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Edited on Sat Feb-23-08 10:35 PM by Bread and Circus
One of the biggest problems I have with Hillary Clinton and Barack Obama is that they both call their plans "Universal health care" and insinuate that everyone is "covered" under their plan.
The term "universal" means that it applies to everyone and when you couple this with the phrase "my plan covers everyone" (a phrase found in their numerous speeches, debates, and policy papers) it is misleading because it implies that everyone will get some kind of government benefit to "cover" their insurance costs.
That's just not the case.
Most people that are not already on Medicare or Medicaid already have insurance and the government is not going to be underwriting those health insurance premiums by and large. Therefore, their plans really don't provide universal coverage in and of themselves.
In addition to the above, both candidates say they will "reduce expenses" in the overall system while expanding the rolls by 35,000,000 to 46,000,000 individuals. They both go as far to say that there will be no overall increase in expense healthcare expenditure. Well, if you keep the dollar amounts the same and expand the number of people getting care then you will have to "increase efficiency" in the system. That means somehow you have to deliver an equal amount of care to more people without the number of dollars going up. So, I gotta ask, how's that going to be done?
They both say they will offset costs by having better IT in health care and more focus on prevention but I find those to be pithy "feel good" solutions and I say that specifically regarding the latter because they don't discuss how they are actually going to prevent specific diseases. There's the inference that we could cut down on obesity related illnesses (dyslidemia, hypertension, diabetes) but people don't need insurance to get a proper diet and exercise like they should. \
The costs of medical care (as billed) are mainly from these things:
physician visits at the office physician visits in facilities ER visits hospital stays hospital surgeries and procedures laboratory tests imaging tests home health nursing physical therapy special treatments (outpatient chemotherapy) drugs and medications durable medical goods
Now, adding 47,000,000 people onto the equation is going to increase demand for all those services and, as far as I know, neither plan actually goes to state that any of the prices of any of those services will go down.
It's like acting as if you could keep the total government candy bar expenditures the same while you gave out subsidies for candy bars for everyone who couldn't afford a candy bar. If you don't reduce the price of a candy bar, you will just end up spending more money no matter what as long as their is a demand for candy bars.
Some will say "but..but...what about the improved efficiency, won't that offset the costs?"
Not if the prices of the services don't go down.
However, if they are right and overall the system cost does not increase then someone is going to have to take a hit on their prices...
Who will it be? The nurses? The doctors? The hospitals? The support staff for facilities and physicians? The insurance companies? The pharmacies? The pharmaceutical companies? Physical therapy outfits?
And with that said, who REALLY thinks the Insurance companies and pharmaceutical companies are going to take the brunt of this increased efficiency?
I agree we need to fix the system, I even agree with a change if it means more societal cost via taxes.
But if you are going to spend all that money why not just do what really needs to be done in providing REAL universal health coverage and go single payer? Then you can actually cut out waste by doing away with the insurance companies. You can dramatically lower physician and hospital overhead by simplify their billing process. You can have an integrated billing and medical record systems that will help them do away with legions of billers, transcriptionists, legalizers, T-crossers, and I-dotters. You will also need to work on an integrated way of reducing the demand of diagnostics and treatments which are over-ordered due to defensive medicine practices or "consumer driven demand".
The vast majority of the healthcare dollar is spent at the tip of a physician's pen, and there's got to be an intelligent way for them to "order less" while getting the same health outcomes. However, I can tell you that most physicians' feet are usually held to the fire if they don't order a test, med, or referral and a lot less if they order something that really didn't need to be done. There's legal and economic incentive for doctors to order more and more and that has to change. Perhaps an integrated single payer system would be able to better address that through public education and published treatment guidelines.
In addition, a national single payer plan will allow everyone to be on the same playing field in collectively negotiating for the best drug prices. I could go on an on.
My point is that adding "more patches" to a patchwork broken system is not going to fix the system. It's great that a lot of people will get health insurance and as a primary care physician I will benefit more than most. However, it's still going to be a broken system.
The best system would be Single Payer Universal Health Coverage that provides for preventative, chronic, and episodic care from conception until the grave that's built in a way so that hospitals, nursing homes, home nursing agencies, and the like can render the same care for less cost.
It bothers me that both candidates take credit for the benefits of a single payer plan but don't actually offer one. They don't actually "cover" everybody because a lot of people won't really derive any governmental benefit as they are already paying for insurance and will continue to do so. Nor do they simplify the system that would allow true increased efficiency. They should call their plans what they are, piecemeal systems that subsidize and expand coverage for the currently uninsured.
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