t think there is inherently anything wrong with government run programs that really are better than privately run programs.)

One commonly mentioned observation about health care in the United States is that we pay a large amount for the care we receive compared to what is paid in other nations. While people for other countries will come here for the best surgeons and specialized care available, the average person in the United States does indeed pay FAR more for health care than in other developed countries. In fact, some estimates suggest that $1.2 trillion of the $2.2 trillion we spend on health care is unnecessary spending. The primary causes of overspending listed are up to $210 billion on unnecessary testing and $210 billion on claim processing. Add in ignoring doctor’s orders and inefficient technology for another $188 billion combined, and we have a lot of inefficiencies that should be easy to address by a unified health care provider like the United States government (allowing them to provide more efficient health care).

In fact, assuming the savings are equal between government programs and private programs, you could double the benefit of government health care purely by addressing inefficiencies. Throw in fraud and other problems with the government program, and we should be able to greatly reduce national health care costs with no changes to existing law. I wouldn’t even think you’d need to make a law to spread these initiatives into the private sector. A first step here would be working with insurance companies to derive a generic, simple, and efficient claims processing standard that provides the information needed by each company to process claims. If the major companies were in agreement, doctors would simply drop any insurer who didn’t adopt the standard. Developing clear guidelines for testing would also seem like something that could be achieved cooperatively. Cash for testing should, of course, always be available as a safeguard.

To summarize: we already have socialized health care, and inefficient socialized health care at that. If the government wants to convince me that they should become a single payer, they need to start by getting their own house in order. Once Medicare is so good people want to buy in and so efficient we can afford to let them, we can talk about making a public option available to everyone.

A Moderate Proposal for Health Care Reform

Published by Atanamis October 13, 2009 in General. 0 Comments

The health care debate has been one of extremism on both sides, with nobody really seeking to find a middle ground. This article will attempt to do exactly that.

Emergency Health Care
One thing many people opposed to universal health care fail to recognize is that we actually already have it. Any person can walk into any emergency room at any time and cannot be refused service for lack of ability to pay. This law has directly resulted in many emergency rooms going out of business since they have been forced to provide health care to patients with no ability to pay. We really do have to examine this area first to determine whether we view health care as a “right” or a “privilege”. Those who truly view it as a privilege ought to oppose this existing requirement, and can accurately point out that it is greatly increasing the cost of emergency services for everyone. Since I haven’t heard much complaint about it though even from those strongly opposed to current reforms, I would assume that most Americans are in favor of mandatory emergency care.

That said, there is still the problem of who pays for it. Under current laws, hospitals are required to simply eat the cost of emergency health care. This appears to be a fundamentally unfair requirement. If the federal government is going to require hospitals to provide emergency care, the very least they can do is to ensure that compensation of expenses is provided. For this reason, I would be willing to support a “mandatory emergency insurance” program enforced on all citizens, legal residents, and legal visitors. People from all three groups will be granted access to our emergency services if needed, and should be able to guarantee payment. This insurance program doesn’t necessarily have to mean that the insurance company covers all expenses, but rather that the insurance company guarantees that the hospital gets paid. Individual contracts between patient and insurer would determine whether the insurer pays out of pocket, with a “health savings loan” to be repaid by the patient, or from a “health savings account” owned by the patient. Obviously, the premium cost of the first would be the highest and that of the last would be lowest. Even in the last case though, the insurer would have an obligation to work out with the patient how any costs in excess of the account balance.

Health Care for Minors
The next area of likely agreement is with regard to children. In the US, we consider those under 18 years old to be legally unable to make their own decisions, delegating these decisions to the parent with some supervision from the state. Most children have little to no choice whether they have medical insurance, and again most Americans would argue that children should not be refused medical treatment by hospitals. Statistics show that around 8 million children are uninsured. One assumes that most people would support programs to insure these children, and in fact “Nearly three quarters of uninsured children are eligible for health insurance coverage under Medicaid or SCHIP. The remaining uninsured children are not eligible primarily because their family incomes exceed program eligibility levels (Figure 3).” This leaves only 2 million kids in non-poor families uninsured.

This gives us another low hanging fruit that is being intentionally ignored in the current debate. Rather than arguing about universal health care for adults, why don’t we first enroll the 6 million uninsured children who are eligible for government care? This can be done through a combination of health care drives where we pull together all the people needed to enroll these children and explain the benefits to their parents and by simplifying the enrollment process. No major legislation or national debate needed. For the remaining 2 million children, I would be willing to support either mandating that they be insured or extending government programs to cover them.

Insurance for the Rest
Getting clearly specified preventative care should be a pre-requisite for all insurance. A great deal of the expense in insuring people results from not catching problems early, and insurance companies have a (moral) right to try to reduce their expenses in this way. The easiest way is to just tack the cost of a yearly visit onto all policies, and provide the patient with a mandatory appointment if they fail to make their own by a pre-determined date. Insurance companies would be allowed to set their own rules about this though, since their interest is in reducing total cost. If a company decides yearly visits are unnecessary, they wouldn’t have to pay for them. In fact, a more piece-meal approach to insurance is desireable all around. Insurance as a concept is really only useful for unlikely disasters, since it is only in those cases that the average person can ever expect to get more out than they put in. That being the case, other than mandatory checkups as described above most insurance should probably be high deductible insurance.

Insurance that kicks in at 5 or 10 thousand dollars has always been cheaper, and allows people to have help when they really need it without paying inflated premiums when they don’t. Current estimates of the uninsured are around 48 million. Subtract the 8 million kids we already discussed above, the 6 million people who aren’t here legally to begin with (but will still get ER care), 9 million making more than $75k, and another 6 million non-minors who also qualify for existing benefits to get 21 million (note that these groups may have a little overlap). What would it cost for this group to get a high deductible plan? Maybe those worried about their status would be better off creating a medical relief charity to buy them coverage than trying to use tax dollard to do so?

All such insurance should be owned by the individual, though it can be purchased through collaborative negotiating groups if desired. Tax benefits that favor employer based coverage should be ended or shifted to cover all insurance plans whether through an employer or not. By having the plan owned by the individual, one wouldn’t experience changes in insurance due to job changes. (That said, an employer might still offer negotiated rates from insurers, though those rates would not change due to a future employment change.)

Health Savings and Health Loan Accounts
The final piece needed is coverage for the expenses between the mandatory office visits and the point where the high deductible insurance kicks in. The best place for this is in health savings accounts, which could remain tax exempt to encourage contribution. Companies wanting to attract talent could also provide automatic or matching funding, much like they do with 401k plans. (My own company currently provides $1500 a year in a health savings account to anyone choosing a high deductible plan.) Throw in a loan program for those who encounter expenses before accumulating enough savings, and you have a nearly complete program.

Conclusion
The above provides health care for almost everyone with very few changes to the existing system. Most people can probably agree about the children, and the ER coverage ought to have been part of whatever bill mandated that ERs take all comers (so you should either support the coverage or oppose the mandate). Encouraging a greater focus on savings and responsible lending should also be acceptable to everyone. I understand the last part is likely contentious, but it really is the best solution for everyone else. The only people whose needs WOULDN’T be met by the above are those with extreme long term illnesses that have an early onset. For these people, the high deductible every year would be a problem, but my hope would be that these people can be addressed through friends, family, charitable organizations, or even government welfare.

More Tales From Universal Healthcare: My One Hour Ambulance Wait

Published by Colin October 8, 2009 in Politics. 30 Comments

For those of you that don’t know, I am currently in the UK working on my postgraduate education. In my own (anecdotal and non-scientific) way, I am experiencing Universal “Government-Run” Healthcare firsthand and writing about it here.

Last night, my wife and I were parked a couple of roads down from our flat in order to use wifi internet - we’ve recently moved and it takes upwards of a month to get internet hooked up here. As I prepared to drive away, I noticed two women walking from their car to the corner of the street, where a body lay on the ground in a fetal position.

I rolled down my window and asked if everything was alright. The women said that this man (about 50 years old) had fallen and seemed to have broken his arm - he couldn’t move and his legs were in an awkward position.

“Do you think we should call an ambulance?” they asked me. I was shocked at this - I figured they had already called one. Why in the world would these women hesitate to call for an ambulance? Even if the man wasn’t injured, it was around 40° F and was raining. He obviously needed help. I dialed for an ambulance right away.

On the phone, they quickly obtained my location and gave me instructions to keep the man from moving, and to keep him on the ground - that an ambulance would arrive shortly. I, along with a 19 year old who had come upon the scene, waited in the dismal weather.

And we waited. And waited.

In the interim, the man kept reaching for his head and holding his left wrist - he appeared to be unable to move it. He was also drunk (probably why he fell over). He was muttering incoherently, repeatedly asking where he was and complaining of pain in his arm, stomach and knee.

After fourty minutes of waiting in shorts and a t-shirt in the cold weather, I called again. With as much civility as I could muster, I told the operator that I had been waiting fourty minutes now for an ambulance - and that there was a man who was clearly injured , out in the cold and rain, and he needed help. She apologised, saying that it was a “busy night” and that an ambulance would be with me shortly.

The Ambulance Arrives - And It’s Just The Beginning
After an hour of shivering out in the rain, an ambulance finally arrived. It went first to a pub down the road - one of the people assembled around the man had to run over and grab the paramedics and bring them to the street-corner.

Before even looking at the man, the lead paramedic slowly walked towards us and asked “who dialed for the ambulance?” I raised my hand. She then said, “right, I am going to beat you up.” I am not sure if she was joking, or if she was upset about something, but in the ensuing encounter, she made it very clear that she felt this was a big waste of her time.

She never touched the man. She calmly walked over and began to mock him - making fun of the fact that he was obviously drunk. She played games with him, asking him questions about what he was doing and where he was going - responding with sarcasm and cold, uncaring paternalism. She never looked at his knee or his wrist - didn’t look for concussion or any other injury associated with a fall.

He complained that he was having pain in his stomach. She replied that it was probably a hernia or something, and that he should go to the doctor first thing in the morning. But she “asked” several times - “you don’t really need an ambulance do you?”

Without checking out the man’s legs or any of his other injuries, the paramedics then stood him up to see if he could walk. He couldn’t. He was either too drunk or injured.

He then held up his wrist and began to complain. The paramedic swiftly pushed his hand down and said, “you’ll be alright, won’t you.” It was a statement, not a question. She then turned to me and the 19 year old and said, “you two can walk this man home, I’m sure he’ll be alright.”

And then they left -and we carried the man a half mile uphill to his apartment.

As we walked back, we all felt a little guilty calling for help. We had obviously been far to concerned for this drunk old man who was complaining of pain, and couldn’t get up. I now see why the women who first found him weren’t sure whether they should call the ambulance - it might very well have been better to leave him out in the cold, wet night - lying injured on the street-corner.

For more of my experiences with Universal Healthcare, read:

Medicare in HR3200

Published by cchrisr October 6, 2009 in Politics and Current Events. 2 Comments

This is part 2 of the series investigating the proposed healthcare reforms. Part 1 is here.

I will quickly review the improvements to Medicare in HR 3200. For those unfamiliar with the various parts of Medicare, I will section the improvements according to each part and provide a very short summary of that part. Medicare applies to individuals to are over 65, those under 65 with certain disabilities, and individuals with end-stage renal disease (kidney failure that requires transplant or dialysis).

‘Original’ Medicare (§1101-§1112)
Medicare Part A is basic hospital coverage. No premium is paid for this part of Medicare as it is geared towards inpatient care, emergency care, and hospice. People under Part A may optionally enroll in Part B and Part D Medicare. The primary change here is to increase payments to medical facilities that operate with Part A by increasing the annual adjustment percentage retroactively from 2004 to 2009.

Part B (§1121-§1158)
This is a basic medical insurance that includes a premium for coverage. This is aimed at outpatient care, physician services, and physical or occupational therapy.
Changes here include modifications to the growth rate formula and consolidation of medical service codes (e.g. services often billed many times for a single treatment, multiple services grouped together for a single treatment). Funding for this is $20M from otherwise available funds in the Treasury. During the years 2011-2012, physicians performing Medicare services in efficient areas (top 20% based on ZIP code) get an additional 5% on all payments for services performed from section 1848 of the physician fee schedule. The Medicare Improvement Fund for years between 2011 and 2019 is increased to $8 billion annually.
Hospitals will received reduced payments for patients who are readmitted excessively, with the intent on full recovery before discharge. The aim of this is to eliminate unnecessary readmissions.

Medicare Advantage (§1161-§1177)
Part C Medicare combines Part A and Part B Medicare into a single package with the exception that the care and coverage is provided through approved private insurance companies. Medicare Advantage payments will begin to be based on the fee for actual services. MA plans which are rated as high-quality and those which improve their quality rankings will receive additional money (percentages that increase annually from 2011 to 2013). Cost-sharing techniques for MA plans will be limited to the cost-sharing amount for non-MA plans. MA plans which do not have a medical-loss ratio of at least 0.85 must give rebates of premiums to enrollees until the medical-loss ration is at that level. If a plan does not meet this minimum for 3 consecutive years, it will suspend enrollment for new enrollees to that plan. If a plan does not meet the minimum for 5 consecutive years, that plan’s contract with Medicare will be terminated. In effect, this is limiting a company’s profit from Medicare Advantage plans to 15% of annual premium totals.

Prescriptions (§1181-§1185)
Part D is the stand-alone prescription plan. This has a few plans, each with varying premiums and coverage. The first item on the agenda is phasing out of the gap between the annual out-of-pocket threshold and the initial coverage limit. Secondly, drugs prescribed to ‘dual-eligible’ individuals (i.e. those who qualify for both Medicare and Medicaid) are required to offset the cost of such drugs by a regular rebate (paid to the government) that will be used to fund the gradual elimination of the above coverage gap. A discount of 50% is to be applied to qualifying drugs dispensed to individuals who are in the above coverage gap.

Beneficiary Improvements (§1201-§1236)
The low-income level for Medicare benefits is raised in 2012 to $17,000 per individual, to be adjusted each year according to the consumer price index average. Beginning 1/1/2011, co-insurance (and other cost-sharing methods) are eliminated for institutionalised individuals as well as dual-eligible individuals who receive full-benefits. Additionally, beginning 1/1/2010, Medicare enrollment is modified so that individuals can self-certify income and resources without the need of additional documentation except in ‘extraordinary situations as determined by the HIE Commissioner’. Individuals who become eligible for the low-income subsidy (above) are also eligible for retroactive reimbursement of prescription expenses. The relevant insurance plans have 45 days to reimburse individuals after receiving notification from the government that an individual is eligible for the reimbursement or after receiving a valid claim from an individual. It is unclear how far back this retroactive period runs as the threshold level is not increased retroactively.
There is also to be a study to discover language barriers and difficulties for Medicare recipients, which will ultimate provide guidelines and suggestions for providing necessary language services (e.g. on-site interpreter, off-site interpreter, bi-lingual staff, etc). These will be tested in a trial run in different regions and Medicare service type providers, funded by federal grants (not to exceed more than $500,000 per grantee over the three year trial period). The bill requires at least 24 grantees for the trial in varying socio-geographic locations (e.g. urban/rural, Southeast/Northwest, large metropolitan area, etc).
Finally, this section also provides for advanced care planning by a consultant once every 5 years. This is to explain living wills, power of attorney, the role and responsibility of a healthcare proxy, etc. Furthermore, this section (§1233) requires states to standardise these requirements and forms to reduce confusion by health care staff. States must provide information about these updates to health practitioners who are able to sign orders for life sustaining treatment (e.g. physicians, their assistants, and nurses, depending on state law).

Christian Morality and Universal Heathcare

Published by Colin August 25, 2009 in Politics, Philosophy and Theology. 1 Comment

Like posts that assert a “Christian” position in favour the legalisation of drugs or are against war, I am going to have to qualify this one with a disclaimer or two.

I don’t propose to have an authoritative (as in God-inspired) word from on high about this or any political issue. However, I do think there are some biblical and theological principles that can be remembered and considered in the discussion about how to provide healthcare for people.

Just as with the question of drug or prostitution legalisation – there is a very clear line between endorsing something and believing that something should be forced on everyone by law. Healthcare for all is something that every Christian should be advocating and supporting. Part of our calling as Christians is to (at the very least) pray for the welfare of our fellow man, including strangers and enemies. But what it really should look like is material support in the form of giving, labouring and strategic action in the form of practical service to our community.

However, I believe that Christian support for government-run (or controlled) healthcare is a well-motivated, but mistaken way to apply these principles.

The chief problem with some form of government-mandated care (no matter who ultimately provides it – the government or private companies) is that in order to “give” healthcare to some, it must be taken from others. Christians can and should support giving – but it is incompatible with Christian principles, no matter how noble the goals – to support taking.

Healthcare is a scarce good. It has to be produced by someone – doctors, nurses, technicians, R&D people, chemists and other scientists. In order for us to give healthcare to people who cannot afford it, we must make those people work against their will. They have to go into involuntary servitude for our morals.

Consider the incompatibility of that idea – what kind of “morals” would condone involuntary servitude? How can Christians claim that we are acting on godly motives, if we support and even participate in the enslavement of our fellow man?

If we want to see a healthier world, we should achieve it by biblical means – educate people about healthy choices, give money freely and encourage others to do the same, volunteer or provide health services as part of one’s job. But we cannot claim to be doing God’s work when we make people support our morals (that is by threatening them with fines, jail or worse). The power of the state is not a means that Christians should be using to “help” God in his plans.

But we can still do something.

The less scarce that healthcare becomes, the cheaper and more accessible it will be. Socialistic healthcare is one way to distribute care, but it is a horrible way to produce it. The profit motive of capitalism drives men and women, even while serving their own interests, to ultimately provide goods to the public. Capitalism is the greatest productive force that man has ever devised. And while not perfect, capitalism could easily make healthcare as abundant as any other good and service we currently take for granted.

Christians are to be good Samaritans - if we see someone in desperate need of care, we should be the one stopping. But it would not be Christ-like to see someone in need, and rather than doing something ourselves, pull out a weapon and force someone else to help them. This is essentially what government control or provision of healthcare means in today’s world of scarcity.

Christians must set a good example by doing, and then, based on that record of self-sacrifice, encourage and educate others about their need to help as well. I suspect that the problem of healthcare access in America could at least be temporarily eliminated if every Christian gave or worked the equivalent of a few hours of labour. However, because this is not happening, does not give the rest of us the right to make others do our work for us.

Like any political issue - Christians need to pursue activism and effort in biblically compatible ways. With drugs and prostitution, it means condeming the behaviour as sinful, whilst refusing to compell people to follow Christian morals. With healthcare, it means seeking universal and equal access without violating the fundamental rights of the honest people who have worked hard, invested or otherwise produced goods and services.

My Latest Experience with Universal Healthcare

Published by Colin August 5, 2009 in Politics. 34 Comments

In case you didn’t know, or don’t normally read this site, I live in England where I am working on my PhD.

Last week I injured my middle finger on my left hand. I presumed it was just a “jammed” finger - these things heal within a day or so and life moves on. However, my finger continued to swell and bruise all over, and soon became rather painful. I chose to take an adventure and see the doctor.

First of all, I want people to understand that Universal Healthcare is not free. We have one income right now, and our family pays roughly $222 per month for the National Health Service (when I am also employed, this cost will rise to about $873 per month for both of us). I also want you to realise that this is our our of pocket expense in taxes and does not include any additional fees, co-payments or bribes. This is currently MORE than we paid in the US for private cover (but less than what was paid in total for us - employer paid some of the premium).

The Good
Anyway, the clinic near my university is extremely nice. The paint is new, the doors are made of glass and there is an automated system for letting them know you have arrived. The reception area is lit by those hip, soft, little round lights. It’s like walking into a nice business office. This is because the facility basically just gives out contraception and deals with the young and healthy - but its financial distribution from taxes is huge. The clinic is in a nice neighbourhood and it has a large amount of patients and the funding that comes with that (nearly every student registers with this clinic). For those in the US, imagine what a public school would look like if it got funding for 2,000 students, but only needed resources to teach 300 - and to those it only taught reading (no sports, no math, no PE, no expensive chemistry ingredients). That school could paint the walls with diamond dust.

Anyway, the nurse I see has no idea what is wrong with my finger. She is not trained to handle this sort of thing. So she pulls a favour with one of the doctors who (fortunately) didn’t have anything to do at the moment. He looks at my finger and concludes that its fractured, and gives me a pink piece of paper which will get me an x-ray at one of two hospitals in a city of just under one million people.

It takes me about an hour to find parking. The hospital has NO parking. If you want to park for free, you must scour the neighbourhoods a half-mile away and farther and then walk (hope you aren;t at the hospital for your legs or feet). If you want to pay (and the hospital DOES NOT validate), you may pay roughly $5 per hour and park on the street (again, still difficult to find).

The Bad
The hospital is one of the grossest working buildings I have every been in. There is no air-conditioning. The walls and floor are dirty. There is used gum stuck to various things. There are two types of signs on the wall that look like they are out of the 1960’s (probably were) 1) informing people of the fact that they will be waiting 2) telling them not to be rude, hostile, aggressive or violent. The lighting is dim, and several lights flicker or are not working.

I give my pink slip of paper to the reception in radiology and I am told to go to “waiting area 3.” I ask the receptionist how long I might be waiting - “not long” I am told.

The room I enter is even more disgusting. There is a thick layer of dust and dirt on the floor. The bright green (again 1960’s) chairs are torn. The cieling panels are broken and some have yellow stains on them. There is a broken table across from me with riped and torn magazines on it, and a big piece of chewed gum stuck on the front. The windows are so smeared that it is difficult to see out of them, and many have the insulation torn and hanging down in dried, cracked strips. Ants are crawling on the floor near my feet.

After waiting in this room with another person, I am called in an hour later for an x-ray. This doctor believs that I may have an “old injury” in my finger and also a torn ligament. He says that I’ll need to wait to see another doctor, this time in urgent care, who can tell me more. He gives me a piece of paper and tells me to give it to the receptionist there.

I have to leave to move my car so I don’t get a parking ticket (one thing the government seems to do well here). This takes about 45 minutes.

The Ugly
I go to urgent care. Again, the conditions are such that it takes me a moment to remember that I am in a hospital in one of the world’s richest countries. The walls are scratched and gouged. Large red signs warn against violence and aggression. There are police in the room. The reception is blocked by thick glass windows to prevent violence against the hospital workers. The chairs look a little newer (1986ish, I would say), but some are broken. The floor is dirty.

The receptionist takes my piece of paper and begins asking me a series of questions required by the government (meanwhile I am liberally soaking my hands in sanitiser) - some are normal: where I live, when I was born, etc… But some are a little more invasive: what do I do, what is my religion, what is my race, where was I born, etc… I then wait for another hour or so.

I am admitted to see another doctor. He tells me that I actually have a serious problem with my finger - that it is broken and also out of joint. He says that I need to see a specialist right away, because it is “unstable” and could be more severely damaged with just the slightest movement. He goes and tries to call a specialist but gets no answer. He gives up and then writes on a piece of paper “needs hand appointment ASAP” and tells me to give it back to the receptionist.

I go back into the main room and give the receptionist the doctor’s note. She passively takes it and sets it aside. She then dryly tells me that it will be at least a month before I can see a specialist. The government will make an appointment for me and call me with orders about where and when to go.

I leave the hospital at 3:30pm after starting my visits at 9:30am that morning. I have no concrete diagnosis, no appointment, nothing has been done, my broken (maybe?) finger is not taped, casted or otherwise treated, and I have no idea when the government will next be able to see me. I may be without treatment for up to a month - hopefully my finger does not incur more problems while I wait for the government to start caring for my heath.

By the time I see a doctor, another $222 will have been taken from our income so that I can have this wonderful “free” healthcare.

Zeal For Truth