Threads from Henry's Web

Tag: Health Care

  • Think about How

    Allan Bevere started some discussion with his post, It’s Fiscal “Cancer” but What Sage Is It?. One interesting thing I notice about discussions of reducing the deficit is that we tend to have certain spending programs that must not be reduced, and those differ depending on our other political positions.

    This is not surprising, of course, but it does make for a problem: One deficit hawk is not like another. For example, deficit hawks on the left would like to substantially reduce military spending, while those on the right look to social programs. Others tend to emphasize eliminating government waste, without looking at just how much waste there is to eliminate, and how it could be eliminated.

    In the health care debate, for example, both sides suggested reducing waste as a way to reduce costs, but as is typical in political programs, the savings are counted before they’re actually incurred, and inevitably we’ll find that those savings are much smaller than anyone projected, if there even are any savings at all.

    That method–counting your savings before they occur–relates directly to the problem I think lies at the heart of our continuing fiscal problems. We the voters, and because of us our politicians, like to speak in terms of what we want, but not to spend time on really looking at how we can get it, and whether the how is actually going to work.

    Even the way proposed laws are labeled and sold to the public reflects this problem. What the title says a bill will due and what the proposed law actually accomplishes may be very different. Savings or spending are stating over varying periods of time to make it appear that more is being accomplished. The titles are written in order to make it appear that great things will happen, but people often don’t know about how long it takes for certain portions of the bill to take effect, or precisely how they will accomplish what the title (or summary) states.

    I think this applies to our problems with government and deficit spending in many ways. We try to hand things out without discussing how they will be produced. In the health care debate this starts with the idea of an open-ended access to health care in general. Just how much health care is supposed to be a natural right? I personally think we need to create more access, but access to what? We don’t really want people turned away from the emergency room for lack of money, but how should we prevent it? Who should pay? How should they pay? You see, with every new innovation there’s more health care that might be something we must provide for everyone.

    Social Security and Medicare have become almost sacred in the public’s mind. But it might be that very attitude that destroys those programs. Why? Because we are asked to keep the retirement age the same while people live longer and longer. We want to be able to retire at 62 or 65, we want to have the benefits keep up with inflation, but the question is just how one is to pay for such things when there are more and more people living on Social Security. Since I’m in my 50s, I understand how people can want the retirement age to stay the same, but at the same time, I can see that this can’t go on indefinitely.

    As an aside, it’s been particularly interesting to see fierce defenses of Medicare by Republicans while opposing similar programs for the population in general. What, precisely, makes Medicare a sacred right while health care for everyone else is not so important?

    But to turn to the other side, we have defense spending. For many conservatives defense spending is largely untouchable, except for the ever-present desire to reduce waste. But waste is not so easy to reduce in the government. Here again we have to ask “How?” How will we carry out our necessary defense activities in a world with terrorism? If we continue to make more and more expensive military equipment and at the same time try to have as much of it as we had before, we’ll inevitably run into a similar problem as we have with Social Security. It is much more expensive to equip a military unit today than it was a hundred years ago, and as equipment gets more complex, that’s only going to get worse.

    So we again have to ask how. How will we carry out our defense? What level of security can we afford? What will the side-effects be? What are we asking of our military personnel when we expect them to do more worldwide and then we can’t keep them equipped as they need?

    Often politicians approach this subject as though one cannot reduce defense expenditures because, well, it’s defense, an important function of government. But I would suggest that a cost/benefit analysis on all defense projects would be valuable, just as it would be on domestic projects.

    And there I would turn to law enforcement. Again, we often think that we cannot economize on law enforcement, and in some ways I agree. But can we consider the way in which we fight the drug war or the war on terror on the domestic front and ask again whether we’re spending our money effectively? Have we made all those overlapping federal agencies actually work efficiently together?

    My fear on that score is heightened by the government response to Hurricane Katrina, and not to the oil spill in the gulf. It seems that what we expect from these government agencies is what we’re getting. If we had to respond to another terrorist attack, how much might it look like Katrina or the oil spill?

    I mean none of this as a slur on our men and women in uniform (I am a veteran myself), nor on our law enforcement officers. I’m talking about what our politicians and government officials ask them to accomplish, the way in which they ask them to do it, and the way they are equipped.

    And in the end I talking about us, me and you, and our expectations as related to, or disconnected from, what we’re willing to do to fulfill those expectations. We want to be secure, but not bothered. We want to be cared for, but not taxed. We want to be protected, but not constrained.

    Now all of those things have some positive aspects, but we need to look at them carefully. How much can we pay? How many liberties will we limit in order to be secure? Are the goals we ask our government to accomplish possible based on the resources we are willing to provide?

    In my private life, I have to ask such questions all the time. If I answer them incorrectly, I’ll run out of money, time, or abilities. It takes longer when it’s the government. But the same thing will ultimately prove true.

  • Few Knew Health Care Bill Got No Republican Support

    I don’t think this is a major issue against the Republicans, in the sense that I don’t think they should be criticized for managing to be united in opposing something that they, well, oppose. That’s good politics, and if they really do oppose the bill (and I’m not certain about some of them) it’s honest politics as well.

    But the voters need to know what their representatives are actually doing, thus I was not surprised, but nonetheless dismayed to learn that according a Pew Research poll, only 32% of those polled know that the senate version of the health care bill was passed without a single Republican vote, while only 26% know that it takes 60 votes to stop a filibuster.

    Why do people need to know that sort of thing? How do you know who is doing what if you don’t understand the basic of the process? Knowledgeable voters are critical to the success of democracy, and we have a serious problem.

    I note that the news story in which I picked this up, Taegan Goddard’s Political Wire, there was no mention of the fact that Republicans did better on the quiz than Democrats. Being an independent, I’m not as concerned here, but it’s an interesting result.

  • Medical Conspiracy?

    This is a good post. Not only is it true, but it’s fun. More of us should dissect certain advertising claims in this way.

  • Lybia 6 Freed

    according to ABC News. These are the folks who were wrongfully jailed for 8 years. I rejoice, but continue to regard with horror the fact that humanitarians such as this could be imprisoned because of ignorance that ought to be criminal. People stupid enough to jail these folks shouldn’t be allowed to drive cars, much less have guns and run countries.

    I blogged about this before here.

  • The Real Cost of Health Care

    Hmm! I don’t really know what that is! But Robert J. Samuelson has an excellent column on Newsweek (via MSNBC) that discusses the issue. He makes a number of excellent points, including pointing out that we’ve hidden the actual cost of health care, though I suspect not nearly so successfully in this country as in some others.

    One thing he points out is this:

    Our health-care system will inevitably combine government regulation and private enterprise. But what should the mix be? Which patients, providers and technologies should be subsidized and why? How important is health care compared with other public and private goals? Will an expanding health-care sector spur the economy

  • Excellent Health Article

    Those of you who read this blog regularly know that I pretty regularly lash out at the news media. It’s not that I think they’re biassed to one end or the other of the political spectrum. I just think they’re biassed stupid.

    Well, I just want to point out an article today in Newsweek that I think exemplifies how information should be presented, especially on the internet. There should be this type of research behind every news story, and even if you present a short, idiot friendly version on the front page, it would be nice to get a well written, extended article such as this column.

    I refer to Drugs Aren’t the Only Option, a column by Dean Ornish, M.D. This article is well-written, it doesn’t prescribe what I’m supposed to want in my life, it doesn’t run anybody down, but it does provide useful information on diet and lifestyle, particularly with reference to cholesterol.

    I happen to be interested in that subject, but the only reason I’m bringing my personal interest to the blog is simply to point out the excellent style and balance of this article. I wish we would see more articles of about that length printed in the online news media. We may be subject to excessive time and space constraints on television, but the internet provides opportunities for more solid, informational content.

  • Innovative Health Care Option

    For years, ever since I first heard of nurse practitioners and physician’s assistants, I have thought that our health care profession could be improved by using less expensive–but not necessarily less effective–professionals to provide primary care. Now, in an article Want Treatment With Those Pills?, Newsweek is describing just such a revolution in progress. Small, walk-in clinics staffed mostly by nurse-practitioners, are popping up all over the place. What they provide is more consumer oriented medicine, including greater convenience, better service, and lower prices.

    Right now the target is primarily those without insurance, for whom the lower cost is the focus. But one clinic, according to Newsweek, reports that more than half of its patients are insured. Quoting the article:

    “The time for this concept has come,” says Brian Jones, CEO of MedXpress, which is opening its first clinic this summer in Texas and expects to have 500 locations nationwide by 2010. “We expect this to be almost a revolution in terms of the delivery-care model,” he adds.

    I agree! I certainly hope that this will be a revolution in how health care is provided. Medical science continues to advance, so that physicians have to have more and more training just to get past the starting gate, and must spend a good deal of their time in maintaining their skills. A good thing, the improvement of medical treatment, becomes a negative because it makes simple treatment much more expensive. If I have a cold that seems a little more persistent than normal I have two options–delay treatment, or bite the bullet and pay the price, most likely just to be told that I have a cold, and have to wait it out.

    Now in my household, with a wife who is a Registered Nurse, and MD/RN parents who are a phone call away, I can often avoid the dilemna. But others don’t have the family resources I do. Because of high cost, they may delay treatment until things become much worse. With a nurse practitioner available, someone surely well-equipped to tell the patient whether their condition is routine or requires more complex handling, anyone can avoid these extra expenses. Most medical conditions don’t require the time of a specialist, and these can be handled much more effectively.

    With standards established for electronic medical records and the means of sending them quickly to a primary care physician’s office, referral can be quick and efficient. There is some discussion in the article of consultation and supervision by physicians, and that would provide an additional layer of safety, again using quick transfer of medical records and test results.

    I think this is a wonderful innovation, and I’m glad to see that it’s catching on in a big way. It doesn’t solve the problems of health care, especially for the uninsured, but it certainly helps. It will not only reduce the total bill for health care, but allow resources to be shifted from routine care to case where more complex care is needed.