Sunday, September 6, 2009

Life is Like a Game of Telephone - and Healthcare is Like Automated Phone Hell

Telephone - you remember that game, don't you? The person on one end of the "phone line" whispers something in the ear of the person next to him/her and that person whispers what they heard into the ear of the next person...and so on and so on. By the time the "message" has been passed down to the end of the line, a simple phrase like "The boy and his dog ran around the block" has managed to become "a toy frogman found a rock". And so it goes in the realm of national media.

I try not to write about controversial subjects in this blog, but unless you actually live under a rock, you've had to have heard about the crisis in American healthcare and the proposed healthcare legislation - and all of the issues and dissention over the "euthanasia" clause, rationing of healthcare, and even the rumors that Medicare will no longer be available, just to mention a few. If I had $5 for every e-mail I've gotten on the subject, I could probably plan a very nice vacation to a distant tropical island by now.

I don't want to turn this into a rant on what's right or wrong, or true or not true as far as the political climate on healthcare... I have my own opinions, I've done my own research, and to sum it up, I will say that the current system must evolve. I will also add that having spent 25+ years in the medical insurance field, I probably have a more informed opinion than the average citizen.

What bothers me more than the proposals is the lack of clarity on the part of the government and even more, the willingness of people to "play telephone" - passing on tidbits of information, often taken out of context or completely manipulated by special interest groups, without taking the time to verify what is "in fact". This type of attitude is not specific to the current healthcare or financial crises facing us - it permeates every corner and walk of life. My husband has a saying about his chosen profession of being a network engineer - "if you put 10 network engineers in a room, you'll get 15 opinions"... I'm beginning to think that's pretty much how all of life works.

I also have a saying - that there is no such thing as an absolute - there are only conditions and situations we haven't run across yet. Scientists will argue the "laws" of science, but I firmly maintain that those laws are simply suggestions - because we are limited by the testing of those "laws" by common and "usual" circumstances... throw in extenuating circumstances and the law of gravity that says all things fall toward the earth goes out the window with the application of thrust and lift - thankfully for all those airplanes that are designed to disregard that law. Just like the "laws" of science, and based on the number of clarifications and changes they also go thru, are the laws of society forever absolute and irrevocable, or do they also deserve revisiting and rethinking?

Things I believe - based on my own experience and research - and not listening to the "telephone game" rumors : (although I'd be curious to see how these thoughts get morphed into new thoughts and ideas!)

Medicare, Medicaid, and Social Security cannot survive under their current structure - read the statistics on the exponential growth in the number of beneficiaries coupled with the increase in average life expectancy and rising healthcare costs and then do the math.

Healthcare costs need to be reined in... be it through caps on awards for malpractice/medical injury, limits to the amount of profit a company can realistically make to recover "research and development costs", or one of any other numerous methods - something needs to be done.

Complete healthcare (including vision, dental, and behavioral health benefits) needs to be made available at reasonable costs to everyone. Do you believe by not having government healthcare that you're not paying for healthcare for uninsured individuals? Think again. Healthcare providers have to make up the costs of treating uninsured people somewhere... and it doesn't often come from the patient. How horrible of them to not pay their bills, you're thinking? If you compare the negotiated rate that you, as an insured patient, would pay compared to the costs that an uninsured patient would pay, you'll understand why uninsured people either don't get care or can't afford to pay for the care. In the end, it isn't free care -so who pays for it? All of us... in the form of higher premiums driven by higher prices - which the providers justify at "retail" (ie non-contracted), not "wholesale" (contracted) rates, or in that portion of taxes which go to pay for - yep, you guessed it - government programs like Medicaid. I personally would rather see programs in place that will encourage people to seek earlier (and hopefully less costly) care than to see someone "wait it out" and have that sore throat devolve into scarlet fever and the subsequent complication of major organ damage...translated - I'd rather have a government plan that pays a dr $50 for a visit than $50,000 for a hospital stay.

People need to be realistic about healthcare, living wills, malpractice, and in the case of the people running the show, realistic profits. Again, nothing comes without a cost, but the idea of that cost being the maximum that can be borne by the people is, to my mind, not only unrealistic but blatantly counterproductive.

From the "user" perspective, the first issue that comes to mind is profit - and yes, I tend to pick on medication when I think of profits. I cannot for the life of me, understand why any medication should cost $30,000/ month - yet some do. Or why, for example, generic medications that some pharmacies charged an insurance plan $50, a week later could all of a sudden be bought for $4 at certain major stores. Clue me in! Why have we not rebelled against this absurdity? I won't even go into my views on some of the absurd, and quite possibly fraudulent costs that hospitals and medical professional bill for certain services and expenses - but the thought of those $200 hammers that the government was buying years ago comes to mind.

Malpractice? I can understand someone getting an award for blatant malpractice, but I'm sorry, I think there needs to be a reality check (pun intended) on some of the awards that people get. $20 million for a medical mistake that results in a loss of income at age 50 when the person was only making $50K a year seems unrealistic to me. Again... that award money has to come from somewhere... the malpractice carrier pays the award, raises the dr's insurance rates, the dr demands more in fees to cover the cost - and we all end up paying.

Another issue - living wills... the thought of succombing to death is certainly an unpleasant one, but let's face it - from the moment we are born, we are destined to die. I don't believe avoidance of the issue means that you have no responsibility in deciding how far medical personnel must go to keep you alive. Yet without a living will in place or having provided power of attorney to someone in the event that you are unable to make those types of decisions, medical providers are placed in the position of having to sustain life at pretty much all costs - even if that would not have been your wish... and if you think that type of medical care isn't expensive, I'll share a statistic. Eight years ago, before my second husband died, he was in the hospital for 12 weeks in an intensive care setting. His actual costs without insurance would have been over $600,000 dollars (no surgery, mind you). Had we not discussed his wishes and had anyone been put in the position of having to keep him alive indefinitely, his expenses would have probably easily hit the million dollar mark. As it was, the self-insured plan that he was covered under through his employer paid out just a little over $175,000 in covered expenses - and because 2 other employees of this somewhat small <100 employee company had similar expenses that year, the insurance coverage for all of the other employees jumped significantly the following year. Three cases, one company - pretty insignificant you would think - but it affected alot of premium dollars and alot of paychecks. Now, take that to a national level.

After all is said and done, I think we also need to be realistic about taking care of ourselves. Yes, some things are unavoidable and unforeseeable. In my family, hypertension is a fact of life... and even a few of my relatives who lead extremely healthy lifestyles have hypertension. And I know that other families have to deal with things like juvenile diabetes or even arthritis. Some people, no matter how healthy they live, develop significant health issues. They're not the ones I'm talking about. I'm talking about the people who choose unhealthy lifestyles as the norm, rather than the occasional greasy cheeseburger. Should healthcare be made available to them no matter what? Definitely - for the simple reason that they're going to need it. Should it come at a greater cost - possibly and probably. Does that suck for most of us? Again... nothing is free.

I've rattled on long enough. Before you make up your mind on the healthcare crisis, read everything you can - but choose your sources well, take a broad view, compare, read, and re-read... and try very hard not to play telephone with the "facts"... and remember that there is no perfect solution - all of them will cost someone, somewhere.

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