Dear Readers,
I would like to take a moment to introduce my husband, Jonathan Choate. He will be guest posting on my blog today and is sharing his views on health care and what kinds of reforms he would like to see as a conservative.
My husband and I are very different.
Yin and yang. He said, she said. Mary Matalin and James Carvell.
(Which is unfortunate as that would make me James Carvell because truthfully, while an attractive man, he would make a REALLY unfortunate looking female.)
If you want further proof of our differences, just compare his post title on health care reform to mine.
See what I mean?
I wanted you to have Jon’s point of view.
I had so much more to write but I cannot.
My basement is flooding.
FLOODING.
I am only in here because my back gave out from bailing and the baby started crying to be fed. So I sit here feeling frustrated. Ugh, I can’t think of it.
Oh, well. At the end of the day none of this matters. What matters is that people keep talking. Keep sharing. If you’re like Jon and don’t want the current plan? What are your ideas? If you are like me and want a plan passed with a few changes, what you would need to feel comfortable with to have it passed? Tell us. If you are very supportive of the current bill what would you need to see happen to get to a place where reform could occur? Where are you willing to be flexible?
I have to go. The need all hands on deck. You know, because my basement is flooded. It’s the first day of school, I haven’t had one ounce of sleep tonight and I think I probably re-injured my back so honestly I do not know how much I am going to be able to be around here today.
If you want to know how you can help me? Continue on with the example you showed in my previous post. People, I had 260+ comments, over NINE HUNDRED EMAILS and guess what? Not ONE hateful comment.
NOT ONE.
I get hate mail for the way I tie my scarf and people have managed to have a passionate, CIVIL discussion about the most emotional issue in the country.
I AM SO PROUD OF YOU ALL.
It restores my faith in humanity.
So please:
KEEP THIS DEBATE RESPECTFUL. CIVIL. FOCUS ON SOLUTIONS. SPEAK UP!
Continue to speak up with your stories, ideas, solutions from BOTH sides. If you don’t do it here, do it somewhere. Fight to keep civil dialogue flowing. Between us all we can do this.
Please.
I did want to answer one question before I go. A reader asked me what in the world I could do to top being invited to The White House.
The answer is easy.
Work to get invited back.
:)
~Loralee
P.S. If you could spread the word that this post is up on the internet, I would be grateful. I think I will be too busy trying to keep the pestilence and plague of locusts that are probably going to descend next at bay. At least the Four Horsemen of the Apocalypse that are parked on my lawn have been watered.
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Imagine that you are at work, just going about your day and your wife calls and blurts out, “The White House will be calling you on Monday.”
That’s just another day of life being married to Loralee.
Apparently I was a rather integral part of the conversation during a luncheon held half way across the country with a room full of people I have never met. Loralee was given an amazing opportunity to speak with Valerie Jarrett about health care reform and she spoke a lot about myself and our frequent disagreements on it.
We have both lived through the same experiences and have come out of it with some different views regarding this hot button issue. While we agree on some things, we have many views that completely differ from one another about what should be done. At the end of the luncheon, Ms. Jarrett announced that she would like a chance to speak with me to hear my ideas for solutions on health care reform. You can read Loralee’s view on the entire thing here.
I spent considerable time contemplating what I would talk about. For those who are not aware, I am very conservative individual. I am not a Republican, and have not supported either of the major candidates in at least the last 3 presidential elections. I am libertarian/constitutional in my views. I have a philosophy on what I believe is the role of government, and so far neither of the 2 major parties has represented those beliefs adequately.
I oppose most of the policies that the current administration has proposed. However, even though I oppose the policies, I do not believe that the president or his advisers are bad people. I think they wholeheartedly believe that what they are trying to accomplish is the right thing for the country. I just disagree with the methods. And that is why they wanted to talk to me, a network engineer from little old Logan, Utah. They wanted to talk to a regular everyday conservative and see how he feels about the health care debate, and for that I give them huge amounts of credit.
True to her word, I received a call from Senior White House Adviser, Valerie Jarrett, the following Monday afternoon.
She is a delightful person. We spoke for roughly 30 minutes, a significant amount of time for someone with her responsibilities. We had a good conversation about her experience meeting my wife and about health care reform. We covered several topics including tort reform, regulatory reform, and methods for improving efficiency in the health care system. Like many political topics, we agreed on several points of view, especially what the problems with the current system are. Due to time constraints there were many parts to the debate that we were unable to address, so I told her I would put my thoughts on a guest post on Loralee’s blog.
I’d like to address what I feel are the real underlying problems with the health care system. It is NOT a problem with health care, and my wife agrees with this. Our family has a wonderful physician. He is a General Practitioner and he has done a wonderful job treating my wife and children. We like him very much. My wife also had an outstanding high-risk OB/GYN and Perinatologist that saw her though her pregnancy. I deeply appreciate the care my wife and baby received during those 9 trying months.
The care of our providers is not in question as far as I am concerned. It is a problem with cost and availability. Despite a lack of emphasis of preventative care (which should be the responsibility of the individual, not the government), the US has the best system for actually dealing with health problems. We should be fixing the underlying problems in the current system, not just shifting who pays for what. We need to address lowering the actual cost of health care and here are a few ideas on how to do that. These have been brought up by other people in other places, but this is just my opinion of them.
Tort Reform – This phrase is bandied about by a lot of people who don’t even know what tort is. “Tort is a system for compensating wrongs and harm done by one party to another’s person, property or other protected interests (e.g. reputation, under libel and slander”[from Wikipedia].
Doctors need to have malpractice insurance in order to protect themselves from malpractice suits. Most of the insurance regulation occurs at the state level, so there is little that the federal government can do in regards to that.
However, as some states have done, they can establish caps on certain types of claims in order to help stem the rising cost or malpractice insurance. This would directly affect the premiums that doctors pay, therefore lowering the overall cost of the services provided. By doing this, this may also affect so called “defensive medicine”. That is when additional tests or procedures are performed on a patient solely for the purpose of protecting the doctor or institution from malpractice liability. As far as I can find, no one has been able to successfully quantify how much waste defensive medicine is causing, but anecdotal evidence suggests that it is significant enough to make in impact.
Another option is to move medical litigation to a special court (much like taxes are) that is designed to deal with medical issues. Having a medically trained judge making the ruling would simplify the process and severely curtail frivolous claims as they would have to sell the story to a medical professional rather than a jury. This would only be for civil suits, not when there is criminal action brought.
Regulatory Reform – The regulatory burden that has been put on many aspects of the health care industry is very significant. I am not saying that some regulation is not needed, but come on people, some of the hoops health care providers have to jump through to provide us services are down right draconian. This applies not just to doctors and hospitals, but to the peripheral industries that support them. A good example of this is HIPAA. While I applaud the effort and good intent to try to protect patient’s privacy, the lengths that doctors and hospitals are forced to go through for compliance with this law are absurd. I know, as I have done some consulting for network and computer security for doctors and hospitals. A review of these restrictions by people in those industries (not a politician or bureaucrat) would find thousands upon thousands of useless efficiency draining regulations that could be removed, or revised.
Regulatory reform especially applies to health insurance. One of the major problems with the availability of insurance is that you cannot bring your insurance across state lines. There are many complications regarding this. I generally prefer states to be as independent of the federal government as possible. Limiting the sale of a product (which is what health insurance is when you get down to it) across state lines is rather silly. We certainly don’t do that with any other products except alcohol, drugs, and firearms. And those are generally restricted by the states themselves, rather than by the federal government. I don’t think insurance belongs in the same category.
Tort reform and regulatory reform are changes that the federal government could make fairly easily and quickly. However, these are only things the federal government can do directly. There are many other reforms that could be made to the basic structure of how we access and think about health care that would fundamentally change the system in a positive way. These are things that must be done in collaboration with industry and states because while the government must be involved it cannot accomplish these things by itself.
Make insurance coverage independent of employers. What used to be a way for a company to offer an incentive to attract and keep good employees has become a requirement for any company employing more than 50 people. That has become a MAJOR burden upon businesses. It also makes it so there is no choice for the individual. With most companies paying a portion of the care as a benefit, the employee doesn’t see the complete spectrum of cost increases. If individuals had to obtain their own health insurance, it would allow them to have real choice, rather than being forced to take whatever plan their employer provides.
The increase in individuals seeking insurance would allow a new market of co-ops and other voluntary groups plans. If we take away the unnecessary regulations they would be able to operate for more efficiently. The money saved by employers on insurance and Human Resource costs could go directly in their employees pocket.
Making a profit is not a sin. Lately, I have heard from several sources that we need a public option because “there would be no profit motive”. Guess what folks? PROFIT IS NOT A BAD THING.
Now, if you are making your money through unethical or criminal means that is a different thing. But if a company does not make a profit, they go out of business. This is true for insurance companies as well. It is the profit motive that spurs innovation and efficiency. If there is no profit, there is no benefit for risk. Why would a pharmaceutical company invest hundreds of millions of dollars to possibly develop a new drug to treat a disease if there is no benefit if they succeed?
I hate to say this to our Canadian and European neighbors, but for your own self interest you should be fighting additional government involvement in the US health care system as the rest of the world benefits from the innovations the United States produces from…. you guessed it, profit.
I do not want you to think that I support the practice by some insurers of denying any questionable or expensive claim until action is taken and they are forced to cover it. If you have contractually obligated yourself to provide a service, you better do it. Since most individuals have no direct choice about their own coverage and that our system has become so bloated, the market is not working. If I have a plan in my name, and I am unsatisfied with the service I will go somewhere else. If I have no choice other than what my employer or government has chosen to provide to me, all I can do when the service is bad is to bitch about it on the Internet. Companies that offer poor service and have bad policies will go out of business because they won’t have any customers. Before we abandon market principals… let’s try using them.
I began this ever increasingly long post saying that I have a specific philosophy on what is the proper role of government. There have been thousands of volumes written on that topic, so I won’t expound too much on it, but having the federal government competing directly with private industry is not one of the things that I believe is their role.
I believe in limited government, especially at the federal level. Government is necessary so that we are not in anarchy. But any power that we give the government is power we as individuals no longer have. Government by its very nature wants to grow. That is why our constitution enumerated and limited powers of the federal government and split the powers among different branches with checks and balances with the hope that they would keep each other from growing. If a state wants to try to offer a universal system then that plan can be debated among the residents of that state, as they do not have the same constitutional restrictions that the federal government does. Does that mean I would support a socialized state system? No, because I believe socialism is morally wrong and, to be blunt, destroys individual initiative and responsibility. But that is for the individual states to decide.
If you managed to make it this far, you get a cookie.
I have not addressed one of the major issues facing many people (including my wife) and that is being “un-insurable”. I don’t have a good answer for that. You can’t force a private insurer to provide services to some one, and I don’t support having the services directly provided by the government.
I think that we might already have the best solution in place now. In Utah at least, there is a program that is partially paid for by the individual (quite expensive, but no absolutely astronomical), and part by fund that all insurers in the state are required to pay into (kind of like Workman’s Comp). The fund is administered by a private insurer that is contracted to the state. This is only offered to those who are unable to obtain insurance though a private insurer. However, if we keep a system like that please for the love of all that is good, remove the stupid requirement that you must exhaust Cobra before you can join. That one bit us in the ass. We weren’t aware of us, the accepted us (when they should not), we verified coverage for our pregnancy and were told we were fine. We have learned the hard way to double and triple check everything.
In summary, I realize that the steps that I have outlined will not solve every problem we have. There is no magic band-aid that will make it all better. But these are steps that I think can significantly improve access, cost and availability. There is also one thing that I think we can all agree on. Our government cannot afford the plan that is currently proposed. The CBO has estimated that is will cost us a trillion dollars over the next 10 years.
Remember, Conservatives want change too. But let’s be certain that we are actually changing things for the better.
I would like to end by thanking you all for listening and my wife for giving me the chance to post this. She did not have to do it. I have not been the most supportive person in the world about her blogging, but am proud of what Loralee has been able to accomplish with her blog. While I do not particularly like the massive amount of time and energy it takes, she is doing a great job.
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Jon,
I’m so proud of you.
Right now you are out in the pouring rain working your ass off to save our basement from damage and I don’t have one word to say about health care, gay marriage, immigration, or if the penny should continue to be circulated.
All I want to do right now is tell you I love you.
Your Wif.
I was very curious to read your post. My family basically agrees with your beliefs and it’s frustrating to us to see these changes being made that will cost our children and grandchild so much of their hard earned money.
Thank you for explaining this so well.
Bravo!
Wow great work Jon I can’t say I agrea or dis,,,But you wrote it and that alone was a great thing to do… Made for merry merry in your house… Made your wife so happy and its such a little thing to make wives happy… Just ask the computer geek in my family (at home)as they are all geeks but me… (my shipping dept for my bookstore)www.readerwave.ecrater.com
I know cheap shot to get my store in.. But really started reading your wife last week.. great work…
1) I want a cookie!
2) Thank you Jon, for putting together your thoughts on this in a intelligent, understandable way. While you (nor anyone else for that matter) will never be able to change my mind about the Canadian system and how well it works for them (I’d say us but I haven’t lived there for 3 years so I’m not really getting the full advantage of it!), you have presented your ideas in a way that I can understand and see how some of the changes you have proposed would work here in the US. I think there needs to be a middle ground somewhere in which some of the ideas you have presented here are implemented but so that no one has to go “without”, especially in the way that your family has had to, again.
I also think there needs to be a middle ground so that some of the more “conservative conservatives” (by which I mean the loonies equating health care to death camps) feel that their needs / demands have been met or at least compromised with, to a degree. As much as any of us think that changes to health care provision would be a good thing, there are always going to be people who feel that it is wrong in every sense, and who will not accept it. I hope that if some compromise is made there will be less of a chance of rioting or violence or spewed hatred from those who cannot see how any change could be positive.
I found this: article very interesting, because I feel that some “conservatives” are fighting health care simply because they “know” they are right and refuse to listen to any of the facts. I hope some of them find there way here to read your, and Loralee’s, words of wisdom.
Awesome post. Long, but awesome.
Thanks for putting the part in about PROFIT being a big motivator. I would LOVE it if we were all motivated by love and world peace, but in reality the almighty dollar is still pretty powerful. And, whatever the motivation, if a cure is found for cancer or AIDS or whatever, isn’t that a good thing?
Maybe as a follow-up, could you explain (cause I just can’t face the onslaught of internet search results) what exactly is CHIP and Medicare/Medicaid for, if not for people who are uninsurable?
My husband and I work really hard to provide good health care for ourselves. We took on debt in order to do so. We are paying it off. That doesn’t mean that I deserve better health care than anyone else, but what does it say about us being responsible people and not expecting other taxpayers to pay for our care?
I mean, we have 4, almost 5 children. I don’t expect the elderly couple up the street to pay my medical costs (through their taxes). Or the family with no children. Or the single guy on the next block.
Which, incidentally, couldn’t this argument be applied to public schools as well? But, that’s for another post…
I am so happy that, last week, my son had an ear infection and I got him into the pediatrician the NEXT DAY. Not in a week, while he suffered. Not a month. ONE DAY. And that’s just an ear infection. Imagine people who have undiagnosed aggressive tumors. Or progressive diseases.
Sorry, I better leave some room for other people to comment.
Great Job, Jonathan. Now go give your wife a backrub.
I want my cookie now, please. I think the problem with the health care system is that the government gives insurance companies a license to steal. That’s who needs regulating. Good luck with that.
Thank you for acknowledging that Conservatives also want choice. And that profit is important. And that a government in control of a lot will ultimately take away more individual rights.
I was born in a country with a socialized health care program. I care about our country. Like so many others do. Like our government does. We need changes. Bravo Jonathan. Bravo.
Good job, Jon. I disagree with some of your comments, but that is to be expected. I agree with some too – I agree I hate being bounded by what insurance my employer decides to provide – for my case, that is partially (if not totally) dependent upon their business. A section of my company is employee benefits provider – not my part, I’m a tax CPA – but they are influenced as to the provider that they have made business negotiations with rather than what is best for employees.
I think that’s why there should be more competition and a public option can offer that – I guess that’s where we disagree.
I worry about interstate rules b/c I don’t want to sign up for a plan that fits my needs but only to find out that the doctors in their network are not in my state or their preferred network.
A federal option that doctors prescribe to I think can fill this void.
Finally, I totally agree there are incredible doctors out there. I see many of them and have had to shop around for them. I have many a time seen bad doctors. I have chronic illnesses. However, some of those good doctors I have to pay out of pocket b/c my insurance wants me to see someone who I’ve tried and isn’t helping me.
Thanks for the post!
I think you’ll be giving out a lot of cookies. I agreed with almost everything you wrote so eloquently. I don’t consider myself a conservative, but like you, I am an independent.
While I agree that profit is the goal of business, when profit is made at the expense of someone’s life, it IS a bad thing. I am on medication that for my thyroid that keeps me alive. I don’t have a functioning thyroid, and as a result, I need to take a pill that gives me the thyroid medication for the rest of my life or I will die. 25 Years ago when I had my thyroid removed, I began these pills. They cost me $10 for a half year supply with no insurance. Today, this would cost me $120 for the same medicine. EXACTLY the same medicine that has not changed nor will change for the rest of my life. WHY? Because they know I will pay ANYTHING to continue to live. If they charged $1000 a pill, I would need to decide if my life was worth that value. I am not talking about a medication that has changed or needs to change or needs a major investment to keep people alive.
I just went to pick up my son’s albuteral, used to keep him alive in case of an asthma attack. Up until last year, there was a cheap alternative (I think I could get the “puffer” for $20 for a 3 month supply without insurance). However, the way it is dispensed changed and now I will be paying $70 for the medication with insurance, $137 without. Why? Because like my thyroid medication, the drug companies can make a lot of money because they know people will pay ANYTHING to keep their children alive and there are a lot of asthmatics in the US. So, I think in cases like this, when life or death is determined by a profit motive, that profits are bad. I am not saying that they should LOSE money, just not make a large profit that could cause people to lose their life.
Jon, I’m going to come back and read this more carefully when I have time. I have to get to work now, so could only skim it. I could tell that it is a very thoughtful and respectful post, so I will come back, because I think we should all try to understand the different points of view out there on this issue. I suspect I (a fairly liberal person, btw) will agree with you on many points. I don’t think profit is evil, and I would LOVE it if we could separate insurance from employment- I work in an industry that tends to have small companies, so my insurance “choice” usually comes down to choosing either the HMO or the PPO that my company’s HR department has picked.
However, I have to disagree on one point right now: you say that you think our providers are great and there is no need to change within the actual system of providing care. I think that is the case a lot of the time, but not all of the time. There are examples where we do much worse than other countries, and really than we should. The one on my mind right now (because I’m super-pregnant with my second child) is prenatal and labor/delivery care. Our infant mortality rate is shamefully high. Some of that is probably related to the lack of coverage problem- people not getting prenatal care when they really should. Some of it is probably related to the worry of malpractice suites. But I think some of the reason goes deeper than that, and that we have some standard practices that aren’t supported by what the medical literature indicates works best. I hate that I feel I have to take the time during a very busy, very tiring time to become enough of an expert in this field to direct my own care.
OK, I’ll stop ranting on that. And I promise, I’ll be back later to read the whole post carefully.
Jon…agreed and agreed. I am glad that you were able to express these points as an “average conservative” rather than just the “talking heads” doing it for us. I think there is a misconception out there that we are ignorant trolls who fill our brains with Fox tv and have no validity to support our stance. Thank you for being an “average” (of course you aren’t average) guy who can intelligently express an alternative view. **You get extra points for being married to someone with differing views, as well! It truly diffuses any argument that, inherently as a conservative, you must be insensitive and egocentric…Kudos!! Maybe you should post more often, or dare I say, start your own blog…
As a fairly uninformed Conservative, I have long maintained that I wasn’t fully behind the current plan, but that I didn’t know what else we could do.
I appreciate you joining the conversation. I hear over and over from Conservatives why the current plan is not good, but no alternatives are usually presented.
Your post was very well thought out, Jon, and I agreed that the solutions you proposed are good and necessary, but I don’t feel like they have much hope for significant improvement, particularly in making health care accessible to the lower-middle class. Are there estimates of the dollar amounts these reforms would save for consumers directly?
While I don’t agree with a lot of what you said, I appreciate the fact that you presented it in such a calm and clear way. I honestly expected to be defensive and I wasn’t! Hooray!
I love that we’re all having a conversation. A rational conversation about such a hot topic. Kudos.
I like the idea of insurance portability.
I’m still a leery on tort reform because I do think there should be a mechanism to punish truly egregious behavior. (The “invisible hand” of capitalism is all good and fine until it slaps you upside the head.) If we could trust the medical profession to police their ranks, that would go a long way in making me comfortable with tort reform. Unfortunately, I think a “thin white line” exists where medical professionals cover each other instead of focusing on weeding out bad behavior.
I completely agree with everything you have written. Beautiful!!
Jon -
Like others I want a cookie.
Moving on though….
When I was younger I was a staunch liberal. Now, not so much. As I get older I am finding myself more and more a libertarian.
Here’s why. I honestly believe that people need to take care of themselves more. I can use the post above and the comment that questions either or not providers are great and respond: Okay, so you have a not so great provider – find another one. Sure, it’s a pain but nothing about government sponsored health care will fix that problem. In fact, it might make it worse. People have to take care of themselves – the government cannot. Another example: you can provide health care to every American in the country but, unless they elect to use it before a problem is catastrophic then you’ve done nothing. My husband works for a large company and routinely has to remind his employees that they do, in fact, have health care over and above going to the emergency room….for a cold. Twenty years ago the Emergency Room was for an emergency – and people respected it as such. To me, to truly make change there are some fundamental shifts in thoughts of what people think that they are ‘owed’ now days. Now, (and this is just the reality of the situation) people use it as a stop gap.
Here is what I would propose – there are groups out in America today that provide basic care to those without insurance through the use of mobile vans and the like. Why not increase that to have more mobile vans (etc) and encourage people to come, in their own community, to use the services. Get doctors and nurses out in the community more than what they are now. Don’t like that idea? There will be some that won’t because it doesn’t give them the ‘level’ of care that is perceived to be a right. Guess what? There’s no where in the constitution that gives you the right for health care. None. At all.
At the end of the day my concern is this: if the President thinks that this is a necessary bill then the White House should work with a member of the House to create and write a BILL itself and not rely on congress to thrash around and come up with something on their own. I would be interested to see what the President WOULD create – what parts of this debate ARE the most important for his administration.
I say all this as someone who has preexisting conditions that would render me uninsurable outside of a sponsored health care plan. I *do* think that there are parts of health care today that are ridiculous and need changing however, the solution isn’t as easy as creating a national health care system.
Absolutely Brilliant post, Jon!
It seems strange to me that so many are instantly willing to jump into instituting the largest example of socialism in the history of the nation without being willing first to take much more reasonable and pragmatic steps to solve our healthcare dilemmas first! While I know there have been many lost opportunities in the past to make such changes, even by conservatives, the fact is; much of what you have written about here has simply never been tried.
This brings us to one of the largest differences between the conservative/libertarian approach and the liberal approach to healthcare reform. Every suggestion you offered here from a conservative perspective can be undone or tweaked if ineffective. Unfortunately, that is not true of the public option being pushed by liberals. Once the government becomes a provider of insurance, it simply will be almost impossible to ever undo. Forever will we have changed not only our Healthcare system but will have created a huge fracture in the wall between our government and our private lives including our free-market economy. While Loralee is right that we can always tweak this Healthcare bill once it is passed, we will never be able to completely undo it if it fails the way we can with the conservative option.
Finally, if we are willing as a nation to nationalize health care in this way because we see it as something that is so essential to society, we then must ask ourselves if there our other industries that might benefit from this philosophy. For Example; what would be the arguments against nationalizing and have the government take over food production, power production, automotive production and all other forms of motorized travel like airlines, drugs and medicine, etc… The list goes on and on. Once someone starts making arguments for socialism, they may find it very difficult to stop applying those arguments towards other “essential” parts of or society and economic system.
P.S. Be careful with this blogging stuff… It can be very addictive! Also, we should get serious about trying to get you and Loralee a weekend show on KVNU. My wife and I were laughing so hard when you two were on! You guys create a perfect balance. Also, if you guys need any help with the flooding, let me know.
Hi Jon-
First off, as a liberal democrat in Massachusetts (I couldn’t possibly be more different from your position) I heartily applaud your entire post, your eloquence and your careful thoughtfulness. To be honest, I agree with the vast majority of what you said, though I’d offer that although you (and my wife and I) have terrific care from great doctors, entirely too many have NOTHING, and that’s part of the problem. We have “RomneyCare” here in Massachusetts, and although I thought Mitt Romney was a horrible governor, the plan is working well. The one major drawback is there’s nothing to control costs, and I agree with you that tort reform is critical. Your post is EXACTLY what we need: a calm, thoughtful, rational discussion devoid of namecalling and excessive rhetoric. I’m also in line for my cookie!
Best to you and your truly remarkable family, of whom you should be very, very proud.
David
In the end, it isn’t really about Socialism. In the end, it isn’t about the fear that the Government doesn’t know how to get things right. In the end, it really doesn’t make any difference how we get there so much as the ends are met. What are the ends? Two. 1. That being ill should never bankrupt a person or family. 2. That the Common Wealth is spent for the Common good.
I applaud you, sir, for taking a stand and voicing your opinions and concerns so clearly. In the end, I think we both want the same things – is how we get there, and the processes we support, that differ.
1. Tort reform is not an alternative to health care reform. That is, they are not exclusive options. Do both. But bringing up tort reform is not an argument against the health care reform being proposed. That’s like saying we should learn how to chop apples instead of how to bake a crust when our goal is to make apple pie.
2. Profit is a red herring in this discussion. Profit inspires innovation, but there’s no innovation in insurance coverage, and the reform is about insurance, not about medical practices. The benefits of medical research and improved medical practices are not tied to the profit insurance carriers guarantee themselves. Pharmaceutical companies innovate for their own profit, not for the profit of those paying for the drugs; it wouldn’t matter if the government or an insurance carrier footed the bill: the innovation would still happen, because THAT profit would not disappear. But suggesting that an option for health coverage that is not profit-driven would somehow affect innovation in medical care is completely misleading.
Good post.
make mine chocolate chocolate chip, it will make the whole, “I work for a small company that does not offer insurance and because of the restrictions and regulations on small businesses will not be offering insurance but as a non pill taking, healthy female i cannot get insurance I can even think of being able to afford unless it comes with a $5000 deductible which must be met before anything will be paid out, so any out of pocket that must be paid up front for the doctor, prescriptions, e-rays, etc. just adds to the overall expense, so I am technically still uninsured for anything short of a catastrophe suck”, easier to swallow.
Hey! I read through the whole thing! Jon, you certainly sounded smart, but it would have been even better if I could hear your deep voice reading it, preferably while I’m tucked in bed with my hot cocoa and a blanket, and maybe that cookie you promised.
Excellent job Jon. You are exactly right in these points and if the government would look more toward these ideas versus a total take-over, I am sure there would be more support.
I believe just as Regan said, “The government great enough to give you everything you want, is big enough to take it all away from you.” We negotiated with our doctor and hospital for child birthing services and paid out of pocket for them rather than adding a pregnancy option to our plan. Saved us $800 in premiums and who knows how much the insurance company would have paid for the same thing.
Additionally, sometimes the cost of drugs becomes an issue and how much they make for a pill or shot. The doctors wanted to put my kids on a breathing treatment for asthma. I didn’t like that idea so in doing some research I found out the symptoms they were exhibiting was indicative of a mold spore. We had our house checked and sure enough it was there. I’m not saying this would be the case for everyone, but at some point people should not just run along with the proverbial 2 aspirins and call me in the morning. Personal responsibility would go a long way to lower cost due to less demand.
I have a friend on a government plan here in AZ for women and children. They are always running off to the hospital for the slightest sniffle or pain. They go there because it is paid for rather than a doctor office or clinic for care. All of her 4 kids are paid for in full until they turn 18. I predict the same thing will happen to the system if it comes into play here in the States.
I read online, but have not verified, the Canadian health care system is running out of money and will need to increase taxes on the citizens to continue. Again, I have not been able to verify this but assuming it is the case, I would bank on a tax increase every year in the US for government run health.
As Richard said, once we start nationalizing “essential programs” where do we end? Shouldn’t auto insurance be subsidized? If my neighbors were helping me pay for mine, I could buy a brand spanking new car instead of older ones. Just think, if I had a better car I wouldn’t be so dependent on oil and emissions would decrease and . . . Oh well maybe Government Motors (GM) will start giving out free Volts subsidized by taxpayers.
Great post Jon, hope to hear more from you in the future as our nation progresses.
Jon, it was a fairly insightful view on Healthcare reform. To everyone else, let us not be fooled into believing that health care today is a shining example of a free market place. Overregulation has been muddying the water for a long time and it is no suprise that with more regulation has come more cost. Do we really want to put our healthcare in the charge of polititions and beauricrates who will forever have a host of special interest group competing for their attention? How many times have Senators and Congressmen pushed legislation and/or spent out money based on what is good for a particular group and not what is best for the American people? We have been lied to so blatently and so frequently that we have become numb to it. Somehow, amazingly, most people still see our goverment officials as “Public Servants” who have our best interest at heart. Government, by nature, is a magnet for corruption. It always has been. That is precisely why it must be limited. Please guys, let’s not make it any bigger than it needs to be!
I read your entire post and I felt enlightened by most of your proposed changes.
Some left me feeling nervous, however, wondering how they would pertain to me and my family.
(Before I bring up those questions, let me just say that as the wife of a car salesman, I totally agree that PROFIT IS NOT A SIN, as long as it’s a reasonable profit and not highway robbery.)
Okay, so back to health care reform…
Question 1: If I am free to try several insurance plans to find the best fit for my family, how will that affect any pre-existing conditions we may have? Will there be a waiting period before new coverage starts, or will it start immediately?
Question 2: Will these insurance companies still maintain the right to deny coverage to someone they feel is undesirable, or will they be required to cover anyone who applies? Will there be a cap on the cost of insurance? (Three of my family members suffer from chronic diseases. Will I be required to pay insurance premiums equal to or greater than the cost of my monthly mortgage payment in order to keep them covered?) This is extremely important to me, as we are barely getting by as it is.
Question 3: If insurance companies are still entitled to choose who they insure, as well as how much they charge for coverage, how will it help the public better afford health care? If they are able to fix inefficiencies, don’t you see them pocketing that difference, rather than giving it back to their customers? I just don’t see how things will be different than they are now for the general public.
I’m (generally) happy with my husband’s insurance through his work. What I really hate is that we pay for health insurance that we can’t afford to utilize due to the high co-pays and deductibles. Like the ER, we use our insurance only in case of most extreme emergencies.
I’d really like to see that change; to be able to take my kids to the doctor for an earache before it turns into a raging infection, without forfeiting my $25 grocery budget to co-pays would be a most wonderful thing, indeed.
I DID come back and read the whole thing. I agree with a lot, have some quibbles with some bits… as you’d expect. But I appreciate a conservative participating in the debate.
I find the idea of a special medical court interesting. I’ll have to think about that one some more. It is certainly true that our regular courts have come up with some results in malpractice cases that really boggle the mind of people like me- scientists working in drug discovery. I’m sure there are cases that are equally puzzling to people with expertise in other areas of the health care system, too.
@V yonkers- I still get super cheap albuterol. It is still on the market. Talk to your doctor about why you were switched and what your options are- maybe you can switch back. They may have switched your son to a fancier delivery system for a reason, or maybe they just forgot to write that it was OK to substitute a generic on your prescription.
Don’t knock innovations in delivery mechanisms, though- sometimes they bring real benefits to patients. I love that I can take my maintenance steroids with an inhaler rather than as a pill- FAR fewer side effects.
@Backpacking Dad- the concern from inside the pharma/biotech industry about the “public option” is that the US will start negotiating on drug prices the way the rest of the world does, which will reduce the money available for future R&D. I have grossly oversimplified this argument, and don’t really think that its fair for the US consumer to be paying for such a large portion of the research done in my industry, but I thought I’d explain why people link government health care with pharma innovation. (If you want more on the view of a lot of things from inside the pharma industry, written by a fairly libertarian chemist, check out the In the Pipeline blog. I don’t always agree with him, either, but his posts are always an interesting read, and most of the comments are also from industry insiders.)
Thank you for posting this. I’ve felt so frustrated and powerless lately reading all of the blogs in support of the current health care reform direction. It’s refreshing to read someone with a view more in line with my beliefs.
It was nice to finally read your voice, Jon.
The goal of any company/corporation is to continually increase profit, year after year. The way insurance companies are doing this now is through raising premiums and cutting benefits, not necessarily through finding efficiencies in the system. I have a friend who worked at a certain insurance company here in the US, as a claims adjuster. She got to deny things. I think she really bought into it after a while (she had to – the job paid well and she has 2 kids), but I couldn’t believe some of the stories she would tell me about coverage she denied. And it’s not just that company, it’s many, many other insurance agencies that do the same thing.
So yes, profit is good in a certain sense, but lost among much of that profit motive is human compassion. Or at least that’s how it’s turning out.
Whenever there is a problem out there, Congress feels the need to throw together some arcane, complicated, 1000-page bill to address it. These bills are loaded with unintended consequences and lead to higher costs and more time wasted on compliance. Like you suggest, Congress should merely address specific issues that are driving up costs, rather than instituting a whole new system which will force people to join plans they are not interested in.
Jon – Nice post, I won’t say anything because this is one of those topics that I feel like the more I say, the stupider I appear but in general, I agree with Craig.
Loralee – The penny should not continue to circulate. I have very strong opinions on this :-)
I agree with a LOT of what you’ve said, Jon, and (again) I want to thank you and Loralee for setting this up so that you could share your opinions. You’re going to be baking a lot of metaphorical cookies, I’d imagine, since this was a great post.
On a purely political note, I *wish* that we had more policy discussions that went outside the classic two-party dichotomy! I’m in your position, but on the liberal side – I gritted my teeth and voted for Obama (who I think is doing a pretty good job), but I am absolutely not a Democrat, nor a Green. I haven’t found a party for my libertarian/socialist self, so until I do, I’ll just be glad when I see other people taking their stands outside of the classic definitions.
I strongly disagree with you about having a public option for healthcare for a few reasons, and I think that you’re right about that being the fundamental difference that comes up – how to insure people who’ve been deemed un-insurable is absolutely my biggest problem with the current system, and it’s the only one where compromise really doesn’t address the basic issue: is it a good idea for the government to be an insurance provider?
For all of the many problems with Medicare and Medicaid, they are a safety net for people who need them. Having something that people can utilize before their financial picture makes them Medicaid-eligible is a necessity, IMO, and the system Utah has sounds more workable than most (Delaware’s plans are such that my 24-year old brother with Type I diabetes would have paid over 14K/year for basic health insurance, and he would still have had to pay for most of his medical care himself. Not doable for a student teacher.) If medical insurance were uncoupled from employment AND this backup option were robustly in place, it would help a lot.
I would happily welcome more structures on the market when it comes to health insurance – a nonprofit insurance company where the profit for the year is redistributed to members could sell like gangbusters while really incentivizing preventative care, for example. Insurance that goes from state-to-state just makes sense, and tort reform to reduce malpractice insurance will really help more doctors and patients have reasonable expenses. A medical court makes SO much sense as well – muddying the waters with medical ‘experts’ is just another expensive red herring, and avoiding it would be amazing. Trying out more practices where doctors are paid a salary, rather than a % of each procedure’s cost, would also help alleviate the ‘throw every test at the patient’ problems that we have.
I am the mother of almost fifteen kids. My husband is self-employed and we are uninsurable because of the medical needs my kids have and we don’t belong to a group. We are every insurance companies worst nightmare.
BUT, and this is a big BUT, I would rather be uninsured than have the government be in charge of my health care. Have any of you been to the DMV or Social Security office lately? Do you want those people running our health care system? I sure as hell don’t. I can’t think of anything worse. I know we need change, but I hope to hell we can figure it out with the politicians.
The government sucks at the things it controls currently, why would we think they could do a better job with something as huge as health care? Look at our schools Look at our prisons. The government needs to do a better job on the shit they are currently in charge of before they bite off something as big as this.
If the USA controls our Drs, Hospitals and clinics, I am packing my little family up and moving elsewhere. I refuse to go through the HELL I went through last week to get my vehicle registered, in order to see a Dr. I can’t imagine if the waiting room I was sitting in for three hours was filled with sick kids. NO WAY!!
1. I want a cookie!
2. Your basement is flooding?!? I can believe it with last nights’ rainstorms; I am going to get my galoshes and come shoo the Four Horsemen off your lawn and help with the bailing. (Warn the horsemen that I am freakishly strong.)
3. Backpacking Dad made the other two points I wanted to bring up, only he did it much more eloquently… Tort reform needs to happen IN ADDITION to changing access to health care. By itself it would not generate substantial change.
4. Turning a profit certainly does not guarantee innovation; sometimes it acts prohibitively. The broker/dealer that my husband works with does not profit (meaning they turn any money “made” right back into the company) and in his professional opinion it is a pivotal reason they weathered the huge economic contraction. You see less “thinking out of the box” when companies feel the need to protect their profit margin; as is the case in the current health care crisis.
5. In the spirit of full disclosure you should have let the readers know what your handle is (Chaos)… they may have thought twice about your “plan” for reform. ; )
6. Lo, I liked how you worked in your penny comment. Clever.
“My husband and I work really hard to provide good health care for ourselves. We took on debt in order to do so. We are paying it off. That doesn’t mean that I deserve better health care than anyone else, but what does it say about us being responsible people and not expecting other taxpayers to pay for our care?
I mean, we have 4, almost 5 children. I don’t expect the elderly couple up the street to pay my medical costs (through their taxes). Or the family with no children. Or the single guy on the next block.
Which, incidentally, couldn’t this argument be applied to public schools as well? But, that’s for another post…”
This is probably one of the most hurtful modes of thought about this issue to me. (No, I am not taking it personally, sweetie but I hear it all.the.time.
I DO WORK HARD.
MY HUSBAND WORKS HARD.
I DO NOT WANT A FREE HAND OUT.
I don’t free, I want fair.
We could not afford/get accepted into an insurance program for years despite working hard.
Should someone in that situation lose everything they have because they develop a serious (or heck, with the costs it doesn’t even have to be that serious) illness?
To add that kind of stress to an already horrible situation is terrible. Trust me, I know. It compromised my situation horribly.
And the analogy about public schools is EXACTLY FOR TODAY’S POST. I argue this point all the time with Jonathan. If everyone in this country only paid for things they “Used” we would be in ruins.
There are many things that we as tax payers pay for that we personally never use.
To me, there isn’t anything more important than education and health care.
We have one of them covered, we need the other one.
And I imagine that in many situations, it will probably echo education. Some schools are districts and states are much better than others. It will not be perfect nor easy. It is a VAST undertaking, but that doesn’t mean that we shouldn’t try.
I am not as familiar with CHIP and Medicare although my father freaks out daily that his benefits will be cut and that some doctor is going to counsel him to end his life if the bill passes. (The fear mongering worked in his case. And yes, BOTH SIDES have done it. Sigh.)
As for Medicaid. I did not qualify. We made too much. We honestly thought about have Jonathan go to half time to qualify,but in the end it would have made everything worse, and it felt icky to us.
I thought about taking one of my MANY Canadian friends (who all seem to really dig their health care) up on the option of flying to Canada to have my baby there.
I ACTUALLY THOUGHT ABOUT IT I FELT SO DESPERATE.
How wrong is that?
I wouldn’t have done it. I am not a Canadian and no way would I free load off a country I respect. SO TEMPTED TO, THOUGH.
People need to realize it isn’t just poverty level people or homeless people who cannot get health care. In fact, they usually can.
Most people who suffer in this are hard working middle class people, too rich for the state option, too poor to afford individual insurance (IF they can qualify) or out of pocket care for anything more than minor illnesses and surgery.
It isn’t right.
We need a government option.
P.S. I am absolutely exhausted right now, so apologies if I am all over the place.
Jon for President :)
You said it correctly at the end: Conservatives want change too. It’s impossible to argue that the system is not broken- it totally is. But change for the sake of change is not the answer. This is not the time to simply throw something HUGE and EXPENSIVE against the wall & see if it sticks. Tort reform (great explanation of it, btw!) and the regulatory mess are the perfect places to start.
Very impressed and while as a Canadian I take issue with THIS “I hate to say this to our Canadian and European neighbors, but for your own self interest you should be fighting additional government involvement in the US health care system as the rest of the world benefits from the innovations the United States produces from…. you guessed it, profit.” Many other countries like the UK and Canada do fine with R&D.
The world is not beholden to the US.
However..I think for the US your ideas are the baby steps in the right direction…The US will never be like other countries.
I do wonder though what happened to the whole Government ‘by the people, for the people.’
I think the ideals of the founding fathers have been lost in mistrust and capitalism.
Richard:
I think that I totally covered enough in my War and Peace length comment over at KVNU, but I wanted to touch on this:
“Every suggestion you offered here from a conservative perspective can be undone or tweaked if ineffective. Unfortunately, that is not true of the public option being pushed by liberals.”
I highly disagree. Tort reform would be a huge overhaul to our legal system and government structure. While perhaps not quite as complicated, I highly doubt it would be ‘easy’ to undo,either. You think if big business got this to happen they would let it go away easily?
And, hey, I am actually for tort reform. I just saw this statement as over simplistic.
And THANKS, I would LOVE to do more radio. It was such a fun time. People may not be able to tell here but that Jonathan and I are pretty quick and humorous in our banter.
I like us a lot. ;)
Backpacking Dad.
I love you, coz. Seriously. While I am for tort reform, it has to go hand in hand with insurance reform.
And the end of the day I see issues with insurance smack dab in the middle of the argument. All arguments, issues, problems seem to lead back to it.
Ok, where to start. First of all thank you all taking the time to read and ponder the post. As Loralee wanted, everyone has been respectful and mature. I am running on very little sleep so I hope that my response will be coherent. I would like to reply to every comment, but that will prove impossible, so I will try to answer those who ahvec posed direct questions.
Texan Mama – CHIP is different from Medicare and Medicaid. CHIP is slightly different from the HIP program although they are run together. CHIP is for providing insurance to children. I have not direct experience with this, so please correct me if I am wrong here. HIP (which I do have experience with) is for those whose medical conditions make them a poor risk for private insurers and therefore unless covered under a group plan uninsurable. It is not cheap. But when you consider that it is designed for people with chronic diseases and other garuanteed to have significant health costs, it is not all that bad. CHIP and HIP are programs that are administered by the individual states, although they do recieve some funding from the federal government. Medicare is for seniors, and medicaid is for the disabled or poor who cannot afford their own insurance.
And important note here. Medicare and Medicaid are partially subsidised by all of use with regular insurance. Medicare paying is roughly $0.14 per dollare short and medicaid is even lower. While private insurance pays about $1.15 for every dollar of provided services. If we somehow expand the public options, we will only make the private options more expensive, or decrease the quality of care as there is just less money paid out for the same services.
V Yonkers – Some of the explanation for the change in your thyroid medication cost can be explained by simple inflation. If it is something that has been around for a while, then the patents have run out. There is nothing stopping another company from offering a competing version of the product. That is how the free market works. If there is only the one choice, I would suspect it is either a very small market so no other manufacturer wants to invest in setting up production. Or if the market is not that small, it may be that after analysis they would be unable to provide the medication at a better price and therefore there is no reason for them to attempt the compete.
As for the albuterol. We too have a son who used an asthma inhaler and as the beginning of the year, we could no longer obtain the regular inhaler. This is not due to your doctor or the manufacturer. But in fact is due to the FDA. They have banned the use of the propellant used in albeterol. Therefore a new delivery mechanism had to be created and that means it falls under a new patent. In about 10 years the new one will be cheap just like the old one. The biggest problem I have with this (aside from the obvious) is that currently the new delivery mechanism is not considered to be as effective as the old. So we are forced to pay more for an inferior product.
Linny – I am not talking about removing payouts for those who have suffered under malpractice. I am talking about streamlining the process and putting caps on “obscene” payouts. According to some source I read yesterday and don’t have the energy to find again so take it with a grain of salt. As of 2002 when the study was completed only about 40 cent of every dollar paid in malpractice insurance actually reached someone who had been awarded a claim. The rest was eaten by litigation costs, (both plantiff and defendant), and administration costs. With the lions share being litigation costs. By moving it to a special court (and yes I understand that would take time and money to set up, but I believe would be more cost effective in the long run) we are allowing the people who are actually injured to receive that money.
Backpacking Dad – You are correct Tort Reform is NOT healthcare reform, however it does directly impact how much healthcare costs. So it is relevant to the discussion. I also effects the availability of care in rural areas. Certain specialities OB/GYN being the most prominent are more impacted by this than others. Many smaller rural areas are losing the specialists as it is too expensive to operate where there are too few patients to cover the operating costs.
You are also correct that there is little innovation in the current health insurance system. Because there is not much of a free market operating at this point to motivate it. When it comes to thing like insurance, much of the innovation will come in the form of new types to plans to fit different needs, ways of making the whole process more efficient, and better customer service. These are the things that a real market driven system would deliver. When there is a need, someone will step up and fill it. Because there is a profit to be made.
MaryEllen – I am actually a fan of the $5000 deductible catastrophic insurance plans. As long as you couple it with a health saving account. I have this type of coverage. I am health as an ox, (aside from being nearly as big as one) and rarely see the doctor. This allows me to save a considerable amount of money in premiums, but still be protected from that unforeseen and hopefully never occuring catastrophy. And with a health saving account, I am able pay for the day to day medical expenses that occur. This is not the right plan for everyone, but I think it would work for a lot of people.
This leads to one other topic that I failed to address in the initial post. I believe that we have become far to insulated from the actual costs of the health care services we provide. When someone else is paying the bill (your insurnance company or the government) you don’t know what it actually costs for those services. As someone who will paying in cash (if i actually went to the doctor) I have the incentive to try to get the most cost effective treatment. I have the incentive to question the doctor as to the necessity of a test or procedure, to ask if there is a more cost effective way of accomplishing the same thing. This helps me to control the costs for myself and my children (loralee is on the HIP plan so hers is different). A perfect is example is Heparin. Loralee needed heparin shots during her pregnancy. There were 2 kinds available. The best one is pretty cool. It only required one injection per day. The other kind required 2 or 3 injections per day. Now especially considering how needle phobic Loralee is, we certainly WANTED the first option. However, the cost of the best option was about $2200 per month, while less desirable option was $50 dollars per month. As much as I hate that fact that she need to take and additional shot, there is no possible way to justify buying the more expensive option.
Kemi – Question 1, with the laws as the currently are, if you are moving from one plan to another, as long as it happed within about 60 days, then there are no pre-existing conditions. If you are entering a plan for a period of being uninsured then the pre-existing condition period is 6 months for most things and 10 months for pregnancy. I could be off on the actual times, but the concept is correct. Here is the reason that we cannot get rid of all preexisting conditions. What would stop me from having no coverage at all, wait until I had some significant health problem, and then sign up. Why it is fair to force an insurance company to pay for something that occured when they had no contractual obligation to you. The real way to combat pre-existing conditions is to inprove the overall system so that people can afford to have the insurnace BEFORE they get sick.
Question 2 – Yes a company would still have to right to not insure someone if they chose not to. But program like HIP which is currently in place is designed for those with chronic illnesses, and in partially funded by any insurers operating in that state.
Question 3 – Yes a company would still be able to set their own rates. However, when the market is operating correctly, we would see real competition. If a company is charging too much then people will go elsewhere. If all of them are charging too much, the there is a opening in the market for a new player to come in and offer better services. If there is some sort of collusion between companies to artificially keep prices high, well that is illegal and that is a criminal activity and should be treated as such.
Chelle – you are correct that profit doesn’t ensure innovation. However without it, you don’t have a company there to offer the service. I think we often misinterpret each other with terms. If I make 1 dollar more than my epenses for the year, then I have turned a profit. not much of one, and I certainly am in a tenuous position as far as the stablity of my company, but a profit non the less. Now there are times that a profit can seem obscene. If I were to discover a way to make a viable portable cold fusion generator. It would change the world, and would positively impact the lives of nearly everyone on the planet. And I would expect to make massive amounts of profit. However in a service industry (like health care or insurance) the profit margins are necessarily much lower. You are not providing a unique product, you are competing to offer what you hope is a slightly better product than your competitors.
Ok I had my nap and it is 2 in the afternoon and I still have to gotten to work (stupid flood) so I will leave it at this for now. Again thank you for all the constructive comments, lets keep it up.
-Jonathan
Sandi,
I had no idea you were against the bill, actually because we haven’t really discussed anything about this other than the social issues around the whole White House thing and you are an Obama fan.
See? Never assume anything!
I can really see your point. I do not want a single payer system but I still think that having an option out there is necessary.
I love you, friend.
P.S. It is really annoying that Jon is running around the house shouting “SANDI’S MY GIRL!!!!!!”
(Tell Brandon not to worry, Jon has his plate more than full being married to me.)
Hee hee hee. ;P
@Loralee- I can’t thank you enough for hosting this discussion. I keep coming back to read more comments because I finally feel like I am hearing the opinions of “the other side”. I’m sorry, but people screaming at town hall meetings wasn’t helping me understand the real concerns.
I have one question, though, for the people out there who don’t want a government run plan and also don’t want to require people to buy a private plan (with appropriate help for those who can’t afford this purchase):
What should an emergency room doctor say to a mother who shows up with her ill child, but no insurance? Or a woman in labor and at risk of complications but no insurance? Or really to anyone who is really in need of medical care but can’t afford to pay for it?
If we don’t answer “turn them away” (we don’t , and I really, really don’t think we should), then we already have a public interest in everyone’s health care options. So I don’t understand why we wouldn’t want to give them the most cost-efficient options available. And I don’t think emergency room treatment is a cost-efficient option.
I also absolutely agree that it is the less wealthy end of the middle class and the working poor that fall through the cracks in our current system. That is wrong.
“Jon for President”
No. Just…NO.
Grin.
Jon, I totally missed the transition in the albuterol inhalers. That shows you how often I fill THAT prescription (and is a testament to the effectiveness of my steroid maintenance inhaler- which costs a boatload but is worth every penny, in my opinion).
I had to go look this up on the FDA website to see why they mandated the change. The FAQ is here:
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm080446.htm
V Yonkers- sorry I spouted nonsense earlier.
Could not agree more, took the words right out of my mouth. I too am a Libertarian and it makes me sick what’s happening.
Mackenzie:
I already adore you but you totally won my heart on your view of the penny. ;P
AND?
HI, CRAIG!!!!!!!!!!!!!!!!!!!!!!!!!!
We love and miss you guys. The “Illuminati” without you isn’t nearly as much fun.
Preach it brother! Excellent, well thought out ideas. Your thoughts on profits are particularly interesting. I’m a contractor and believe me, I understand the necessity of making money. However, I’m not playing with peoples lives. Jon and Loralee, your family’s health care is a commodity. Not to you, but it is nothing more than that to the major players in the healthcare industry. Commodities are something of intrinsic monetary value to be possessed, traded, or sold. Who are the big players? BigPharma is top dog. They spend BILLIONS every year on direct campaign contributions, donations to PACs, K Street lobbyists, Slick advertising, etc., Why? Are they, or the corrupt politicians who rely on their largesse to finance their campaigns, concerned about Jonathon Choate’s children’s health? Only if it’s profitable for their executives and stock holders. Simple question: Why is a prescription drug that is $100 in Yuma, AZ available for $20 just across the border in Los Algodones, Mexico? Same drug, same quality, same manufacturer, different language on the container. Are American’s being gouged or is it possible as you suggest that American taxpayers are subsidizing Mexican’s share of American pharmaceutical’s R@D costs? This is HUGE here in Arizona. Especially among our senior citizens. My wife runs our local Senior Center (Meals on Wheels, etc.) and those folks organize car pooling day trips to the border so they can afford their prescriptions. WTF? Why is a citizen of Mexico, historically one of the most corrupt nations on earth, getting the exact drug, manufactured by the exact company, for pennies on the dollar compared to what the Choate family pays here? Kind of muddies up the waters in the discussion of profits and who generates them doesn’t it. About now you might be wanting to ask me a question. OK Mr. Smarty Pants, what’s your solution? WE NEED SYSTEMIC, NOT SYMPTOMATIC SOLUTIONS. As citizens we need to INSIST on massive cuts in special interest campaign contributions, massive restrictions on special interest lobbyists, and EXTREMELY stiff penalties for violators. It’s our only hope of returning true representative government to our country. Every single American needs to check out their individual elected representatives and see where they got their money. The second largest industry buying influence? INSURANCE! Are we already seeing a trend here? In the last 4 or 5 days I have seen more good ideas on Loralee’s blog than I have in months of big media driven blather. (Insert image of tv viewer barfing here) Is it possible, could it be, that big media might be special interest driven as well? HOLY BATLIGHT SHINING ON THE TRUTH BATMAN! Thanks to Sandi I don’t have to take up space providing more examples of why not to trust government. I know I’m getting close to required cookie provider length but just a couple more of my ideas. Make out of pocket medical expenses (excluding elective cosmetic procedures) tax credits. NOT EXPENSE DEDUCTIONS. CREDITS. The Choates have $10,000 out of pocket in one year, $10,000 off their tax BILL! Talk about a direct stimulus for regular Americans. The special interest driven government would not get their greedy hands on the Choate’s money to misappropriate it on some stupid porkbarrel extravaganza. I like this idea ALOT! Ok, last idea for now. Some of you want government involved in healthcare. OK. My massage therapist’s husband is a pharmacist. He’s in the Navy but you would never know it. He pretty much has a civilian life but he works in a government pharmacy on an Indian reservation. My ex-neighbor had the exact arrangement but he was a dentist. The services to the tribe members are dirt cheap or non-existent. Doctors coming out of medical school are buried in debt. There is a shortage of primary care physicians. What if the government paid for that education with a service contract stipulation. Similar to the service acadamies 6 year obligation to service after graduation. Focus this program on primary care of low income citizens. Participants sign a waiver agreeing to not sue, doctors get a fair salary and can focus on their hippocratic oath instead of malpractice insurance lawyers. Drug prices are negotiated with BigPharma,(or picked up in Mexico) No legal person turned away. Then at the end of the service contract the physician can re-up or move on to medical glory elsewhere. This program could also be the test kitchen for electronic recordkeeping and laboratory for efficiency changes. I like this idea ALOT! Finally, for now, Thank you Loralee. You are very special and Jonathon is a lucky little 1 man militia. steve
Chelle: I love you, BFF. I want to put your comment on a pillow and pet it.
:)
Jon.
I love you.
However, that whole argument about my heparin injections has me pissed and sad.
We?
Are SO talking when you get home.
xo
hahaha, oh jon, I promise to let them use the expensive pain killers after Loralee goes all Lorena Bobbit on you!
Great blog. I totally agree with everything you said. I hope that more voices like yours, that are opposed to the current flavor of reform, can be heard and that we will make the necessary adjustments to the our system to improve it rather than REMAKE it.
Great thoughts!
I completely 100% agree with everything in this post!!
No wonder I love Loralee so much. I am her husband. Great post.
I want my cookie. :)
Great post. For me, from my distant point of view, it was a great lesson how to disagree. In a civilized, respectful and yet strong way. I think it’s great when you can have totally different positions on something and yet still remain happy couple, loving each other. Way to go, Jon & Loralee!
And way to go all commentators, I’m impressed!
regards,
Amelia.
Jon, an explanation about the medication for the thyroid. Some medications for endrocrine problems (thyroid, pituatary, diabetes type 1) can have a terrible effect on the individual when the brand is changed. You would think that the fact there has been a generic for this medication for almost 15 years would mean the price went down. However, when pharmacudical companies were allowed to start marketing and advertising their medications (derugulating the industry) the price doubled because there was SUCH a large number of people that suffered this problem. In fact, in my area, on the east coast, we have an unusually large number of people that suffered from thyroid disease because of nuclear testing in the 1950’s in Neveda. A storm cloud deposted radioactive waste from one of the tests. So there is competition and there should be lower prices. However this product is what economist identify as non-elastic (water is non-elastic–although it sounds like you would rather it went away at this point from your basement, if you lived in the sahara, you would pay anything for it to survive). I think these types of products do need government oversight.
Also, you mentioned the price of the paperwork. My sister is a speech theropist. She works in 5 different counties, all of which require different forms. One county will only accept work made out in blue pen, another will only accept electronic versions. Wouldn’t it be cheaper and more efficient if the government(s) (at all levels), healthcare industry, and insurance companies could agree on one form that could be used anywhere? Wouldn’t it be great if you didn’t have to fill out the same information for every place you went to? I broke my foot a few years ago and had to fill out the same information on the 10 antibotics that I am allergic to at the urgent care facility, who sent me to the hosipital, who then sent me to the orthopedic doctor. My own family doctor has all of those records and I would have willingly given each one a form my doctor could have printed out for me, but my doctor can’t print out that form for ME (he can for the insurance company though…I’m not sure why). I just wish we could find a way to all come together to create a common system so all would have access to records, funding, and basic medical care.
I could kiss you right now! Sorry Lor, do you mind? ;)
That was excellent and I agree with you 100%! I’m not very eloquent at discussing my political views or opinions but you did an excellent job at articulating what I feel. High fives all around! Wahoo!
Excellent, Jon!
Thanks to you both for such thought out posts on this issue. While I agree that there needs to be changes, I tend to agree with Jon on how to get there.
Love you Loralee!
@Becca
Hee! Thanks for piping up! I love it when my friends from high school visit!
So I have to admit that I am not familiar with what the Obama administration is proposing. Life as a single, working mother, and college student leeches away at time like you wouldn’t believe.
I do, however, want to share my experiences with healthcare/insurance.
As you (Jon and Loralee) already know, I got married at the tender age of 18 to a low ranking enlisted Airman. Before I was married I was still on my parents’ insurance. So I went from having no knowledge or responsibility for anything to do with insurance or health care to TriCare.
TriCare is the military’s insurance (and DoD employees too I think) and it’s pretty much the most amazing health insurance there is. At times I find myself half tempted to land myself another guy in the military just so I can have TriCare again. ;)
Now TriCare, as with any insurance company, has some crazy hoops to jump through. But if you jump through them you don’t have to worry about medical bills almost at all. My daughter still has it and the only time I ever have to pay a medical bill for her in the double is when she gets immunizations and even then, it’s pretty freaking cheap.
When I was about 4 months pregnant I moved with my ex-husband to England (yeah, the country) because he had gotten orders there. In the last week or so of my 8th month, I developed a blood clot in my leg. It took three weeks for the idiots on base to figure out I had a blood clot. Three different OB/GYNs examined my leg and it was only when I saw my regular OB, Major Augnst (who I am convinced is the only halfway decent doctor in the ENTIRE USAF), again after my leg first swelled up like a Violet in Charlie and the Chocolate Factory that someone (again, Maj. Augnst. I’ll love that man forever and always for saving my daughter’s and my life) thought it might be a good idea to another scan on my leg just to be sure it wasn’t a blood clot.
Yeah, it was. I was hospitalized on base, started on a Heparin drip, and put on immediate bedrest. I had bathroom privileges only and I was told very implicitly by a Colonel (who was smaller than me but still made me almost pee my pants with her amazing intimdation skills and no, it wasn’t just the pregnant bladder) that if she saw me out of my bed and it wasn’t bathroom related that she would revoke those without a second thought and I’d be stuck with a bedpan.
Anyway, I ended up being transferred to a civilian hospital because they had the capabilites to at least save the baby if anything went wrong (that’s how it was explained too. Great news at 20). I was transferred to Addenbrooke’s, an NHS hospital.
My experience with socialized medicine was frustrating to say the least. In the morning a group of doctors would come in and talk to me about my situation and what they thought the best course of action was and then a few hours later a different group of doctors would come talk to me and completely contradict what the previous doctors had said. The next day, they’d contradict what they had said the day before. The left hand literally did not know what the right hand was doing.
I was also not super happy with the way patients are prioritized. In theory, making sure that the most high-risk and needy patients come first is great. In practice it’s pretty absurd. As I was in a maternity ward and my baby was perfectly healthy (it was my health that was the problem) I was not very high on the list.
I could write a whole book on the frustrations I had with that situation but my time is running short and I have a little person demanding my attention.
Before I go I do just want to add my most recent frustration. I recently had to take a Leave of Absence from work due to… crap. Anyway, my total leave was about three weeks. Less than a month, less than 30 days. But that didn’t stop my insurance company from terminating my benefits. So instead of being able to see a doctor so I could get medicated for my ADD before classes started and FINALLY getting my annual exam done (pap smears ftl) I got to stress about whether I’d have benefits when I got back to work or if I’d have to wait for open enrollment. After a lot of digging on my company’s HR website (and I mean A LOT!!) I was finally able to find the information I was looking for regarding why my benefits were cut and if/when they would be back.
Sure would’ve been nice to have that info handy when I applied for the leave.
Anyway, I better go before WWIII starts.
<3
To do a sweeping statement instead of individually answering every email and comment.
My apologies for not catching the misspell of Valerie’s name. I should have probably waited to hit publish until my eyes weren’t crossed from tired.
The basement will be ok. We were up at 4 am working through Jon’s post and so we were awake when the flood hit.
I joked with Jon that this was obviously The Universe telling him that he should not put a conservative point of view on the Internet. Oh, and that President Obama saved our house from flooding.
He disagreed.
(Sometimes I think we love toying with and baiting each other a wee bit too much.)
What I love about this post is that it is THOUGHTFUL and sticks to a real discussion of the issues. It doesn’t put down, it doesn’t demonize. Some so-called news outlets could learn a lot from you two.
@Suebob.
Just when I thought I couldn’t love you more.
I get a cookie!
My husband and I are so with you on this. The last two elections we voted the constitution party and believe in small government. Go Ron Paul?
Anyway, this was an excellent post–and thanks for supporting your wife in her blogging. I read her whenever I get the chance.
Excellent post. It’s great to have a side-by-side look at the two views. It’s easy to agree with both of you.
Tell Jon he owes me a cookie.
Max and I also agree with most of what Jon said. We also don’t have an answer for the uninsurable, and that is why I lean more towards socialized healthcare.
P.S. Just my hospital bill for my knee surgery was $15,000. WTF??? I was there for 4 hours!!! My surgery was 45 minutes!!!
Bridge,
I wish that I could say I was surprised by the bill. That is over half of what the average American makes in a year.
FOR ONE NON-EMERGENCY SURGERY.
Something must be done.
Bravo Jon! Thank (both of you) for speaking your minds. The following is not intended to be critical of you guys speaking up, just a reality check for the rest of us. :)
I have one question: How did the world ever make it past the 1500’s without organized health care and why are we so convinced that America will end if we fail to reform it in 2009?
Have you ever stopped to consider that all of this “reform” may be nothing more than a way to get you to give up more of your liberty?
If I have learned anything in my 40 years on the planet it is that nothing is ever as it seems.
I get nervous when governments start pushing agendas laced with emotion. We have two wars birthed out of “sure things wrapped in red white and blue that must get done now”.
How’s that working out for us?
Can we please stop this ridiculous notion that the American health care system is in crisis? I know of no place in this great land where a call to 911 will go unanswered, or a visit to the ER turned away.
Can we stop complaining about how much it “costs” to save your life or the life of someone you love? They saved your LIFE for Pete’s sake! At least we live in a country where we can pay off those “outrageous health care costs” and watch another sunrise. Half of the world would give anything to be squeezed out on this land, and all we want is more, more, more.
You want to talk about a health care crisis? Africa is in a health care crisis and I for one would love to see more people upset about that.
Thank God we live in a country where we can sit in safe homes, drink clean water, relax in air conditioned spaces, and post comments anywhere in the world whenever we want.
We are rich beyond half the world’s wildest dreams and our great debate, our shining moment in history, our great contribution to this planet is endless banter about who gets richer.
Ugh.
Go hug a doctor or nurse or firefighter and thank then and thank God almighty we have it so good that we get to complain about how much better we think it should be.
Jon -
I commend you for being thoughtful and honest in your points. I do not consider myself a conservative, nor a libertarian, but I am always pleased to read a well thought out, respectful argument that has constructive suggestions.
While you have made a one time stint on this blog, I do want to throw out a few comments about your post, in the blind hope that you or someone else will respond (respectfully, of course).
Tort reform – is that really going to lower costs? What is going to motivate a doctor whose costs are now slightly lower to pass on the savings to their patients/clients if profit is the big motive? Sure, they might want to outcompete other providers, but last I checked, there was no excess supply of providers. The demand is always there, so prices do not need to come down as long as a precious commodity (health) is on the line.
Regulatory reform – what you have to say sounds reasonable. Still it is important that consumers are somehow represented in any regulatory reforms. In principle that is one function that government, and our elected representatives, serve. I honestly do not have the time to become an expert in all the nuances of interstate trade and commerce, and I trust that in our system of democracy, my elected representative will do that work for me in a way that best serves the needs of the majority and protects the fundamental rights of the minority. Of course, that only holds true when my representative is truly accountable to me and not getting half of his or her campaign contributions (aka lifeblood) from PACs and businesses that are donating so that they can influence legislation and further increase their profit through legal loopholes.
Profit – Profit is not a bad word, though obscene profits that come about when people are duped or manipulated or denied the products or services that they pay for certainly make the profit motive look like a bad one. Health insurance CEOs are making obscene amounts of money right now at the expense of individuals whose insurance claims are being rejected or needlessly delayed in the hopes of wearing out the consumer. These are tactics that are acknowledged by current and former employees of health insurance conglomerates.
Profit can be a good thing, particularly when it results in innovation. But that works best when there is an additional influence in the system – with that influence coming in the form of competition. Right now, we have essentially an oligopoly of health insurance companies and little to no competition. So somehow we need to help consumers to have more choices. This is where we probably fundamentally disagree. Except in the high profile cases of waste, corruption, and excess, I do not see government intervention as an inherently bad thing. An awful lot of the big $$ innovations that are allowing drug companies to become so profitable are the product of government money (taxes) used to fund scientific research. A lot of the skilled employees that make, market, and distribute those drugs come out of publicly funded universities and schools.
Anyway, I do appreciate your post. Thank you for sharing your thoughts.
Loralee…
Max and I believe that my total bill will be around $40,000 to $50,000 once it is all said and done. /sigh
Davie-
I adore you, I just disagree. I feel that the country is indeed in crisis over health care. Perhaps not as much as Africa (and yes, it is HEARTBREAKING there, I agree.)
I am glad you spoke up and I do think that there is too much expectation in this country of something for nothing (which I do not agree with) but I want to counter one thing you said: “Can we stop complaining about how much it “costs” to save your life or the life of someone you love? They saved your LIFE for Pete’s sake”
So what about my Matthew? What about others who have loved ones receive expensive treatment to try and save their lives and they die?
Can we have that money back?
It took us 2 years just to pay off his Ambulance bill. And it really sucked to get things addressed TO HIM in the mail. (I want to get into the way these insurance companies and hospitals bill patients, but am too tired tonight)
I don’t think people are not grateful when I life is saved. I think people complain because if someone almost died it is usually due to traumatic injury or illness which puts EXTREME stress on everyone and everything in their lives. Crushing medical debt? Can’t help.
And? Without the safety net of friends and family? We might not be able to do many of those things you listed off Davie. Medical debt can be a huge, huge destruction to a life. A family. Hopes. I just want that to stop.
Wow, I finally made it to the bottom… Now, where do I begin. Jon, you are a walking contradiction, like the rest of us. We all are, so don’t worry.
This isn’t an argument about profit or socialism, because, guess what (I hope you are sitting down!) – every other first world country on the planet earth are rich, capitalist, democracies AND they all have a medicare-for-all type option for their citizens, as well as a private option.
And you need to understand Jon, that making changes to the health ‘care’ system, will actually SAVE money and give more access to care.
And I also want to let you know, that not all leading research happens here Jon. Research labs from around the world, in every country, share information, work together in tests and trials and meet several times each year for conferences designed to help FIND cures and treatments, not JUST to make a profit. When you meet these researchers, the first thing you will notice is their love for the people they are helping and their urgency to find effective treatments for tragic diseases. They are a truly different breed of people.
Profit is not bad, but it can be when you are talking about the state of Health Insurance Companies in the US right now. We have paid THOUSANDS to an insurance company that has given our beautiful children (who have Rigid Spine Muscular Dystrophy) almost 0 help. And huge bills. And lots of stress. And compromised care.
The US health care system is one bandaid fix, upon another bandaid fix, upon another. The doctors are as good as anywhere else, the staff are trained and the floors are clean – and yet as a country, the United States is ranked #37 as a health system by the World Health Organization.
This is because actually accessing care is impossible for tens of millions – even those that have health insurance, because they simply cannot afford to pay the bill.
The United States spends nearly $7000 per capita each year on health care – the highest in the world – and yet it is estimated that 18,000 people die needlessly each year, simply because they are uninsured or underinsured.
Phoenix’s intensive care doctor was sickened to receive her into intensive care in February. She was sickened to her stomach because Phoenix could have had an RSV vaccination two months earlier, but because of the highly inflated cost of $3,300 for three needles, we had to literally turn the delivery man away at the door. This was a very difficult decision for us to make and it ate away at me for weeks because Isis (my 8 year old son) nearly died from RSV at Phoenix’s age. Earlier that morning, Phoenix’s doctor had admitted a young mexican boy who had become blind from an untreated tumor – this tumor was untreated for the exact reason that Phoenix didn’t get her RSV shots – the cost.
Yes, malpractice insurance that doctors have to pay these days is ridiculous, and is, in my opinion representative of an extreme greed that has laced itself through the fabric of modern American culture – a flaw that is eating away at this once great nation. Reforms to help in this area are necessary, but minor in the big scheme of things.
Australia spends just over $3000 per capita and every person has access to care. The current Australian system, known as Medicare, coexists with a private health system. Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidises prescription medications. Doctors still make GREAT incomes (Australian nurses earn more than US nurses) and the public (I tell you this from experience) hardly notices the tax (I never noticed it).
It is a very efficient and fair system. I would suggest that you do more research on the topic Jon.
As my sister put it sitting by Phoenix’s bed in intensive care, “In Australia, we all take care of each other”. This is not a socialist concept – there is no secret communist movement in our culture – it is HUMANIST and fair. I can have private insurance in Australia if I wanted it, but I don’t. Medicare works so well.
Profit driven insurance companies are not qualified to be in the driving seat of US healthcare. Let my doctor decide. Having a government medicare-for-all option is fair and gives people choices.
Because right now, most people do NOT have choices.
I hope to be able to sit by my children’s hospital beds in the future and be able to focus all my worry and attention upon my sick child living and recovering, rather than how on earth we are going to pay for it.
I hope for the day where we all take care of each other here too.
Jasmine.
I love your passion for this subject. I love my country more than anything but this? Almost makes me move to Australia.
We have had to struggle to keep insurance for our son these past 17 years. He is considered uninsurable and so we cannot let his coverage lapse. For a few years (after the tech bubble) we had to become self-employed and subsist at a poverty level to qualify for state-sponsored health care. It was a nightmare.
Fortunately, the tech industry picked up again, we found employment with a large firm, and our son is now on the company insurance plan. He is well on his way to maxing out his lifetime benefits after a bout with cancer (chemo is too damned expensive) and several major surgeries. I want to know what happens then?
A friend of ours could not get the same coverage (through state-sponsored care) as an institution could to care for her medically fragile son (who required 24/7 nursing care) and once it became cost-prohibitive she had to give the state guardianship and place him in a facility. How is that right or fair or even humane?
Dear Jon,
I was so interested to read your ideas about health care in this country, and I’m glad that you wrote so much. I would like my cookie, now, please.
Thank you for your point about tort reform, which I had not considered before. I will definitely look into this aspect of reform; I think that what you write makes sense. Certainly the litigiousness of American society amplifies the cost of what is necessary care.
The point about profit being an impetus for development in medical technology made me think of a documentary I saw last year, called “Sick Around the World”. Loralee has asked me to link to the PBS page:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
You can watch it online, but if you don’t want to sit through the whole thing, then the last “chapter”, about Switzerland, is the relevant part here.
It is made clear that before Switzerland switched over to a public option from a health-care system that resembled the USA’s, people’s fears that the profit-seeking insurance and pharmeceutical companies would lose their driving edge in efficiency, seeking knowledge, and developing technology were completely unfounded. (Sorry about that convoluted sentence.)
The point is, the loss of the profit motive has not impacted the scientific drive to produce health-related products. I think the profile of an example so close to America’s is a very important and comforting one. I recommend the whole documentary, though.
My personal opinion about health care, is—and I have to state this generally and briefly for love of my sleep—it’s that I think it is a basic human need. Therefore, it is a right. A human right.
In our industrialised western democracies, when someone is too poor to buy clothes, there is a charity or government institution that provides them, a Salvation Army or a shelter. For food, there is a similar set-up. These things don’t always work as hoped, but they’re there. People recognize that it is inhumane, below human dignity, to ignore the cries of the needy. Even in the legal profession, there is pro bono work.
I have no doubt that there are doctors and other medical professionals in the United States who work for free or who pay for medications themselves in order to serve others. But for various reasons, systematic and formal free medical care for those in need is not readily available in this country: neither charity nor (universal) government assistance exists.
Something needs to be there. SOMETHING.
Thank you again for your thoughts. I really like learning from others’ perspectives.
leila
Indeed, the health care system in this country is in crisis. When the only way for some people to get any attention at all is to go to the ER for non-emergency issues simply b/c the ER is legally bound to treat them, yes, it is a crisis, Davie. Many ERs have had to close or severely curtail their range of services because they cannot handle the onslaught of uninsured people with no other options, who have to come to the ER to get a cut bandaged at taxpayer expense that should have been taken care of by a GP physician. Just sit in the ER on a typical weekend night and look around. I have, on shifts, and it is heartbreaking to see the extremely specific demographic that visits the ER.
I’m studying to become a doctor. Most doctors I know are against universal health care in any form whatsoever, but I am not. I am in medicine b/c I WANT to be, not b/c I wanted to be loaded by the time I’m 50, and I plan to use part of my practice for bona fide work, whatever my specialty might be. My lot in life has been extremely lucky. I am incredibly, unbelievably grateful to have parents who will be able to put me through medical school without debt in my name. I am incredibly lucky to have been admitted in the program that I was. Yes, I worked hard, but it is LUCK that put me on this path. Working for the less fortunate is the only way I can pay it forward. Every opportunity I received was an opportunity taken from someone else, and I HAVE to acknowledge that.
I am very liberal, pretty much the definition of a bleeding heart liberal. However, I really can see where you are coming from. The way insurance is structured in this country, it’s screwing over even those who can/will pay anything at all for coverage. Doctors are getting screwed over in malpractice suits and their own insurance costs. EVERYTHING needs to be reformed before we can guarantee health care to the masses, which I do believe must be done. Otherwise, yes, it is simply too expensive.
I don’t see why the conservative/liberal views can’t be reconciled here. I honestly do think that once the reforms you have mentioned are made, health care can be guaranteed because it will, in fact, save money – through preventative instead of defensive health care, first and foremost, which has been shown to save enormous amounts of money in the long run, and also by taking the stress off of overtaxed ERs. I agree with you, these changes will be for the better. It will automatically improve accessibility and maybe even, to some small extent, quality. It will greatly dramatically increase the number of people who can afford their own coverage, but then, I STILL believe it’s necessary to cover whoever is still left behind. So much money is saved (taxpayer money!) when someone goes to get treated at the onset of a medical issue, not when it has reached medical crisis point. Getting someone on Lipitor is just a fraction of the cost of ER care for a heart attack and an open heart surgery. Conservatives need to remember that.
At the very least, coverage for children/pregnant women/chronic diseases should be required. Health during childhood is the BEST indicator of health later in life, and good healthcare during this time could save millions in the later stages of a person’s lifespan. And chronic diseases? Absolutely. I agree, profit is not a dirty word, but the way insurance is structured around here, the people who actually need insurance can’t get it, including your own wife, and that completely beats the point.
I think both you and Loralee are right. She wants change, change that would result in healthcare for everyone, but the thing is, I think your changes could more or less lead to the same end, done properly. If it didn’t, well then, there would only be a few people left and it should not make any difference to this entire country to extend the new and improved health care system to these people, using just some of the money that had been saved through reform.
Thanks for writing, Jon. For once, a conservative viewpoint didn’t involve beating up all the liberals. Ann Coulter has given the right wing a terrible name. This piece was intelligently written, great food for thought.
Jon,
Thank you. Your views are well thought out and make a ton of sense.
I’m currently uninsured, because I have chronic health issues. Self insurance plans are astronomically priced for those with lifelong health concerns. Never mind that I watch my issues like a hawk-I was born with issues that I have no control over.
I love your idea of state offered insurance for people like me and especially love removing COBRA from the equation.
What I hope to see in all of the reform is that no one EVER has to lose a house because they had to decide between medical treatment for a family member and paying a mortgage. That’s where we are in this country today. I am proof-and I’d love to be the last one to say ‘it happened to me’.
Jon, well spoken.
I don’t live in the US but, through blogs and other sites, have been reading what is happening over there regarding what the government would like to do with great concern.
I hope your conversation with the White House is really listened to and heard, and not just as ‘well, we’ve heard what people have said, but we want to do this anyway.’
Again, well thought out and spoken.
[...] loraleeslooneytunes.com » A conservative view on health care reform. loraleeslooneytunes.com/2009/08/24/a-conservative-view-on-health-care-reform – view page – cached * You know I ADORE Sandi and Brandon Benson, but here is another reason to love them: Sandi truly loves her readers. (Well, the non-asshat ones, anyway.) If you are non-asshat and not reading her, you should be. I loved her as a person first and then I loved her blog. She’s one of the most open people out there. — From the page [...]
Jon,
THANK YOU! You’ve made so many points that spot on with regards to how conservatives feel about health care reform. I’ve passed on your post to my very conservative parents and other relatives who feel the way you do.
I’m so thankful to read someone who shares my opinion.
Jonathan – Thank you so much for posting. It’s been really cool getting to see/hear/read your point of view both here and on the radio show after reading Loralee for so long.
I am as educated on this topic as I should be, so I appreciate you breaking things down the way you did. The way that I see trying to become informed in politics (and pardon this comparison, but I just can’t think of anything better) is like trying to become informed on a soap opera you’ve only seen commercials for. If you don’t have someone sitting there with you telling you who is who and what is what it’s incredibly easy to lose sight of what you’re looking at and want to look away.
I really like what you have to say about insurance from employers. Perhaps another way to look at that as well would be for employers to be able to offer different plans from different providers. If insurance providers were forced to compete a little bit more perhaps they would offer better service at a better cost.
The reason that I’m taking it to that level, as far as keeping the insurance with the employer, is that a lot of people (especially those who don’t make much money) can’t really afford to get insurance on their own. I know very few people who have health insurance and only a small percentage of those people obtained it outside of work.
I wish I had more to offer on the subject. If I think of anything more, I will be sure to post it.
Thanks again for taking the time out to write this out and share it with us.
left to get a cookie yesterday towards the end of the post and didn’t come back until today . . .
we have very similar views, but have never been able to express it quite as effectively. usually, we can’t even get out the first few words before others yell at us for being cold-hearted, selfish, etc. thanks for writing it. we’ll have a place to point other folks to and when we’re too frustrated to talk.
Wow! So many comments. 1st, I want my cookie. Second, way to go Jon. Ever thought of running for office? I would totally vote for you.
I have many thoughts on this post, but am not sure I am up to writing a treatise as the subject matter tends to be quite frustrating to me. However as a lawyer who has defended physicians in medical malpractice suits north of the border, I do have a point to make on tort reform. In Canada we have a cap on “pain and suffering” damages (not just for medical malpractice, but for all torts). The cap does not preclude awards for loss of income, any out of pocket expenses, etc., simply pain and suffering as the Court in Canada has decided that “pain and suffering” is not something that can be properly compensated in dollars. This reform happened through jurisprudence and without the need for any complicated legislation.
I am not at all against tort reform if done properly. However, I am of the opinion that much of the litigiousness that is experiences south of the border is a result of the health care system as it is currently structured, which applies not just to medical malpractice, but to negligence across the board. With a single payer system as in Canada, if I break my leg when I slip on your sidewalk (which may be due to the icy sidewalk, or to the fact I wasn’t paying attention), I go to the hospital and my leg is taken care of without any cost out of pocket. I could sue you and we could fight about whose fault it is for years, but unless I have lost any income, I probably won’t. Similarly, if I have an infant who needs substantial medical care, in the US I may have no choice but to sue my OB/GYN for any number of things: issues with the delivery, failure to diagnose before birth, even potentially the failure to advise me so I would have the opportunity to abort the fetus or not get pregnant in the first place. When people have significant medical costs they often have no choice but to turn to litigation. With “socialized” medical care, the costs of caring for that child are covered, thus turning to litigation becomes less of a necessity.
None of this is to say that people don’t sue physicians in Canada, or that tort reform is not something that should be considered. However, If I am right that the current state of the medical system has an effect on the rates of litigation, certainly that is another piece of the puzzle that needs to be addressed.
mr & mrs looneytunes-
i was led to your blog via a comment on blurb’s website and am happy i did.
jon, while i mostly disagree with you on HC reform i’d like to say kudos for offering an intelligent, thoughtful and calm perspective and discussion on this very important issue. thank you.
I suggest taking another page from the Australian book – have all people that sue and lose, have to pay for the other persons legal bills also.
Hello! How brilliant is that! So even though the Judge Judy and other similar shows have all made their way onto Australian tv, (eek! there goes the country!) coupled with AL’s comments, and malpractice is not an issue. So nice.
Jasmine-The lawsuits in this country are totally out of control, I agree and I don’t disagree with the idea of this, but would hesitate because there are plenty of cases where the lawsuit is legitimate and a person simply loses. I would hate to fine them for trying to get justice/legitimate compensation.
I would have NO problem with people who have been deemed to have a frivolous lawsuit paying fines and attorney costs, though.
NONE.
I do understand the thoughtful process of going through options. And I do appreciate intelligent and thoughtful recourse on new options in the proposed health care debate.
What fails me beyond all understanding are the people who think “it can’t happen to me.” And then their obvious arguments that supplant that position.
I am one of them. It couldn’t have happened. I was born happily middle-class, educated well and completely within the confines of southern California public schools. Nurtured by well employed parents with health care that covered us kids. Luckier than many.
And then I got hit by a car. Driven by an uninsured driver who was at fault because he hit me while I walked in a crosswalk with a green light. Two surgeries. Hit in a parking lot working at a grocery store while attending college. Worker’s compensation barely covered the bills. And then, 20 years later, slipping on pea-gravel on what should have been a paved sidewalk that separated my knee cap from my knee. Requiring 3 more major surgeries. In the last 2.5 years, I (and my parents) have paid more than $22,000 in bills, and more than $47,000 remain.
How can that ever be right?
In between, I exercise, keep weight down, maintain a healthy diet and lifestyle. And what do I get?
Scorn, and insurance companies that deny coverage. Insurance companies that give coverage, and exempt/except my knees. How can that possibly help me?
All of the above arguments are great. I have no quibble with discussions. I do have to say something when it all veers to the esoteric. WHAT DO YOU DO WHEN YOU HAVE NO OTHER CHOICES?
That is the question that needs to be addressed.
xandy
Even more baffling? Those who it has happened to that still don’t want change.
You’d be surprised how many I’ve heard from that feel this way. I don’t get it.
I don’t understand their reasoning. I just don’t.
Do they have Medicaid or something else that takes the sting out of the medical bills?
I have gone from being successfully self-employed, albeit it at a low-ish level, yet sustaining myself, to being completely dependent on 3 $9/hour 6-hour shifts in a 400-mile geographically isolated community of 2,220 souls. I am underemployed, uninsured and completely in debt with debtors calling me all of the time. I am currently filing chapter 7 bankruptcy. I do not qualify for under/un-employment, food credits or health assistance.
I exist because I make it work. I like being independent and work hard, but a bit of a safety net in the form of a public option would be a nice touch in a cruel world.
I am more than willing to work hard (and have done so all of my life), but I am not going to let someone else, someone who DOES have health insurance, make me feel bad simply because I have made different choices throughout the course of my life.
None of us has a crystal ball.
What is so wrong with supporting ALL americans?
“Real Choice? It’s Off Limits in Health Bills.”
http://www.nytimes.com/2009/08/26/business/economy/26leonhardt.html?ref=todayspaper
Superb. Really. I feel like you crawled into my head and put my jumbled thoughts and feelings into a concise and well written post.
I was looking forward to your thoughts on the pre-existing condition issue, as that one has me stumped too… ah well.
My limited thoughts on it are that if people were required to be covered, regardless of pre-existing condition, as they are on most group policies, the cost would be mitigated by those who don’t use their insurance as much… as happens in group policies. How exactly that would work, legislation-wise, especially coming from someone like me who just wants the gov’t to back off? Don’t know, really haven’t given it much thought. But, that’s my 2 cents :-)
Again, thanks for the awesome perspective. And especially for the ‘profit is not a sin’ section. I wish more people understood how much we’ve benefited from the motivation and incentive that money provides.
I did want to mention though, that I think it’s terrible (disgusting, really) the disparity between rates charged to those with insurance and those without.
Conceptually I understand the insurance companies contract those better rates because they provide a volume of business, however, the result is bizarre and catastrophic.
It is my understanding, as a tort lawyer coming from a family full of doctors, that practitioners and hospitals do not rely heavily (or at all in many cases) on the astronomical uninsured patient fees. If there was some kind of cap, say an uninsured patient can’t be charged more than 5 or 10% more than what the median insurance provider is charged, then this would go a long way to mitigating the pain of being uninsured.
I mean, really, why should an insured patient’s pregnancy cost about $5,000, while an uninsured’s costs $25,000???
I wanted to tell you how much I have enjoyed visiting your blog. I hate politics. I hate the health care crisis and the drama that it entails. BUT you and your readers have made this crisis something I can stomach for the first time.
I get so pissed off when I watch or read national media sites. They are all either one sided or argumentative and I want nothing to do with it. But over here, I feel like I could, and I do, visit often and LOVE the perspective that each person shares. I wish we ran the country. I think we, looneytune readers, could do an amazing job.
Thanks again for making a HOT topic tolerable and interesting.
Sandi:
My father was a career-long newspaper man. I lived, ate, and breathed the news for most of my life.
Then my 3-month-old died and I have never been the same.
It changed so many things, including my ability to digest the news and discuss politics.
I used to love debating. I relished it. After Matthew passed away, I completely flipped and went out of my way to avoid any sign of confrontation.
I couldn’t stomach any kind of news. It was too painful.
I was already suffering so much…seeing so much of it in the world on the television or in print was just too much for me.
It remained this way for a very long time. However, as we humans are wont to do, we start to heal from grief and loss. Even if we don’t really want to.
Little by little, I am rediscovering my enjoyment of things I used to.
What I do not enjoy is seeing the treatment of others by people fighting for their view. FROM BOTH SIDES.
So, while I am finding my love to discuss things like this again, I also bring a different attribute that stems from the loss of my Little Bug…a great desire to have peace, civility, kindness, compassion, and as much understanding as possible.
That is why I love the way this discussion has gone so far. It is a credit to us all.
We’re all here for such a short time. I think that kind of ugliness around you isn’t the way to live. It’s not something you should put on your fellow man, even if they disagree radically with you. I want my time to be spent trying to focus on important things to me rather than let anger get in my way and distract me from the issue.
I am human and fail at this. All of us do. The important thing to do when it happens is just pick yourself up from the depths you’ve sunk to, apologize and continue to try and be as level-headed as you can. (If you hadn’t noticed I may or may not really struggle with that last thing. Heh.)
I love you. Thank you for writing this.
I really enjoyed reading this post, and the comments. Like many others have said, the debate on most blogs and websites is one-sided or lacking in civility, so I hope a senior WH staffer (Valerie Jarrett?) reads through the post and all the comments to get a feel for why many people are concerned but also want reform that makes affordable health insurance accessible to all Americans, especially those with pre-existing conditions. I agree with those that think the biggest failure of our current system is its inability to provide affordable coverage to people with chronic conditions. Our system is also not doing well in holding down costs (health care costs are 16% of GDP in the US vs. 10% in Canada; the extra 6% equals $800 billion per year). From a broader social perspective, it seems wasteful to set up a health care system where taxpayers pick up the tab for the most expensive segments of the population (those over 65 and disabled are covered by Medicare, and the very poor, covered by Medicaid, are at higher risk for many maladies) but the rest of the population (the segments of the populace with the best risk profiles and so the lowest health costs in aggregate) is left to a for-profit market where 20-25% of every premium dollar goes to administrative costs associated with cherry-picking good risks and denying/rescinding coverage. I agree with Jon that health insurance needs to be made independent of employers since employer-sponsored plans insulate people from how much health care costs but I don’t think doing this without strict regulation of insurers, like in Switzerland, would really offer people real choices. One reason is it is nearly impossible to do genuine cost comparisons of insurance plans and the assorted optional riders without an actuarial science degree. Plus, I would argue that people really don’t have an especially informed opinion of what their future health care needs will be. You can eat well, exercise regularly, not smoke or drink too much and still get struck down by illness that depletes your life savings. Insurance needs to provide real peace of mind that if you do your part and pay the premiums, the insurers will do their part when you file claims covered by a plan without unfair rescission triggers buried in the fine print. The parts of the US health insurance market where satisfaction is fairly high, like employer-sponsored plans at larger companies, work mainly due to regulations that require employers to offer plans to all employees at the same rate regardless of pre-existing conditions. This sort of community-rating approach combined with an individual mandate (this prevents free riders from gaming the system by joining just before they get sick and dropping coverage when they get well and includes a hardship provision for those that fall on such hard times they cannot even afford a basic health care plan) gets at the problem of pre-existing conditions by preventing insurers from pricing policies based on health risk profiles and instead reorients competition to managing health care for populations since everyone is charged the same rate for coverage, aside from allowances for age (max disparity of 2 to 1 in the House bills and the Senate HELP bill). Discounts for healthy behaviors like not smoking can also be factored into this type of approach. At root, the problem of pre-existing conditions (or, more broadly, adverse selection) is why opening up insurance markets across state lines will not work without regulation. National insurers would compete to identify the best risk pools and deny coverage to everyone with poor risk profiles or charge them inordinately high premiums or set their deductibles extremely high. In a worst-case scenario, the economies of scale in amassing the largest low-risk pool by screening for the healthiest people would lead to a few giant insurers dominating the US health care market and put affordable coverage out of reach for even more people than today. The reality now is that a single health insurer has over 50% market share in 21 states and two carriers have over 50% share in 39 states, according to a 2007 AMA study. This sort of oligopolistic market structure does not yield even the efficiencies of competition, so Americans that do not belong to employer-sponsored plans at large companies get the short end of the stick in every way. A community rating system combined with an individual mandate would reorient competition away from getting the lowest risk pool but would not displace private-sector insurers. Yet this does not address the problem of high market concentration, and that is why many Democrats (me included) want a public option. Yes, cost transference to private insurance is a problem but given that private-sector insurers draw their premiums from a relatively low-risk pool while US taxpayers cover the higher-risk pools and that 20-25% of private-sector premiums go to admin costs and profits, I don’t think this problem is unduly onerous compared with the other problems in the US system. I would favor a regulatory scheme like Switzerland’s on at least two fronts: (1) require insurers to offer two or three standardized, regulated plans (easy price comparisons) to everyone along with high-end, unregulated plans with dental coverage etc. and (2) require insurers to use at least 80% of premiums collected on the basic plans for medical costs in return for a government program that requires everyone to buy insurance and subsidizes low-income households so they can afford to buy the cheapest basic plan. Insurers would in this system compete to find ways to offer preventative care to keep the overall medical costs in their coverage population low and team up with hospitals and other providers to find more efficient, integrative ways to care for people and manage the health data of their coverage population. A regulator would monitor compliance (with a whistleblower hotline that people could call with complaints) and a expert panel of doctors and economists appointed by the President (yes, that sounds ominous, but at least it is clear who is making appointments and who would be on the panel, and insurers have plenty of lobbyists to ensure their views are heard) would review the specific coverage of the basic plans and whether to raise the ratio of premiums required to go to medical costs (one way to get health care costs down) every two years or so. I understand concern about government intrusion into markets, especially given how much influence corporate lobbyist and other special interests have in Congress as well as state and local governments, but our system is broken and needs to be reformed.
I have so many things to say but luckily for anyone reading this, I don’t have time to actually type them all out right now.
Jon, thanks for sharing your views even if I don’t agree with many of them. I just read the blog of John Mackey, Whole Food’s CEO, and apparently you listen to or read the same libertarian-approved talking points! ;-)
For both you and Loralee, thanks for putting your thoughts and feelings out there in such a civil way.
Ok, we have had lots of opinions expressed in these comments bout what we want to happen. Now I have some additional questions for you all. (this is really just for those in the US, but feel free to weigh in if you want anyways)
Do you support the currently proposed legislation?
Do you know what is in the currently proposed legislation?
Feel free to support you answers or not. It is up to you.
-Jonathan
Jon,
Thank you for writing so eloquently about a valid alternative to the currently proposed health care reform. We share the same political philosophy and I could not agree more with what you have outlined. I have been feeling really frustrated and powerless regarding the direction of our government, especially when it comes to this issue. I can’t tell you how hopeful I feel that someone in the White House heard your views, and through you, heard my views as well – thank you!!
Thank you so much for sharing your point of views on this subject, Jon. I really can see where you are coming from. When all of this started I didn’t know what needed to be done, but I knew something HAD to be done.
Thank you Loralee for sharing Jon’s point of view with us (and yours too!) You totally rock!
I’m also posting this under my wife’s blog address.
Thank you for this post. As a physician, I see the good and bad associated with our system daily. I appreciated your characterization of yourself as a conservative libertarian/constitutionalist as I find myself in a similar frame of mind. You have articulated many of my concerns and views very well and I thank you for that. I agree with you that one of the major problems with the system is the inability to purchase health insurance across state lines. In my state, there is only one major provider of private insurance and they are indeed the “800 lb gorilla in the room.” There is no negotiation either from the physician/institution side or the patient/consumer side. How can we complain about a so called free market system when the market is anything but “free”? The laws of supply and demand no longer hold any meaning in a system without competition. Also, I am 100% with you in support of profit in general. Profit gained by providing a quality product or service is how a business survives. It keeps the lights on, the employees happy and provides incentive for a job well done. After spending the majority of my adult life in training and acquiring a large amount of debt which still hangs over my head, I am disheartened by the characterization of MDs by the media lately. Although there are certainly a few outliers who may keep the stereotypes alive(thanks Dr 90210), most of us work very hard and devote a lot of emotional and physical energy to taking care of people and not so much toward our golf game. I find that we are being maligned with comments by the president that a physician would chop off your leg for money(BTW…if you needed that service it only pays around $500 rather than the $30,000 he stated). Finally, in terms of tort reform, I agree that if your MD does something horribly wrong (i.e., no informed consent, criminal negligence, etc) you should be compensated. However, we are human and mistakes will happen. Also, bad things just happen sometimes. A physician’s judgement is nothing but clouded by the constant threat of litigation from a misguided individual who views a known complication as a lottery ticket. Thankfully, most people a genuinely GOOD and appreciate the service we provide.
I hope we can all calm down and come to a general consensus about our healthcare that doesn’t involve a government takeover which in my opinion will only make things much more complicated and inefficient.
Thanks again. Sorry for the rant. Also, I feel you when it comes to the amount of time she spends on the blog, but glad it makes her happy.
Why is it that all of the wealthy industrialized countries of the world have made the moral and ethical decision that ALL of their citizens should receive good health care. Except the USA, of course. Here we think universal health care is socialism…..hmmm. you mean like medicare, medicaid, the V.A.hospitals, farm subsidies, social security, etc???… Why do we continue to make the choice to leave out the poorest people? and still claim to be so Christian.
And another thing, (and then I’ll stop.) Take a look at the administrative costs of our private health insurance companies in the USA. It equals about 20% compared to 5% in countries like Germany (who also have private insurance companies but are very regulated!) We are so afraid that the government will get into this field and screw it up……well for my money, the govt can’t do worse than the crap done to us over the years by the lawyers, insurance companies, incompetent doctors, hospital conglomerates, pharmaceutical companies and their paid lobbyists. While we are fond of saying that capitalism, competition, and deregulation is the American Way….trouble is, we’ve gone so far down that road that now we’re in a mell-of-a-hess with health care costs, a banking system meltdown, and the economy in general going to the dogs. Happy Labor Day Everyone!
[...] the posts where Jonathan and I discussed both sides regarding health care reform, both of us were very proud of the civil way people handled the discourse. There was a lot of [...]
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