Zero Comments so far! This topic is so important to all of us and no one jumps on it? Outrageous!
On the other hand, this is an issue that is partly dominated by economics and who understands that?
Right now we have a marketplace that is in some sort of equilibrium. Not pretty, but the consumers are matched by the health care providers. If we increase insurance (and we should, in some fashion), then we will lose the equilibrium and the market will become further distorted.
So, it seems to me, and I am neither an economist nor a health care provider, that the first step is to put in place a plan to increase health care providers. Not living in North Andover, I live in a place were there is a shortage of health care providers for the population as a whole. There are places like Montana and North Dakota where there are not only great distances, but few health care providers. Inner cities have shorter distances, but still a shortage of health care providers considering the population.
My suggestion (a person without a solution when criticizing the existing solution is a bit of a four flusher) is that the US Public Health Service should encourage people to go to school to become Physicians Assistants (PAs) and Nurse Practitioners (NPs). In payback, these newly minted health care providers would go to places they are needed to provide increased healthcare. Because PAs and NPs take much less time to train, they could be out there making a difference much sooner. A payback of five years in a USPHS Uniform seems reasonable to me. The USPHS is just like any of the other six uniformed services. Join the Air Force, join the Coast Guard, join the USPHS.
As for life expectancy, I wonder if that is the proper measure of success? Maybe we need several measures. For example, I bet that given our very bad infant survival rate if we factored that out we would do better in the stats in terms of longevity. But then I am not an actuary either.
Our health care and health insurance situation is such a multi-faceted issue. Kudos to Congress and the president for tackling it and shame on those who are shouting at each other rather than conducting civil dialog. First, my reaction to some of Cliff's comments. I don't see how increasing insurance will create a market imbalance since I don't believe the number of providers is a direct corollary of the number of insurance options out there. I agree that increasing the number of medical providers should ease access, but there have to be incentives to get those providers to offer services in Montana, North Dakota, etc. I also agree with the North Andover Citizen that we need to honestly confront some issues. We have been absolutely unwilling as a citizenry to compromise on any of the three legs of medical care - quality, cost, and availability. We don't want to lower quality of services, keep screaming about cost, and get panicky about the thought of rationing. In truth, we have de facto rationing today - otherwise, I wouldn't have had to wait for a month to see an orthopaedic specialist when my broken leg wasn't healing - and that's in the Boston area where we have an abundance of medical services and providers. (If I was in ND, I'd either still be waiting or would have had to travel some distance to specialized medical services. The time has come to expand the public option of Medicare, opening it up to folks <65. I also think we should remove the earnings ceiling on which Social Security and Medicare taxes are levied to alleviate some of the pressure on each of those entitlement programs. Those panicky voices about the evils of socialism have to acknowledge that our numerous entitlement programs for senior citizens, retired military, students, handicapped citizens, and disabled veterans are created in the spirit of acknowledging that it's appropriate for a government to reward service, honor the elderly, and care for its citizens who need assistance. The many challenges of health care/insurance reform include the need for greater efficiencies, more transparent pricing, improved record-keeping, and a number of other issues. There is much work to do.
While I don't deny that quick or easy access to health care in the US is problematic for some, so is food and housing, and transportation, and clothing.
Having acknowledged that a problem exists, I am going to utter a heretical statement. Who says that health care must be reformed and what is the motivation behind that intitiative? While I agree that improvements should be made, the American system of medical care is far from broken and the US has no reason to apologize.
Again, who is pushing for "reform" and why? Importantly, WHAT is to be reformed? And, it is this last question that has so much of society, well, lacking the "courage" to face the challenge.....or should I say.....knuckle under to the pressure of the reformists.
Need more providers? Sure we do, the WORLD needs more health care providers. But who will pay for their education? And more importantly, who will pay for their malpractice insurance and their income? Amidst all of the political breast beating about making lower tier professionals more available to the public, I hear not one comment about how these people are to be paid enough to live on and pay their liability premiums. If one examines the recent history of medical care delivery in America, putting NP's and PA's out in the boonies (urban or countryside) simply fails to work because of that issue. An NP or PA is not authorized to provide care not supervised by a physician licensed to practice in that state. Thus, for each clinical subprofessional employed by a physician to deliver care in his "business area" the cost of his liability insurance goes up precipitously and the PA and the NP must kick in their share. The problem is that very few PAs or NPs can make a living once all the costs are paid.
The USPHS long ago departed the scene of actual patient care in the community setting. They can be found now in the NIH, CDC, etc. To return them to their pre-1940's luster would require massive funding and considerable ramp up time as we have largely converted USPHS facilities to other roles in structural life.
Tort reform? Sure, but I wouldn't hold my breath since medical tort actions have almost nothing to do with prevention of medical errors and everything to do with avarice on the part of the legal profession and sadly, the plaintiffs. Frankly, until human nature is "reformed" I don't see lawyers....most of Congress are lawyers.....or the public giving up this ripe plum for "a kinder, gentler" way.
Finally, in defusing much of the hyperbole and hysteria over health care reform is the inescapable fact that anyone who needs health care today can access it, and even receive it for free. Why they don't covers the gamut of reasons and/or excuses, but mostly it is just not convenient. They show up at ER's and get irritated because they have to wait 6 hours to see a doctor about a non-emergent medical problem...or they don't want to drive 20 miles.....or its too hot...or its too cold...or the "game is on TV" or any of a million other excuses. As one who served in the medical business for years, I can attest to the abusive nature of patients when it comes to using the system.
In a country that is slowly sagging downward under the increasing weight of its own population, despite efforts to reduce those numbers through a growing pandemic of alcoholism and drug addiction, I am not at all certain that "reform" of the health care system is the answer if one carefully examines the problem(s).
And as for asking the government to grow even larger to give us all "what we deserve" is indeed a brave leap of faith and a likely heart breaking outcome when one looks at recent government successes like the Big Bailout (somewhat akin to what is known in MA circles as the Big Dig), Automobile Manufacturing Reform to include the most recent monument to Federal ineptitude...Cash for Clunkers.
If you think medical care is a problem now, just wait until it's "free."
Those who have want no change -- to include in the costs/price they pay. Those who have not are losing their voice -- their access to the system is low to start and they are losing their champions. Stalemate and rising costs are the result. I.e., the thesis of the article; where is the courage? No one has the political courage to tell America bad news -- unless they want to lose their "job"
4 comments:
Zero Comments so far! This topic is so important to all of us and no one jumps on it? Outrageous!
On the other hand, this is an issue that is partly dominated by economics and who understands that?
Right now we have a marketplace that is in some sort of equilibrium. Not pretty, but the consumers are matched by the health care providers. If we increase insurance (and we should, in some fashion), then we will lose the equilibrium and the market will become further distorted.
So, it seems to me, and I am neither an economist nor a health care provider, that the first step is to put in place a plan to increase health care providers. Not living in North Andover, I live in a place were there is a shortage of health care providers for the population as a whole. There are places like Montana and North Dakota where there are not only great distances, but few health care providers. Inner cities have shorter distances, but still a shortage of health care providers considering the population.
My suggestion (a person without a solution when criticizing the existing solution is a bit of a four flusher) is that the US Public Health Service should encourage people to go to school to become Physicians Assistants (PAs) and Nurse Practitioners (NPs). In payback, these newly minted health care providers would go to places they are needed to provide increased healthcare. Because PAs and NPs take much less time to train, they could be out there making a difference much sooner. A payback of five years in a USPHS Uniform seems reasonable to me. The USPHS is just like any of the other six uniformed services. Join the Air Force, join the Coast Guard, join the USPHS.
As for life expectancy, I wonder if that is the proper measure of success? Maybe we need several measures. For example, I bet that given our very bad infant survival rate if we factored that out we would do better in the stats in terms of longevity. But then I am not an actuary either.
Regards — Cliff
Our health care and health insurance situation is such a multi-faceted issue. Kudos to Congress and the president for tackling it and shame on those who are shouting at each other rather than conducting civil dialog.
First, my reaction to some of Cliff's comments.
I don't see how increasing insurance will create a market imbalance since I don't believe the number of providers is a direct corollary of the number of insurance options out there.
I agree that increasing the number of medical providers should ease access, but there have to be incentives to get those providers to offer services in Montana, North Dakota, etc.
I also agree with the North Andover Citizen that we need to honestly confront some issues.
We have been absolutely unwilling as a citizenry to compromise on any of the three legs of medical care - quality, cost, and availability.
We don't want to lower quality of services, keep screaming about cost, and get panicky about the thought of rationing. In truth, we have de facto rationing today - otherwise, I wouldn't have had to wait for a month to see an orthopaedic specialist when my broken leg wasn't healing - and that's in the Boston area where we have an abundance of medical services and providers. (If I was in ND, I'd either still be waiting or would have had to travel some distance to specialized medical services.
The time has come to expand the public option of Medicare, opening it up to folks <65. I also think we should remove the earnings ceiling on which Social Security and Medicare taxes are levied to alleviate some of the pressure on each of those entitlement programs.
Those panicky voices about the evils of socialism have to acknowledge that our numerous entitlement programs for senior citizens, retired military, students, handicapped citizens, and disabled veterans are created in the spirit of acknowledging that it's appropriate for a government to reward service, honor the elderly, and care for its citizens who need assistance.
The many challenges of health care/insurance reform include the need for greater efficiencies, more transparent pricing, improved record-keeping, and a number of other issues.
There is much work to do.
While I don't deny that quick or easy access to health care in the US is problematic for some, so is food and housing, and transportation, and clothing.
Having acknowledged that a problem exists, I am going to utter a heretical statement. Who says that health care must be reformed and what is the motivation behind that intitiative? While I agree that improvements should be made, the American system of medical care is far from broken and the US has no reason to apologize.
Again, who is pushing for "reform" and why? Importantly, WHAT is to be reformed? And, it is this last question that has so much of society, well, lacking the "courage" to face the challenge.....or should I say.....knuckle under to the pressure of the reformists.
Need more providers? Sure we do, the WORLD needs more health care providers. But who will pay for their education? And more importantly, who will pay for their malpractice insurance and their income? Amidst all of the political breast beating about making lower tier professionals more available to the public, I hear not one comment about how these people are to be paid enough to live on and pay their liability premiums. If one examines the recent history of medical care delivery in America, putting NP's and PA's out in the boonies (urban or countryside) simply fails to work because of that issue. An NP or PA is not authorized to provide care not supervised by a physician licensed to practice in that state. Thus, for each clinical subprofessional employed by a physician to deliver care in his "business area" the cost of his liability insurance goes up precipitously and the PA and the NP must kick in their share. The problem is that very few PAs or NPs can make a living once all the costs are paid.
The USPHS long ago departed the scene of actual patient care in the community setting. They can be found now in the NIH, CDC, etc. To return them to their pre-1940's luster would require massive funding and considerable ramp up time as we have largely converted USPHS facilities to other roles in structural life.
Tort reform? Sure, but I wouldn't hold my breath since medical tort actions have almost nothing to do with prevention of medical errors and everything to do with avarice on the part of the legal profession and sadly, the plaintiffs. Frankly, until human nature is "reformed" I don't see lawyers....most of Congress are lawyers.....or the public giving up this ripe plum for "a kinder, gentler" way.
Finally, in defusing much of the hyperbole and hysteria over health care reform is the inescapable fact that anyone who needs health care today can access it, and even receive it for free. Why they don't covers the gamut of reasons and/or excuses, but mostly it is just not convenient. They show up at ER's and get irritated because they have to wait 6 hours to see a doctor about a non-emergent medical problem...or they don't want to drive 20 miles.....or its too hot...or its too cold...or the "game is on TV" or any of a million other excuses. As one who served in the medical business for years, I can attest to the abusive nature of patients when it comes to using the system.
In a country that is slowly sagging downward under the increasing weight of its own population, despite efforts to reduce those numbers through a growing pandemic of alcoholism and drug addiction, I am not at all certain that "reform" of the health care system is the answer if one carefully examines the problem(s).
And as for asking the government to grow even larger to give us all "what we deserve" is indeed a brave leap of faith and a likely heart breaking outcome when one looks at recent government successes like the Big Bailout (somewhat akin to what is known in MA circles as the Big Dig), Automobile Manufacturing Reform to include the most recent monument to Federal ineptitude...Cash for Clunkers.
If you think medical care is a problem now, just wait until it's "free."
Bestest,
Neal
Those who have want no change -- to include in the costs/price they pay. Those who have not are losing their voice -- their access to the system is low to start and they are losing their champions. Stalemate and rising costs are the result. I.e., the thesis of the article; where is the courage? No one has the political courage to tell America bad news -- unless they want to lose their "job"
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