Alright Devin, challenge accepted.
Let me make say something first, I believe in capitalism. I think that for the most part, capitalism has led to great advances and truly turned America into what it is today. But there is an area of capitalism that I am frankly absolutely disgusted with. This part is known as health insurance companies. Tell me how this makes sense. Pay enormous health insurance premiums to a company designed to deny you as much health care as possible in order for them to maximize profits. As a future physician and part of the 40 million uninsured Americans, I believe our health care system is tremendously flawed. Talk to any doctor and they will tell you how difficult it is to deal with health insurance companies. Is this patient pre-approved? Does their policy cover the care I need to give them? If they are uninsured, how are they going to pay me? How can I give care to this patient and pay my malpractice insurance premiums? Currently the United States is ranked #1 by the World Health Organization in cost of health care (about $7500 per person per year.) Health care costs represent the largest portion of our GDP (I think around 16%.) But for paying the most for our health care, our system is rated #37 (you may be interested to know that ranking #1 is France, who have a universal health care system and they spend half as much as we do, and are consistently healthier than we are.) According to the Institute of Medicine of the National Academy of Sciences, the United States is the only wealthy, industrialized nation that does not ensure universal coverage. Approximately 18,000 people die each year because they are either uninsured or underinsured (I consider this to be a great irony, since most republicans are the ones adamantly opposed to universal health care while claiming to do anything possible to protect the sanctity of life, until it costs them money.) Stopping the legislation of universal health care are health care lobbyists in Washington, making up 3 times as many members of congress. I believe that a health care system patterned after France's would actually decrease health costs, improve the overall healthiness of all Americans, and improve the quality of life for all of us (for good articles about this from NPR, http://www.npr.org/templates/story/story.php?storyId=92419273 .) I do not think universal health care would mean less quality care. I know some of you have experienced universal health care in other countries (Argentina, England, Canada) and may have had negative experiences which turned you off to the idea. But I think we as Americans can develop a better system that gives high quality health care and targets preventive care to reduce costs that arise from people waiting too long and needing more expensive care. And if universal health care is too socialist for us, what about universal coverage? Mitt Romney was able to do it in Massachusetts, and I think it could work nationwide. I'm interested in everyone's opinions on what can be done to better the U.S. way of giving health care.
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Let me tell you about universal health care. Being military, we have Tricare. I'm thankful that we have something, but sometimes I think we'd be better off without anything at all. Tricare IS universal health care, and because of that the care we get when we're assigned on Post is pathetic at best. I can't even begin to tell you how many ER trips I've made for my youngest daughter since she was 6 months old. Every winter it's the same thing-she gets a cold, it goes straight into her lungs, then I have to fight to get more Albuterol for her nubulizer. It isn't the particular place we might be stationed, either. It's military-wide. It's shoddy health care on a good day. It's doctor's that are entirely too busy to completely listen to you because they have 46 other patients waiting to see them. And it's not a shortage of doctors, either. It's a lack of care, burn-out and contracted civilians. I'm not saying we're all better off without any sort of health care. I'm just saying spend a day in my shoes filling out claim after claim after claim because the over-worked insurance company didn't file your daughter under the right name!!
People are always talking about how great the military benefits are. That's funny beacause, yeah, we get lots of things that most people don't. BUT we pay dearly for those things that most people take for granted...like a simple Rx fill at Walgreens because the wait was 3 hours at BOTH of the pharmacies on Post. Who has time or WANTS to sit for 3 hours waiting to get an Rx filled?
Universal health care isn't as wonderful as anyone thinks it is. Come live here for 24 hours and deal with all the things insurance related I have to. I'm still fighting a bill from August 2004 for an ER trip because my middle daughter had an ear infection. 2004!!! Universal health care isn't going to do anything to fix the problem. If anything, it'll only make it worse. It isn't just Tricare, it's the way universal health care works. I live it everyday and can see the MANY disadvantages it will bring.
PS- I have no idea how to make it better without raising everyone's taxes. Perhaps we should leave it up to the state governments. Leave the feds out of it.
I think you would get similar negative comments from doctors who deal with Medicaid and Medicare - any time you get someone, whether it be private insurers, employers, or government, in between patients and their doctors, there will be serious trouble. Still, I am in favor of some things being universally covered, such as innoculations and prenatal care. The problem is, it is hard to know where to draw the line on partial coverage. If prenatal care is covered, is it cruel to deny help with labor and delivery? Is it even practical to do so? When Devin was interning for Sen. Bennett, there was a bipartisan plan ("Healthy America"?) that was supposed to address some of these issues. The details escape me, though.
While I don't know very much about the health care debate, I do know a little bit about statistics. And the one phrase that was ingrained into our brain was, "association is not causation." Let me explain. Yes, France may be ranked #1 with the best health care system, but that doesn't mean that their universal health care system is the reason why they are "healthier" than we are. Other things would need to be looked into like their lifestyle choices, i.e. their eating habits (I bet per capita we have the most obese people here in the US), their exercise habits, even how many of their citizens own a car, etc. Countless things could be contributing to the reason why they are healthier, not just because they have a universal health care system. Association is not causation. Statistics 101.
Yes, the proposed bill was called the "Healthy Americans Act." Senator Bennett (conservative republican from Utah) and Senator Wyden (liberal democrat from Oregon) are the co-sponsors of the bill. While I haven't followed it all that closely since leaving DC, I know that when I left, 16 senators had already signed on. 8 reps and 8 dems. It really was a bi-partisan effort - the rule was that no republican or democrat could sign on without someone from the other party signing on too. It truly was bi-partisan, including some free market principles and some "universal" concepts as well. I don't remember the specifics (I worked for Bennett's economic and foreign policy advisors, not the one in charge of health care), but I remember it picking up steam in the senate, but not too much due to the fact it was an election year. Given that I haven't studied this issue as much as Creighton or others, I will wait to weigh in until I have something intelligent to add to the discussion. Hopefully that will be soon, but that is doubtful because finals are coming up.
I think people should have access to basic health care, and yes, in a country as wealthy as ours, it is a tragedy that many people go untreated for serious illness, which in some cases leads to death. However, I also think that the expectation that universal health care would significantly improve health care in this country is, in part, a fallacy. I agree with Melanie, that a large part of the reason France is much healthier is becuase of lifestyle choices.
I think a big factor for poor health care in this country is a lack of basic education not only in terms of healthy lifestyle choices, but also in terms of the free market options already available. The truth is that most people who really can't afford insurance do have some options available such as free clinics (which emphasize prenatal care and innoculations as Chris mentioned) and emergency rooms are legally obligated to treat emergencies even in the event that someone can't pay. Not ideal solutions, but not much in life is fair, just like me paying the same in health insurance premiums as someone who smokes, drinks, and is obese.
I also agree that anyone who deals with Medicare or Medicaid will likely tell you that they would prefer a private option as the care and benefits are almost always significantly better with a lot less red tape.
I would like to see an expansion at the state level of health care programs that don't diminish the role of the private sector. I think a universal federal program is bound to be a bureaucratic quagmire that stands to eventually bankrupt itself much like social security.
Finally, there are other ways to address many of the ills in our health care system. For instance, a large part of the reason that premiums are so outrageous is becuase of the malpractice insurance that doctors are required to carry due to the litigous nature of our culture. Those costs are passed on to us at a high price. Maybe Devin/Chris can suggest some legal solutions to our health care issues.
Healthy Americans Act (S.334) Update: Senator Arlen Specter (D-PA) is the latest to sign on to the bill, as of 9/24/2008. Its co-sponsors now total 18 - 9 dems, 8 reps, and Lieberamn, an independent senator. This is from a press release from Specter's office about the bill's purpoted goals and desired effects:
"The Healthy Americans Act would: give Americans choice in where they get their health care; break the link between employment and insurance to make health care portable from job to job; promote personal responsibility and preventative medicine; and reform the insurance market so that insurers are forced to compete on price, benefits and quality."
Also, both the Congressional Budget Office (CBO) and the Government Accounting Office (GAO) - both of which are non partisan - released reports this past summer indicating that this bill would be budget neutral by 2014, and actually create surpluses thereafter.
-All this certainly sounds good, but my conservative/libertarian knee-jerk reaction makes me a little hesitant to buy into it 100%. Why? I guess I am a bit skeptical that this bill could be effectively enforced without significantly encroaching upon individual liberties and freedom. Especially by a powerful pro big-government congress and executive whose more liberal members (some, not all) have called for enforcement methods such as garnishing wages to enforce a 'universal' mandate upon Americans. I don't remember who said this, but I really like its message: "a government that is big enough to give you everything is also big enough to take it all away."
I'm not sure if S.334 is the ideal way to "fix" the current health care problem, but on the other hand, will things get "fixed" under the status quo? This is a tough, polarizing problem. One promising about S.334 is that its components appeal to both sides of the aisle, which hopefully means that maybe it will at least get out of the Senate Finance Committee (where it is currently awaiting action) for a more thorough debate by the entire Senate body. Like Jen, I'd just feel more comfortable if something like this was implemented at the state level - I think it would be better to leave the feds out of it.
-As a first semester law student currently enrolled in Torts, I've thought a lot about the (for better or worse) litigious nature of our culture and its effects on the health care system. I'll save those thoughts for another day, and for now, I defer that topic to my more experienced dad Chris. Besides, this comment is already too long! Ha ha.
Chris here. I talked with Fred Lewis about this a few months ago. There are two arenas that I can think of where insurance premiums have been brought under some control through tort reform, and could be instructive in altering malpractice premiums / barriers to practice.
During the 1960s automobile insurance was reduced through no-fault laws at state levels. Only really big incidents could be the subject of a lawsuit (permanent disability, death, dismemberment, property damage over a certain level). Everything else (fender benders) is handled between insurance companies.
The other area is worker's comp. On-the-job injuries are covered by worker's compensation insurance carried by employers. Fault is not a question - if you are injured on the job, the insurance pays the compensation, regardless of whose fault the accident is. There are no pie-in-the-sky awards; there is a very detailed schedule that outlines what the award is for given injuries / disabilities. Lawyers do represent claimants, but their fees are regulated. The employer benefits because if the coverage is there, the employee is limited to the recovery. So, less quibbling about fault, and more awards, but smaller than a private home run, and more predictable, which is the main factor in keeping premiums down. Some businessmen (especially in California) consider worker's compensation insurance to be extremely pricey, and it is. But it is nowhere near as pricey as having to cover liability to your employees outside of that system.
Would similar reform work for medical malpractice? One of the challenges is that in the environments of driving and working, the norm is safety and good health - bad outcomes are not to be expected in the majority of situations. But with healthcare, most interactions between patients and doctors start out with in a negative-health and risky situation.
Torts (suits for negligence, malpractice, etc.) is a reflection of how we, in society, program to spread the risks around. Plaintiff's lawyers argue that if you dramatically change that system, you remove incentives for perps to mind their ps and qs. Defense lawyers say that the tort system, especially spin-the-wheel jury verdicts, are no better than the lottery. Ironically, both of these voices in the debate stand to lose something with true tort reform; they need each other. Plaintiff's lawyers need the secure deep pockets (insurance companies) to pay heavy-duty awards. Insurance companies need the scary litigators, court delays, and uncertain jury outcomes, to justify high premiums and the to give the insurance companies time to get a return on the investments where they park the premiums between the time the premiums are paid and the awards are paid (the time "spread" is where insurance companies make much of their profit).
That's what I know about tort reform. Politically, at least in Texas where torts were a bigger deal than here in the Intermountain West, the plaintiff's lobby tended to be democratic / liberal (looking out for the little guy), and the defense lobby tended to be republican / conservative (watching out for the monied interests). I remember George H.W. Bush's acceptance speech in the Astrodome in 1992 (I was there in person), where he included tort reform among a long and disconnected laundry list of things he would change. His claim that he would rein in "tassle-shoed" plaintiffs' lawyers with tort reform sounded hollow, since Bush had been in power for 12 years (including two terms as Vice President), yet no progress had been made.
Until as a society, we are willing to let go of the possibility of high awards and attaching blame as a means of assigning responsibility for compensation, not much will change in terms of medical malpractice. It is hard to tone down expectations in an industry / profession, where six-figure treatments and procedures are commonplace.
Those are great insights on tort reform. One of the ways they have been able to control costs in France is by doing reform and putting limits on malpractice cases. In the United States the average physician makes 4 times as much as the average American. In france they make twice as much. The reason they are able to do this without the doctors going on strike is because all of the medical schools are funded by the government. So right now I am looking at anywhere from $150,000 to $250,000 in student loans. My cousin is already at $250,000. This is already like a mortgage. Doctors almost have to make that much in order to pay off that much debt. In France they graduate debt free. From what I understand the schools are still very competitive. Last year I did a 10 page research paper on obesity, health care, and how it was going to affect us. Currently, 2/3 of the country is overweight. This leads to all kinds of problems that leads to higher medical bills. One of the things I proposed in that class was for the Government to adopt a "junk-food tax." Alabama has already done this on soft drinks by taxing every 12-oz by an extra 2 pennies. They generate revenues upwards of $40 million a year because of this 2 cents. My argument was that the people who neeeded the health care from obesity-related diseases would end up paying for it through taxes on these high-fat, high-sugar foods. A same type of tax was adopted on tobacco in order to help curb tobacco consumption but also use the revenue to educate youngsters on the dangers of smoking. Since the tax has been added smoking has gone down drastically. I think the same thing could be done for junk food. I can't put 10 pages of research into one comment on this but it is another idea to consider that would at least make paying for health care a little bit more fair and not pin it all down on the rich.
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