Wednesday, May 4, 2011

Why We Need TRUE Health Care Reform

Health Care Reform, Single Payer, Socialized Medicine, Universal Coverage – I really don’t care what you call it but something has to give.
Health Care should be a basic human right. Those that claim we have Universal Health Care because someone who can’t afford to go to a doctor should go to the ER don’t wish to realize that an ER visit is probably the most expensive form of treatment that there is.
However mandatory universal coverage (and I happen to be a fan of a single payer “Medicare for All” system) can work. People who are against any type of universal coverage because they feel they don’t need insurance seem to forget what insurance actually is. If you own a car you don’t wait until AFTER you’ve had an accident to buy insurance. You buy it and pay for it and hope you’ll never need it. That’s really what insurance is. The same holds true for homeowners or renters insurance, travel or trip cancellation insurance when you go on a trip etc. Now some of these insurances you don’t have to purchase but insurance that affects society at large should be mandatory. Automobile accidents don’t just affect you – they affect the community at large. Health issues are the same.
Now in order to make a universal system equitable I believe that a large number of factors have to be put into place and considered to make it work.
This should include statistical analysis of age to condition related circumstances. That means that if you need a procedure done there should be a statistical analysis that looks at the success rate for one’s age group for that procedure. If your age group shows that a good percentage of people having the procedure benefit and recover from it successfully then it should be covered. If, however, the opposite is true, that is where private or supplemental insurance coverage comes in.
The current Medicare system in the United States is pretty untenable because it doesn’t have these limitations. The idea of the current health care reform bill, while a wonderful idea, is a case of reinventing the wheel. Everyone is scared of the national debt soaring but, at the same time, it doesn’t stop the members of Congress from seeing how much pork they can stuff into each bill.
A prime example of this is the defense budget. For the 2011 defense budget the Pentagon cut some items from their defense budget request including some weapons systems and things like a second engine for the F-35 Joint Strike Fighter. This was in recognition of the severe financial crunch the country is in and the Pentagon bean counters were doing their part. However the people in Congress decided to pass a $760 billion defense funding bill that put back in the money for programs that the military had intentionally left out.
According to Secretary of Defense Gates one of the members of Congress said “Why is $3 billion for the alternative engine such a big deal when we’ve got a trillion-dollar deficit.” Gates’ response was “I would submit that’s one of the reasons we have a trillion-dollar deficit – is that kind of thinking.”
Pork is pretty bad when it looks like the Pentagon has to fight Congress to not fund certain budget lines.
Remember – we are talking about $3 BILLION dollars here. Compare that to the just under $67 MILLION direct grants to public radio stations and the just under $30 MILLION given for programming, production and acquisition grants. So we’re talking about just under $97 MILLION vs. $3 BILLION and yet all I hear are people screaming to get rid of CPB/NPR.
What other cost savings could the Pentagon find? Well – probably quite a few except people go ballistic every time that there is a base closing.
So why this rant today? As many of you know, I am a diabetic. I test – a lot. On average I test 8 times a day. Over a 30 day period that means I need 240 strips. However my new insurance company will only pay for 180 strips in 30 days. (It’s actually 150 strips every 25 days.)
I have appealed but when I phoned I was told it can take up to a week for that authorization to go through – IF it goes through. Now I realize that it could be worse. I’ve heard of insurances that will only pay for 3 strips per day and 3 strips per month.
The problem is that not every diabetic is the same. Even diabetics with the same diagnosis (example: Type 2 – which I am) will react differently to the same foods and quantities. And that’s assuming that the diabetic cares and tries to keep their diabetes in control.
There are diabetics who just totally ignore everything and refuse to understand why they are candidates for amputation while there are also diabetics like myself who will, no matter how hard we try, develop some complications. But if we did not fight to keep our diabetes in control we would be in far worse shape.
Each diabetic that cares about him/herself develops their own care plan in conjunction with their diabetes care team. (Subject for another post.) In my case testing a minimum of 8 times a day means that I end up feeling like a pin cushion but it also gives me better control. 6 times a day doesn’t cut it.
So needless to say I’m P.O.’d big time. And that brings me back to the beginning of this post. We live in a country that practices reactive medicine not proactive medicine. Insurance companies try to spend as little as they can and really don’t want to realize that, doing so over time will actually cost them more money as complications arise. Now I’m talking about diabetes here but the same holds true for cancer, stoke, AIDS and more.
Encouraging one to get involved with their care is, of course, desirable but insurance companies are more interested in the “15 minute” visit than practical, viable results that can occur from decent patient care and involvement.
I can understand prior authorization requirements but there should be other elements involved. When a request such as mine is received the insurance company should contact the policy holder/member right away to find out WHY this request is being made. A prior authorization decision should be able to be made on the spot. Instead I am told when I phoned them that it could take a week and I might be turned down. Anyone want to hazard a guess as to what’s wrong with this picture?
This became a bit of a ramble and I certainly didn't get all I wanted to in here but I'm fading. Comment and I'll respond. Thanks for visiting.
OK – enough for now. Ciao all.


  1. I do find the US health care system in need of some you mentioned, it should be just to the system and not adding alot of 'add ons'....I'm astounded at the way the insurance companies deal with the people who pay them regularly- it is almost like "what is the point??"

  2. I think that some insurance companies feel that if they can keep from providing treatments to people long enough they will make more money. It's the same thing as when they deny people with pre-existing conditions. They cost too much. Personally I'm for free enterprise to a limit but in the case of essential services (and I do consider Health Insurance to be an essential service) I feel that there should be a serious cap on salaries for administrators. That way you will lose the people who are in it just for the bonuses and get people who truly care about people.