Obama’s Speech on September 9, 2009 was dense, logical and ambitious. There are things that readily clicked, parts I had to rewind Tivo and playback to thoroughly digest, and parts that seemed lofty without practical details to back it. However above all I credit Obama for opening one of the most feared Pandora’s Boxes: a debate on our failing Health Care system.
Affordable Choices: This is, in fact a capitalist move that provides greatest utilitarian good. For all of us will be protected whether we are working, unemployed and especially trying to make that anxious step to our own business. Very few can disagree with the idea of insuring everyone unless they inherently believe that health care is not a right. This is a question we should all be asking ourselves, for this fundamental belief system will guide who and why we support certain sides.
Marketing vs. Socialism: Our present system offers benefits to very few: to the insurance companies, pharmaceutical companies and to some health-care providers yet costs for coverage are skyrocketing. I have yet to find many happy with their current health insurance. As for the men at the coffee shop, they benefit from medicare. Medicare is our society’s way of taking care of our elder. This was a system that, prior to being legalized, was met with great resistance, including threats of socialism. Nonetheless, we are still not providing enough and many of our seniors cannot afford their medications.
We all bear the brunt of the counter-logic in our system: if we get sick and lean on our insurers to help us, we are more likely going to be dropped by them. When we change jobs, become unemployed or move we will not be picked back up because of our “pre-existing conditions.” This may be one of our greatest problems. Outlawing this will protect our citizens, something long over due. The method of executing it, however, has yet to be seen.
One option he discusses is to provide “emergency coverage” for those who are waiting for our new system to kick in. This was a concept proposed by Mr. McCain. It is a low cost coverage to protect against “financial ruin” if one becomes seriously ill. This concept does not define “preexisting”…is that acne, blood pressure, anxiety disorder? Additionally it sounds like we have to wait for the disaster hit before we get assistance. This is hardly protective if you ask me.
Despoiling the Children: It is time to get everyone coverage, for in the end we will all bear less of a toll on our health care system simply because everyone will be healthier (right now we are ranked 37 in the world in health care systems, yet we are ranked 1 in highest cost). Additionally, they will all be assigned a proper provider rather than 1. Waiting until the problem is severe, more detrimental to them, requires less days of not functioning in society (be it work or otherwise) and calls for more expensive treatments 2. Seeking care from the inappropriate sources (i.e. going to the ER for pap smears).
We must also realize that it is not possible to give everyone what they want all the time. Often I listen to complaints of “socialized medicine” and realize that many are complaining about their full access to all imaging studies, blood tests and specialist all the time. It just is being over used and services need to be more directed.
Public Option: I had a great time going to Santa Monica’s Third Street Promenade. Parking can be a hassle, but I am virtually guaranteed available parking with first 2 hours free and $1/hour there after. Are we suffering with lower quality parking, are the spots restricted. They certainly are not, however we all get a spot and don’t pay the $20 prices that going to popular parts of Chicago, SF, NYC and downtown LA have. Other benefits include supporting local businesses by buying a gift and drinking a smoothie on the promenade.
When you have a large group of consumers negotiating with pharm companies and hospitals, the negotiating power becomes stronger, stiffening the competition. Obama brought up 34 states have 5 health insurers or less in the state. That kind of monopoly is hurting the insured. Strengthening the competition will force efficiency, decreasing administrative costs (which equals 30% of our costs in the US compared to <5%>
Funding the Cause: More people insured + Better care = Lower costs??? It’s like the ultimate magic trick and Obama is the magician.
Reigning in the unhealthy and checking up on the uninsured that fell off our system is going to be a major cost. We are now taking onus of all the Alzheimer’s, hypertensive, diabetic and asthmatic patients. It costs money to see them more often, to check their blood work regularly, to get them their regular eye exams and the support services they are long overdue for. We have to get a sick nation healthy. No matter how you spin it, it is expensive. Once everyone is insured and stabilized then costs will go down. That isn’t going to happen overnight. This has not been addressed.
Obama justifies that he will not let this add one dime to the deficit and that if it does he will cut from somewhere else. This sounds unrealistic and a solution by reshuffling (Schwarzenegger style). He says that since our system is so expensive as is, the costs will be redesignated rather than increased. None of this accounts for the baseline increase in medical care everyone is going to initially need. However, down the road this all may prove to be true.
Regardless the focus has to be diverted from for cost care to healthier care. One of the most productive ways is to allow each provider more time with the patient. It is a simple as: more time means a better history, means less unnecessary tests, means more reassurance and a strong relationship with the patient, means less uncomprehensive care, means decreased missed pathology and less law suits.
Not discussed: The role of pharmaceutical companies in our increased costs. Plavix is the number two seller in the world, we all have some concept of the medication because of the frequency of their ads. We like to think that we are the most research heavy nations, but we are one of the few that promotes prescription medicines like soda. There is no irony that prescription medications abuse has become a large source of addiction in this country. The markup between US and India runs about a 20x markup; the cost of our copays are often more expensive than buying the drug in another country.
While some things work and make total sense, others need to be extensively flushed out. However, having a blueprint on the table gives us somewhere to start. Having the vibrant discussions gives us the concepts to expand upon. Having a decrease tolerance for frivolous rumors and increased tolerance for productive criticism will lead us in the right direction.
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