Tuesday, July 21, 2009

Fred: A Few Suggestions

But, Cal, what are we to do--nothing? The present health care "system" is completely broken. It's a scandal that the US is the ONLY developed country that doesn't have a public health care system.

It's not just 50 million people who have no coverage at all, and probably an equal number who have inadequate coverage; it's the fact that health care costs increase steeply every year and will soon bankrupt everyone--except, of course, those involved in the health insurance, pharmaceutical, and hospital businesses. The first two, in particular, are making billions in profits every year, are among the most profitable of US industries. At present, from what I have heard, about 30 cents of every dollar we spend in the U.S. on health care goes to the health insurance companies--whose main goal is NOT to provide us with health care, but to maximize their profits by figuring out ways to avoid paying for tests, procedures, etc. It's a business, after all! In other words, this 30% of our health care costs is completely wasted. Well...it does go into the pockets of the armies of insurance bureaucrats and employees who decide what health care we get, or who can get insurance at all, etc., so it does keep them afloat financially. But, I think if we recaptured that 30cents on the dollar by closing down all the health insurance companies and using the money to provide actual health care, we could cover everyone. The former health insurance employees would be out of jobs, but could be offered jobs (or retraining and jobs) in the business of actual health care--now providing it, not denying it. There's a lot of need for nurses, people to help with rehab, etc., and they could be put to work doing that instead of studying someone's claim to see what they can weasle out of. A single-payer plan may be the only way to get costs, especially for drugs, down to realistic levels. Only it would have the clout to force pharmaceutical companies to charge something closer to the cost of production of the drugs, rather than gouging us ("your money or your life!").

There's a lot of talk about how Big Pharma needs all that extra gravy to support R&D for new drugs, but (1) there's a long history of Big Pharma pushing new drugs that aren't really needed just to make the killer profits they bring, (2) much research is done with NSF grants at NIH, universities, and at the pharmaceutical companies themselves. In the present miserable excuse for a proper health care system, I have pretty good insurance coverage--a group plan through my employer. It's not cheap; there are monthly premiums and a 10% copay provision; and the idea that I have some magical instant access to "my" doctor is a delusion--she is scheduled at least a month in advance, so for any quick treatment I must go to the emergency room, where costs are astronimical. A more clinic-oriented system for walk-in treatment of routine matters would be nice, but where is it? Certainly not in the present system, unless you can afford to join an elite group that is only for the rich. I think a public plan crafted to eliminate at least the largest defects of the existing public plans in other countries, which have been running for years and for which we have good data on effectiveness and cost, would be far preferable to the mess we have now. And, in the long run, probably much cheaper that what we will face in 10 years if the scare bulletins of Big Pharma, Health Insurers, etc. about "socialized medicine" sway enough people away from reforming the system now. Britain, France, Germany, Canada, Israel, and every other developed country has a public plan, and most work pretty well--so let's study those plans, eliminate the few glitches they contain, and tailor a system that will give us quality care at reasonable cost for every human who sets foot in the USA--citizen, illegal alien, tourist, it doesn't matter: we're all humans and now and then need health care. I'd much rather pay higher taxes for that, and lower correspondingly our outlays to the Pentagon; but we may not need to raise taxes, if we can eliminate the 30% insurance overhead and keep spiraling costs down.

Best, -Fred

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