Sunday, October 11, 2009

Health Care at a Human Level

Readers of HR3200 realized that it was a deeply flawed document. The Baucus Bill has so far shown itself to be politics at its worst.

Health care is just too important for individual people to be controlled at a Federal level. Your health is an attribute of you. In an ideal world, the resources for the care of your health would be near you and under your control. Your health care resources should not be in Washington, under the control of an unelected bureaucrat.

Employer based health care is bad. Washington controlled health care is worse.

Anyway, all fifty states and local communities are flush with unique efforts to engage in health care.

Since the national debate is really ugly, one way to get our nation off the path of the health care power grab would be for people to spend time talking about local state and community efforts that are affecting health.

I've had first hand accounts with efforts on the county and state level that actually did make a positive impact on people lives. Each of the efforts that I've personally encountered started with the recognition of real people with real needs and not some theorizing by a pencilneck in an ivory tower.

I just read an article by Wilson Ring about programs in Vermont to engage in handling chronic illnesses.

You will notice that this health care reform starts with patients and doctors while the bills in Washington are about ideology and partisan maneuvering.

The pundits on TV keep threatening that the Senate will sneak through the health care disaster in procedure. Perhaps talk about the good things done at the state and local level might jingle some brain cells in Washington and remind us that health is about people. The resources need to be close to the people.

Perhaps if people talked about the good things done locally, some might catch onto the fact that the health care reform of 2009 is both Unconstitional and diametically opposed to the vision of the founders of this nation.

There is a good reason why the founders wrote Amendment 10 "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

Central authorities will always grub for maximum power, yet the really important issues, like health care, happen at an individual level and the resources for health care need to be local.

I would love to get some links to stories of real human level efforts to improve health. Please drop a comment.

7 comments:

RD said...

"Your health care resources should not be in Washington, under the control of an unelected bureaucrat."

Are you referring to the panel setup to determine what the minimal coverage should be, or the medical consumer reports that would be setup so that the effectiveness of treatments can become well known?

I will note both of the programs above can only suggest and have no power over your insurance company or your insurance company's unelected bureaucrats.

"Employer based health care is bad. Washington controlled health care is worse.

I agree, Hopefully the state exchanges are swapped for a national exchange. And thank heavens none of the bills shut down the option to buy your insurance from whomever you like.

"The pundits on TV keep threatening that the Senate will sneak through the health care disaster in procedure."

This is actually an interesting conversation in of itself. I have seen movement to do this if they can't get a 60vote bill through. I will also note that the republicans have used this procedure to pass legislation 3times as often as democrats(not trying to justify using this both sides using it is terrible.)

Also what they can pass doing this is very limited, most of the regulations and programs would have to be thrown out. The only things they can put in such a bill have to have a great effect on the budget. Basically the only thing they would put on it are the tax's and the buy into medicare before your 65 option.

y-intercept said...

RD,

There are things I like and dislike about all plans discussed. When looking at the whole pile of ideas, one realizes that health care is just too complex for the decision making process that is bringing it into existence.

The distributed free market does a better job at handling such complexity that an top heaving command and control system.

Lacking future-vision, I don't know what is in the Baucus plan. Conservatives have been talking of fines and jail time. I tend to take suggestions from authorities ... especially when I will go to jail for not taking the suggestion.

Definition of minimal coverage is a great deal of power which can make substantial swings in the cost of insurance. The standardization of care delivery to make the consumer reports means bureaucrats defining step by step instructions on care.

It is like the NCLB bill of the hated George W Bush where teachers taught class for the test and not the needs of the students. The consumer reports you like have doctors administering care for the needs of the standardized forms and not for the needs of the patients.

The point of my post was that a real health care debate should start with the patient.

The form of Healthcare Reform is wrong and because of this we will end up with less than optimal results.

RD said...

"The distributed free market does a better job at handling such complexity that an top heaving command and control system."

This statement has no foundation, health care is currently a free market system with minimal government interference. In fact their is a large amount of evidence to the otherwise, Medicare's inflation rate is much lower then the free markets inflation rate. This is entirely due to the growth of administrative and profit costs in the private health care industry.

Further health care doesn't function like a typical market, demand being a function of disease rates and not price or availability of a treatment. Diseases often being commutable It can be said the quality of my neighbors health care can effect my health, their are few other markets where this is the case.

Actually I liked NCLB, for all of it's problems It really showed how broken this nations schools are.

"Definition of minimal coverage is a great deal of power which can make substantial swings in the cost of insurance."

As I said the panel over this only posses the power of suggestion. With the minor creavat that do get to decide what constitutes "preventative care", And tho it is not said in the bill it is likely they will be used to determine the public options minimal coverage. Private plans can entirely ignore this comity if they like excepting for the preventative care.

The senate finance comity bill has zero chance of passing so I wouldn't worry about it, Their bill is just political posturing so the democrats can say they tried being bipartisan when they shove through a bill using reconciliation. Given that is just my guess.

y-intercept said...

RD, the assumption of your argument is that employer based coverage is a free market. Employer based insurance creates a commons for a group of people and suffers the tragedy of the commons.

Back when I was a progressive I spoke with well learned Marxist professors beaming with the theory that by supporting tax breaks for employer based insurance, wild tort legislation and the open vilification of self-financed care that the United States would have socialized medicine within 50 years.

The progressives of my youth were tickled pink with the idea that one could radically transform a society by running a change campaign during an engineered crisis.

The statement about not being like other markets as it is driven by disease seems based on a negative concept of health.

Let's assume that health is an attribute of an individual. Diseases is an absence of health. If this were the case, then health care is about maintaining a state of being. Care suddenly transform from simple reaction to disease to a more whole body effort to maintain health and health care becomes the most human of all markets.

A could example of where things are wrong is chronic diseases. There's hundreds of thousands of people on expensive medicines right now to check chronic conditions that would be better kept in check with radical changes to diet and lifestyle.

The medicines are free under tax-incented employer based medicine; therefore, the person takes the significantly more expensive route of medication to lifestyle changes despite the fact they would have had a more optimal result with the dietary changes.

RD said...

The employer based system is what the free market came up with. Health insurance has enjoyed very few regulations, the insurance company's enjoy an exception from anti-trust laws even. the amount of hand off is just incredible, and we can see where it got us.

"A could example of where things are wrong is chronic diseases. There's hundreds of thousands of people on expensive medicines right now to check chronic conditions that would be better kept in check with radical changes to diet and lifestyle. "

Grand assumption and Generalization their are plenty of major diseases that don't fit into this.

"The statement about not being like other markets as it is driven by disease seems based on a negative concept of health."

No its based on reality. Their maybe things you can do to prevent disease from happening in the first place, thats great do them but its not going to stop disease by any means.

Ohh and I don't mean to sound supportive of HR 3200, I have read the bill and its better then doing nothing but not by much. My preference is for HR 676 and S 703.

y-intercept said...

RD,

I worked in the insurance industry. It was highly regulated when I was on the inside. Roughly a third of my year was spent producing reports for regulatory compliance.

It still appears highly regulated from the outside.

Insurance actually depends on tight regulation for its existence. Everyone has a different definition of what "health care" should include; so insurance companies have often been on the forefront of promoting regulation.

The reason for monopolies in insurance is the very close relation between state regulator and insurance company.

Because the industry is eager for regulation, the regulation usually happens behind closed doors with little public scrutiny. Perhaps that is why people hold the opinion that it was not the creation of regulators.

RD said...

I am away from how regulated the insurance industry is, McCarran-Ferguson Act anybody?

Their are very few federal regulations, most of the regulations out their are state regulations.

The reason for monopolies in insurance is the very close relation between state regulator and insurance company.

No just like the telephone industry the health care industry is an atypical natural monopoly "market". Health care insurance works more efficiently when its big(aka more profitable nothing wrong with this given), so the insurance company's have simply merged and merged over the years leaving us where we are now.