Bazbo wrote:
There are no death panels in the ACA. Tis is a cynical right wing myth that does not seem to go away.
You can't have unlimited care with limited resources. Those two ideas are mutually exclusive. I don't understand all of the implications of the ACA and I'm a physician, but I wish someone were put in charge of the health care system who actually understands health care and how it is delivered. Government delivery of health care is the most inefficient form of health care delivery on the planet--just try working in the VA environment. Even in private practice there are abundant examples of government imposed inefficiency. For instance, there are patients who I see everyday who are admitted for overnight stays in the hospital because medicare/medicaid will not pay for the necessary outpatient procedure unless they stay over night. So we pay twice as much for the same health care because we force patients to stay for unnecessary hospitalizations.
Here are a couple of things I think are reasonable starting points for designing a viable system and would potentially do a lot to get us moving in the right direction. I'm not a politician and haven't thought the whole thing through, so I'm just shooting from the hip here. Mostly what we need are attitude adjustments that reflect reality.
1. I think that if we, as a country are going to allow anyone to get health care who desires it (as in showing up to the ER), everyone has to be willing to pay for it. Those less able to pay should pay less, but everyone should contribute to the cost of health care. If that means that there is less money for cigarettes, tattoos, cell phones, cable TV, discretionary entertainment, etc. so be it. Health care--a necessity of life comes before non-essential things. We have a big priority problem in our country in this respect which is contributing significantly to the health care crisis.
2. Someone has to decide what is covered and what is not. People call this death panel decision making, but the fact of the matter is, that we are going to have to choose what is covered and what is not as not--that is a fiscal certainty and the sooner we come to grips with it the sooner we will be able to solve the problem. Failure to recognize this and accommodate it will result in the entire system failing and nothing will be covered for anyone. Something is better than nothing. This is not denying care, as it can still be obtained, it is just shifting the burden of funding from the government to the patient or some non-governmental agency (individual/charity/family whatever). This is where the tough decisions are made, however, because someone always comes out on the losing end, and none of us want that to be us or our family members. That is the emotional component of the problem. On an individual basis, I personally can sympathize with any of the patients that will be affected. As much as we might wish, we do not have the luxury of designing a national health care system around every individual. If you look at where the bulk of health care dollars are spent, it is often wasted on futile care during the last two months of life by the families of patients who insist that "everything" be done, when "everything" only prolongs suffering and delays the inevitable. Death is part of life, and until we come to grips with this, we will be unable to deal effectively with end of life issues. As unfortunate as this is, it is life (or is it death?).
3. There should be a two (or more) tiered health care system where the basic of health care are covered for everyone. With everyone participating, such coverage might be more affordable than we think. Those desiring coverage for things not covered must optionally purchase privately funded insurance [which should be strongly encouraged and should be viewed as just as essential as it is today--but cannot be required per the Supreme Court (the one part of Obamas plan I actually agreed with because if you expect to receive health care if and when you need it, you should be prepared to fund it. Many think they will never need it--until they do)]. The "basics" is merely an emergency back-up plan for those unable to get their private insurance so that they are not abandoned by the medical system.
Think about it, I can't expect a car dealership to give me a car free of charge just because I show up needing a ride. But that is exactly the way health care is meted out in the ED. For those who choose not to purchase more than the basics, they still have the option to privately fund treatment options in emergencies, or get charities involved to help, or just accept what the basic system has to offer, but health care system cannot cover everything. Such patients can be made comfortable, not abandoned, but uncovered services (whatever they are determined to be) will not be provided.
4. I think that every insurance company should cover every doctor and hospital everywhere. Let doctors and hospitals compete with one another for patients by improving facilities, improving care, and efficiently providing for their patients by giving patients what they want. Patients then become consumers and will do more to improve the quality of and decrease the cost of health care than anything else because they will seek out the best. If you are a doctor or hospital and want patients, you need to be the best.
5. Decrease the bureaucracy of health care delivery by standardizing all forms for coverage and all medical records. I don't care who does it or what it includes, but it should be the same in the entire system. Imagine how much more efficient health care could be if we didn't have to have a different form for every provider, institution, and doctor's office for approval of and payment for care. Keeping current on all the changing forms, guidelines, and requirements of various providers is overwhelming for doctors and patients alike. And imagine how much easier it would be to transfer and maintain records.
This is getting long, which was not my intent, so I'll stop here. But this might be a starting point. I'll stop now.