Health Care Reform

[yovargas]

[River]

[ToshoftheWuffingas]

I sometimes wonder about the personal histories of the people running these abstinence programmes.

[vison]

Oho, yes, indeedy.

Either guilt or fantasy there, Tosh.

[Frelga]

Here's an SF Gate article on another health care bill:

Health care bills do promote healthy living

There's a sleeper in both the House and Senate bills that could do more to promote health in the long run than any of the insurance we may - or may not - get.

Both bills address long-term disease prevention and health promotion with innovative strategies and startling amounts of funding. The House appropriates $15.4 billion over five years, the Senate over $7 billion. This level of federal investment nibbles at the historic imbalance between spending for medical services and spending that averts the need for services in the first place.

In summary, the bills include things like public assistance to wellness and prevention programs in communities and workplace, risk-reduction education for Medicare patients, and Community Health Transformation grants to address pollution, build parks, open gyms, and so on.

[Inanna]

That is actually pretty cool, Frelga.

[Primula Baggins]

Yes, very cool. Investing in things that will save the system money—what a concept!

[Holbytla]

Somewhere back in the bowels of this thread, I had suggested that we as a country and as a society couldn't handle sweeping changes to health care (or pretty much most things). I am of the mind that people seriously do not like change most of the time, and people especially do not like change if they can't figure out what the change is without a road map.

The present bill, in my opinion, tries to do too much at once while pleasing very few.

If you are old enough, you can remember the days when doctors smoked in the hallways and actual patient's rooms in hospitals. It was quite common to see people smoking in restaurants and grocery stores.

Today, those practices are all but unheard of, but the change didn't happen over night. It was a systematic movement that started out small and eventually morphed into today's world. Small changes that had some people gnashing their teeth, but were eventually accepted one way or another given enough time.

I believe that this society, for better or worse, has to operate this way. We need baby steps to progress. We need to work towards an end result that actually accomplishes what it set out to do in the long run.

Compromise for the sake of passing "something" serves no one.

I don't know anyone that is completely happy with the current health care situation, and I don't know anyone that is at all happy with the proposed legislation.

Baby steps eventually worked with public smoking, segregation, women's sufferage and many other things. The clashing of ideals will eventually compromise if given a bill that takes steps in the right direction, while totally disenfranchising no one.

Easy for me to say, I know, but I do believe that is the road that needs to be taken to overhaul this situation. The country has got to the point where it is very unwieldy to handle size wise, and I cannot even fathom the work it takes to progess as a society at all. Still we seem to manage to get along, even if limping at times. I think we have set the stage to continue to progress, but we need to take it slow in order not to relapse and essentially piss off the people who see that change is needed and the time is ripe if done correctly.

[ToshoftheWuffingas]

A while back I quoted this study

http://www.commonwealthfund.org/usr_doc ... ction=4039


Mr V responded with this and I didn't pick it up

That 100,000 figure is exxaggerated. A recent exhaustive study by the Harvard Medical School put the figure at almost 45,000, still obsenely too high, but less than half of what Tosh's study is claiming.

Harvard study finds nearly 45,000 excess deaths annually linked to lack of health coverage

With respect they are two different studies measuring two different things.
The Harvard study looked at the relative death rate of insured versus uninsured people in the US and came to a higher death toll of 45,000.

The School of Hygiene and Tropical Medicine study looked at wholly national figures of early deaths from certain treatable illnesses in different countries. If anything the latter study implies 55,000 insured people die earlier in the US too each year compared to fellow nations.

But the figures are not comparable. They were measuring different groups - the one study is only an internal comparison of mortality; the other was an external one.

Take your pick, 45,000 a year or 101,000 a year to keep the US safe from socialism. Better dead than red.

[Cerin]

Holby, do you have any examples of what you would consider a baby step in health care reform?

[Voronwë the Faithful]

The problem with the idea of doing health care reform in small steps is that all the components are interrelated. For example, probably the most popular reform idea is to regulate insurance companies to prohibit them from denying coverage to people with pre-existing conditions. However, if you do that without the other components of reform, particularly the mandate, the insurance exchange and subsidies for those who can't afford to pay for coverage, the result would be that the premiums would be prohibitively expensive for those being offered new coverage and/or that rates would increase significantly for everyone.

Tosh, please stop with the "better dead than red". That doesn't help the discussion at all and tends to lower you to the level of the Facebook debates that you have mentioned before. You are better than that.

[Primula Baggins]

The problem with the idea of doing health care reform in small steps is that all the components are interrelated. For example, probably the most popular reform idea is to regulate insurance companies to prohibit them from denying coverage to people with pre-existing conditions. However, if you do that without the other components of reform, particularly the mandate, the insurance exchange and subsidies for those who can't afford to pay for coverage, the result would be that the premiums would be prohibitively expensive for those being offered new coverage and/or that rates would increase significantly for everyone.

Yes. Whereas if you passed something that had the effect of limiting premiums, the pre-existing condition problem would get worse: they would simply deny coverage to an even higher proportion of people who might ever need to use the insurance. And, no doubt, work even more assiduously to find reasons to drop people who become seriously ill.

And there are plenty of other examples of how fixing one subproblem is only likely to make other subproblems worse. Only tackling a lot of them at once will prevent this.

[Ellienor]

I found this interesting article on the BBC which helps me understand why people vote against their best interests. Because, I really haven't the faintest understanding of why people like Hal are so dead set against "politicians" and would prefer status quo and insurance company rule rather than nothing at all.

Why are so many American voters enraged by attempts to change a horribly inefficient system that leaves them with premiums they often cannot afford?

Why are they manning the barricades to defend insurance companies that routinely deny claims and cancel policies?

It might be tempting to put the whole thing down to what the historian Richard Hofstadter back in the 1960s called "the paranoid style" of American politics, in which God, guns and race get mixed into a toxic stew of resentment at anything coming out of Washington.

But that would be a mistake.


Drew Westen argues that stories rather than facts convince voters
If people vote against their own interests, it is not because they do not understand what is in their interest or have not yet had it properly explained to them.

They do it because they resent having their interests decided for them by politicians who think they know best.

There is nothing voters hate more than having things explained to them as though they were idiots.

As the saying goes, in politics, when you are explaining, you are losing. And that makes anything as complex or as messy as healthcare reform a very hard sell.

Here's another part that struck me:

Right-wing politics has become a vehicle for channelling this popular anger against intellectual snobs. The result is that many of America's poorest citizens have a deep emotional attachment to a party that serves the interests of its richest.


Thomas Frank thinks that voters have become blinded to their real interests
Thomas Frank says that whatever disadvantaged Americans think they are voting for, they get something quite different:

"You vote to strike a blow against elitism and you receive a social order in which wealth is more concentrated than ever before in our life times, workers have been stripped of power, and CEOs are rewarded in a manner that is beyond imagining.

"It's like a French Revolution in reverse in which the workers come pouring down the street screaming more power to the aristocracy."

This anger at "elitism" is something I just don't get. I read Sarah Palin's book, and one thing that comes out over and over again is her assertion that you don't need to study briefing books or know the issues, you just need "common sense." She characterizes herself as coming into office in Alaska, and applying good old down-home common sense to solve longstanding problems.

I don't get this. At all.

When I read Hals' posts, one thing that comes out is his anger at the "scientists" who presume to know it all, and the politicians that tell us what to do, etc. I mean, these are people who make it a life study to know the science, or know the policy. I tend to give them some credit for this. But I guess, this isn't universal.

http://news.bbc.co.uk/2/hi/americas/8474611.stm

[vison]

Americans want health care reform. That much is clear.

Beyond that it is a mystery. But surely a large part of the mystery HAS to be the profits that the insurance companies presently make - pretty much by insuring only healthy people.

Someone somewhere suggested that the answer could have been to just expand the government health insurance plan you already have. Is it Medicaid? Whatever. It's there, anyway. Come up with a premium, something reasonably affordable, and watch people line up to sign up.

[Ellienor]

I am personally really sorry that they didn't extend Medicare down to 55. Because the years in your 50s can be really difficult to keep yourself in health insurance through your job, because the job market just doesn't like people in their 50s. My husband found this out. Good thing he has his 44 year old wife to work and get health insurance.

[Túrin Turambar]

Americans want health care reform. That much is clear.

Beyond that it is a mystery. But surely a large part of the mystery HAS to be the profits that the insurance companies presently make - pretty much by insuring only healthy people.

Someone somewhere suggested that the answer could have been to just expand the government health insurance plan you already have. Is it Medicaid? Whatever. It's there, anyway. Come up with a premium, something reasonably affordable, and watch people line up to sign up.

That would have been the simplest solution in my view. Make Medicare coverage universal, and set some sort of scaled premium based on income. People can buy into it if they like, or not, or get some sort of privaate health cover instead. Then regulation of the insurance companies becomes unecessary - they can charge what they like and cover who they like.

[Ellienor]

Yeah, that was the original idea, but the "blue dog" Dems (read: paid by insurance companies and pharmaceutical companies) didn't want that. And then cynically argued against it because "health insurance companies couldn't compete in that environment"......afraid of the market, and denying choice to consumers. And, of course, it was "socialist."

[Ellienor]

Holby, would "sweeping change" to health care include extending Medicare "buy-in" to at least the 55 and older crowd? What did you think of that idea? (Dead as a doornail, of course, now.)

[vison]

Holby, would "sweeping change" to health care include extending Medicare "buy-in" to at least the 55 and older crowd? What did you think of that idea? (Dead as a doornail, of course, now.)

What would happen if you tried? I mean, seriously? What if, say, 100,000 Americans, all over the country, went and tried to sign up? With TV cameras following them?

Start a movement. Call it the GreenTea Health Care Tribe.

[ToshoftheWuffingas]

Yeah, that was the original idea, but the "blue dog" Dems (read: paid by insurance companies and pharmaceutical companies) didn't want that. And then cynically argued against it because "health insurance companies couldn't compete in that environment"......afraid of the market, and denying choice to consumers. And, of course, it was "socialist."

I don't quite undestand why I am chided for using the 'better dead than red' phrase when I read this. I did preface it with a study showing 100,000 Americans dying each year from treatable illnesses. I am quite aware how reforms were defeated by painting them as socialist.