This is going to be a rather dull post. There's not going to be any finger pointing, nor any shots at the left or the animus right. I'm going to stay on substance only, and that could mean this post is quite boring.
Fear of change
We live in a society that fears change, and probably with good reason. For many, change means the loss of something near and dear. In the health care debate for a typical employee in the work place it means losing the insurance that they get throught their employer. In a down economy having a job and having health care is a pretty good gig. Taking away what you have and replacing it with something you think might not be as good will make you think twice about embracing change.
If you're a physician with a sexy specialty, health care reform means that the focus will be more on prevention, rather than the current state where you make a lot of money. Your world could radically change, and a fee structure shift toward rewarding family practice medicine (low on the income and physician food chain) is a threat to your lifestyle.
If you're an insurance company executive, change means a private pay option, and you're now going to have compete, and you can't screen out potential claimant's because of pre existing conditions. This means the high executive salaries and bonus for share price and PE ratio means the gravy train may be leaving the station without you.
If you run a small business, you can't afford health insurance for yourself, let alone your employees. If everyone is required to have health insurance this could put you out of business. You're having enough difficulty just staying in business and putting food on your family's table.
If you run a large business, maybe this change in health care could be a bonus for you as you could eliminate this benefit which would free up capital to do other things, like pay higher wages, or reinvesment or high dividends to shareholders. Your fear of doing so might make you lose your best people to competitors who don't opt out of providing benefits.
If you're a hospital adminstrator, health care reform means that medicare fees will drop. You'll also be asked not just to manage patient admissions, but treat the patient from admission through recovery. While currently you don't have a hopsital owned home health program, you farm it out and let the vendor deal with the reimbursements. Reform will require your managing the whole patient and that gets in the way how you manage revenue. Your incentives which is all about patient admissions and readmissions will change.
A Reform Package that is revolutionary
As you can see from the different interest groups, any reform is going have to address all these issues, and people's lives are going to change, some for the better, some stay the same, and some will get worse.
If the reform that is proposed tinkers at the margins, than there will be no competition for large insurers and no incentives to drive costs down.
As the drama unfolds, each interest group will line up and try to get reform watered down so that the impact to its constituency suffers minimal trauma.
The more dramatic the change, the more resistance it will create. However the system is so fraught with incentives to different constituencies, the main function of health care, that is treating patients, gets lost in the shuffle.
Make the complex simple
The best solution is find a solution which make the process simple, for the providers and for patients. This is radical change, and as you can see from the first section of this post, there is a lot of change that needs to be over come.
Make health care a free market, where people can choose what they want. Disengage health care from the employer, so people have the ability to move to another job without the fear of losing their health insurance.
Provide incentives to family care docs, whose numbers are shrinking.
What about the insurers, specialty and specialty docs, and hospital administrators? I guess they'll have to do more with less, work smarter not harder, just like the rest of us.
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That sums it up.
Some fear from ignorance, some from irrational reasons, and most from greed.
RATED
Bill -- I don't think you're splitting hairs. There is risk aversion in our country. A great deal of it.
Yarn Over -- there are going to be winners and losers with whatever reform is created. We have a tendency to make it more complex in the interest of compromise. Our legislators and the special interests should focus on collaboration rather compromise.
and rated sheeps for deep thinking
This isn't about mindless fear, this simply makes no sense, where good practices and employee "benefits" are already established. I do not work for one of these companies, though my husband does as well as most working people I know. It would be a nightmare to loose those already established benefits where necessary long term medical treatment is already in place with a presumed higher standard of medical care, in many cases. Just saying. There are many ways of looking at this issue and I do beleive some compromise or an alternative solution will be the reality, rather than the dismantling of health care already provided to so many. Neither the insurance companies nor the government should have all the power over such an important aspect of everyone's life. We have a right to work for a company that provides and will continue to provide optimal health care packages as part of it's incentive. We also would benefit from a government "option" that would provide for the many who are not employed by companies that already have medical coverage in place. From what I have seen over the last few days, Obama leans this way...that is to say, an "alternative" and not an aboliton of what is already in place.
Zuma -- thanks very much for getting this out there.
It's like home owners insurance. My folks paid for over 50 years, never filed a claim and when they hit their 70s the insurance company dropped them as a bad risk. What did they do wrong? They didn't fix a broken window. If that isn't bullshit I don't know what is.
Rated
Ric -- Insurance companies are part of the problem, but not the entire cause of it. You have to change everyone's incentives to change behaviors.
Fab -- thanks for the support
John -- If they only knew what they were talking about.
Lefty -- thanks. enjoyed you piece on the cover.
Ding ding ding!!!! You said it. Our society is allergic to nuance. Pretty much every Republican I know is not "against healthcare reform." We are against "Obama's proposed healthcare reforms." There is a big damn difference, and while Washington demagogues, nothing changes.
Rated. And it wasn't dull.
Chuck -- We've been conditioned for the last nine years to believe lies instead of the truth. There's been little effort to reach common ground when the animus Republicans believe in a scortch earth policy.
1BN -- Thanks for your comments. I would love to understand why it so difficult for people with different points of view to collaborate. Not compromise collaborate.
This is wonderful and offers a much needed "cut the BS" perspective. THANK YOU!
Rated!
Make health care a free market, where people can choose what they want.
I can't understand at all what you are proposing.
Roger -- I was being somewhat rhetorical in my comment. I felt this was one of my best posts.
Rosemarie -- I possess an MBA and worked for a health insurance carrier earlier in my career. Make it simple; complexity drives up costs and creates inefficiencies, which any Lean Six Sigma black belt will tell you (one of those also).
"the system is so fraught with incentives to different constituencies, the main function of health care, that is treating patients, gets lost in the shuffle."
The 800 pound gorilla in the room is that most of our global food corporations have a profit model based on the bad habits of the populace (enormous quantities of hyper-sugared and salted foods) and the pharmaceutical industry would prefer to keep us sick and medicated on lifestyle drugs rather than keep us well and out of the hospital. There are so many medical specialists because many of their services are discretionary and targeted to rich people, ie, that specialty pays damn well. And the insurance industry relies on our dumb faith that they will be there when we need them, when the evidence is clear that they would rather see us dead than pay up.
Any wising up, any rational discussion of change in those situations sends shivers up the spines of those corporate executives and puts a fire in the bellies of the lobbyists. Far better to pay off congressional shills from both parties than to risk their multi-million dollar bonuses. No rationality is ever to come from this subject. Only if Obama had the balls to force it on us will we ever see actual universal health care.
bobbot -- Interesting analogy. I agree.
- rated
Susanne -- I'd rather try to edify instead of vilify.
The fear of change issue is real. Fear is the ONLY medication that is given out for free and many people are addicted to it. It is contagious and can create panic and pandemic. Healthcare has borrowed mightily from religion and used fear as its biggest weapon and tactic. How much longer before war breaks out in the name of an x-ray? Very well stated, Sheepy. All of it.
Cartouche -- I appreciate you stopping by and your wise comments. Earlier today I thought this post was going nowhere fast. But the comments are worth reading...almost better than the post itself.
When I'm running errands, even the slightest amount of responsive, dynamic thinking seems to leave people cold. I can't tell you how many times a simple request like "Could I have the sandwich special, just without onions, please?" causes the person to look at me as dumbfoundedly as if I had just demanded they solve Fermat's Last Theorem or something.
We are getting dumber and intellectually lazier as a society, and of course that in turn makes it easier for us to be manipulated by the powerful . . . what a mess.
I mean, Democrat, Republican, or Martian, where is the national outcry when our representatives blithely admit to voting on bills they HAVE NOT READ?
Also, as one of the previous posters said, there are fewer family docs to see these people, and even in the city where I live it takes forever to get an appointment for myself or my children.
What I am really saying is that YES we need BIG change, but I would like more acknowledgement from our gov't about what the real problems are. We DO need to work smarter, not harder.
The reason, besides the fact that I care about others as well as myself, is that I have no faith I'll have this plan next year. While I worked, my company changed its plan several times. I opted for an HMO one year--boy, was that a mistake. I got shut out of most care I needed and the insurance company wanted me to change my doctors. When we were both on my insurance and I was laid off, we paid $950 a month for insurance through COBRA, and nearly that much in share of costs. My husband has been laid off of three jobs in the last 10 years and we are now dependent on his job now for insurance. I don't trust our current good luck with the insurance plan to continue.
I have no faith that I will have my health plan, which we contribute to, next year. I count it as a windfall that I've had it for 2 years. One reason it might go away is one of my providers is gouging. I've spoken to both this procedure center and the insurance about the costs, but neither will change what they're doing, so I expect the company might reconsider this plan.
I would trade my current temporary first-class plan for some security and consistency, not to mention having an idea of what will be paid for and what's on me to pay. Even with a good plan, I still fight to get some things paid for. Yes, you guys do have to pay the anesthesiologist, because I selfishly chose to sleep through that surgery.
None of what we have in terms of insurance and healthcare now makes sense. Even people with unions see their plans change with each contract. There is just no security at all, and if you think you have good health coverage, realize that you could come down with a long-term illness, go on SSDI, and see your insurance go away for good. Then you get to wait two years to be eligible for Medicare. No matter what you have now, you have no guarantees as long as your good health plan is tied to employment.
JRdog -- thanks for sharing this with others
Latethink -- I tried not to go after any group, but the for profit insurers seem to have the profit motive ahead of patient care
Britomart -- I think I misunderstood earlier thanks for clarifying.
1womansvu -- Yes this would make a great case study for historians.
nurseliz -- I think the elected officials wouldn't be able to raise cash in the ER, but I like the idea.
patie -- please share with anyone you'd like
sirenita lake -- I hope you don't lose your coverage. This system is just too complex.
As one who has made my career in healthcare, I have been seeing and saying the same for nearly 20 years, but far less eloquently and succinctly. This is one very important post. Copy it to D.C.?
--rated--
MS -- Good idea, and thanks
in answer do nurse liz, the reason healthcare costs have skyrocketed is greed on the part providers and insurance companies.
It's access to care that most specialists are concerned about--not lining their own pockets.
Where is medical tort reform in all of this, by the way?
Cindy -- Thanks
Capn -- Fear sums it up.
jocoserious -- The tort reform red herring has been out there for years. Please show me some independent data which supports your argument. There are serious lapses at hospitals and an even bigger issue is infection control. BlueCross BlueShield of Massachusetts has begun renegotiation with hospitals not to reimburse for hospital induced infections or poor quality treatment, to put pressure on the provider to clean up their act. Tort reform, if necessary, should be done within the state court system, not at the federal level.
danni -- I'm not independently wealthy to run, nor do I have the temperment to be an effective politician. Thanks for the suggestion.
" the system is so fraught with incentives to different constituencies, the main function of health care, that is treating patients, gets lost in the shuffle."
The main function of health care will always get lost as long as the motivating factor is insurance company profit, but I don't see any hope for real change in that area. I agree that we need to disengage health insurance from the employer - I think that would reform many things, and not just health care.
Here's a *novel* idea. Why don't we simplify health care by going back to the way things used to be... doctors make visits to houses and have small, personal practices, they aren't part of networks and groups and special interest thieving scams, insurance companies don't run the show, hospitals become more simplified and transparent... no more breaking charges into so many categories and sub-categories to be able to rip patients off... no more separate physicians groups charges, nurses groups charges, lab charges, emergency charges, physician assistants groups charges, janitorial charges, administrative charges, you looked at us the wrong way charges, astronomical charges for useless and cheap implements that they make you think you need to heal with, we-whiped-your-ass charges?
Insurance is nothing but organized crime and thieving. Fuck the corporate thieves. I'm sick and tired of them ruling EVERYTHING.
Change aside, fear tactic helps keep the wealth with the wealthy, that much I do know mon
Interestingly (to me at least) is that many Americans are reacting to and from a moral imperative position about health care, when it is basically an economic situation. You have addressed this in your examples in the section headed “Fear of Change.” I keep hearing the argument that insurance companies should not be allowed to deny insurance due to pre-existing conditions. That argument is really nonsense, because insurance is predicated on actuarial tables and morbidity statistics (as are pension funds, social security benefits, etc.) to guide their degree of risk. Forcing them to take on higher risk only forces them to raise premiums for all. That is why a public option is needed. The only reason insurance companies are in business is to make money – pure and simple. So of course they are going to use their economic clout to maintain their market position. So are the drug companies. So are the physicians and so on and so on. It’s not so much fear of change for these players as it is simple loss of income. Perhaps greed is the word. And you have addressed this well in your post.
My 85 year old retired physician father who voted Republican all his life voted for Obama. Really. Now he says Obama is a socialist and is driving this country toward doomsday and socialism. He believes this. He will not be argued out of this belief, nor will many Americans at this point. Obama is correct that a compromise is needed, but not at the cost of no public option. The issue is that we have too many people uninsured and lacking access to decent health care. We don’t need to take away from those who have it in order to provide for those who don’t, and that’s where the public policy mistake was made. The “haves” in this country are not simply going to give it up for the “have-nots” so let’s stop going down that road.
Leave the private insurance industry to its own ends, but make the public options so attractive that people will want it, and health care providers will work in that system. How? Tax employer subsidized health care as income for starters. Cap the percentage of income that any taxpayer must endure (say 7.5%) for medical treatment and make every dollar after that a dollar-for-dollar tax credit. I spend $10,000.00 beyond my 7.5% and I get a tax credit of $10,000.00. My health care dollar is now as good as an insured person’s health care dollar, and doctors won’t care as long as they are getting paid. Regulate all medical fees and drug costs. Period. Then there’s no economic incentive for certain drugs., or to see patients with private insurance. And finally, tort reform is needed. It’s not a red herring. End it and set up medical review boards that have the authority to award compensation and to terminate physician and hospital licenses. Now that‘s radical.
OK, way too long winded, but I am hoping to see more detailed discussion (as you have provided and called for), and less name calling and hysteria. Great post. Thanks.
It took a long time to get into this mess and will take longer to get out of it.
I don't think those social programs are failures. I think there can be changes to them but again that takes political will and it is difficult to affect change.
DBD -- I'm not advocating anything here other than discussing the disparate groups that drive the current system.
Patrick -- thanks
Grif -- It's time to reincent the system. Reward people who get preventive care penalize those who don't. Reward primary care docs, add more post hospital home care, and use the insurance companies to sell catastrophic coverage.
This is has been a thoughtful discussion with differing points of view and I thank the commenters for being civil.
I ran into this over the past year, when I was laid off from my job and then found out I had cancer. I was getting coverage through Cobra. My insurance company refused to reimburse me for some of my expenses in my first month of Cobra (which they were required to do under Cobra laws). I filed appeals, I spent hours and hours on the phone, I filed a complaint with ERISA, but no one did anything. It dragged on for over 9 months. My former employer refused to get involved at first because I wasn't an employee any more. I finally begged the HR department to get involved, and I guess they felt sorry for me, because they finally brought in the big guns and threatened the insurance company - and I think I'm going to finally get my money.
The problem is that an individual just doesn't have enough clout to get the insurance company to follow the rules. And our current regulatory system is so weak, they can't seem to do it either. I was shocked at how little the Department of Labor and ERISA did after I filed a complaint - after 3 months they sent one letter, and then never followed up when the insurance company ignored it. When I called and asked, their response was "there's nothing else we can do".
I think tying insurance to employment has a lot of drawbacks (especially if you get laid off like I did), but if you throw everyone into the private insurance market and then don't pass regulations or enforce the laws, then the insurance companies will have more power than they do now. And unfortunately, the US is bad at regulation - there are too many politicians who think "all regulation is bad".
I think we can do this if we are careful.
RATED
Fear is our ongoing national disaster. It screws up so many things.