So this started out as a comment-response to Josh here http://www.outlandishjosh.com/drupal/blogs/sicko_or_my_adventures_w
and grew and grew - so I made it a post but you may benefit from reading his original first.
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I really need to chime in here that while I enjoy my new occupation, there is a devoted part of me that is mad as hell that I feel in many ways I was 'forced' into it. That's a bit of over-dramatization, but we're talking how I felt, not facts and figures here.
I'd hit the wall in theater - feeling that on the tech side of things I'd gone as far as I could without making the big time or joining the union (which isn't nearly so enticing as it may seem outright) - and I looked around seeing people with 10, 15, 25 years more experience than I struggling still.
One of those guys - probably about 10 years my senior, was a guy named Jeff. I was working in a shop in Long Island City, NY when Jeff made his one mistake. He said it wasn't that painful, but it was definitely surreal watching the tip of his left thumb go twirling up over his head to land behind him. About 3/4 of an inch - not much at all until you're talking about fingers. Somewhere between $16k-$20k - maxed out four credit cards for that 1 (one) - big mistake in roughly twenty years of work. We all tok up a collection that maybe made a 5% dent in that bill.
I remember NYU mandating health insurance. So when I cut up my pinky finger for 13 stitches and a nerve surgery, doing stupid shit, I paid $150 on a $3600 and change bill. Same as you I remember them asking if I had insurance and I seem to think that the nerve surgery would have been my choice if I didn't. The two weeks between the accident and the surgery I had an extra funny-bone in my hand. Whenever it bumped something my whole arm jerked - while thats a fun party trick - its not conducive to life in general.
I still can't use Vi properly, but I can type - which is a plus in the web development world. After starting my own business in web-dev I eventually got a job offer a decent amount of money - plus health insurance. The Holy Grail. Now, beyond the broader discussion of why exactly America makes it SO hard for the small businessman or individual to so much as pay his taxes, let alone get reasonable health insurance, lets drill down a little here. Oh poor Sam, you have a good job and health insurance. Well, yeah, dammit. This isn't what I wanted to do, nor anything that I would have chosen on my own eventually. This is the career I saw as the only potential life-line in the storm. Government sponsred Student Loan debt effectively told me that Grad School for another career was not an option - and even if I had tried that route - I really wasn't crazy about being sold another education when I wasn't pleased at all with the first. I got real lucky. I'm not unhappy doing the job that this countries screwed up secondary education system, tax system, and health care system landed me in.
Lets take a step back and look just in our own circle of friends of people who have taken jobs just for the health care. And feel tied to them for similar reasons. I have a very dear friend who recently had to move back to Long Island so she could still be under the umbrella of her father's healthcare - due to chronic health problems, and no option of getting other healthcare.
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On the other side of this coin though, none of those bozos on the stage has a real health care plan for the country. In my humble opinion we need to fix secondary education first. Make it so that there isn't a monetary boundary on being able to get a M.D.'s education, first, or concurrently, then we can talk about health care access.
But, also, insurance is NOT the way to look at this problem. When you're only tool is a hammer, every problem is a nail. What is the best solution? Then lets look at how we make that happen.
In a perfect world, you could be anywhere in America (or maybe just anywhere), have a health issue and go see a qualified professional about it. This would apply to mental as well as physical health care.
Well, that's nice Sam, who pays the bill? I adamantly refuse to believe any whack-job who tells me this won't cost that much money. What it comes down to, is, are we willing to foot the bill as tax payers so that all of us can have the privilege of health coverage.
Man that gives me the fear just writing it... Anything, and I mean anything that the State touches gets covered in four layers of bureaucracy. Its not that they don't want things to be good but, man, we just Cannot have the hospitals run like the DMV. That means, in my mind, but I'm open to suggestions, that we need to keep this competitive. You need to be able to pay more for the 'good' doctors or else there is no reason to be a 'good' doctor. And where ever the free market meets the taxpayers dollars you get corruption - or even honest business that just doesn't need to be happening - much like my opinion of this war in Iraq. It serves a great job of funneling our tax money into the pockets of the Military Industrial Complex. Well, what happens if health care turns into our next war in Iraq - how much tax money can be funneled into research for better face-lifts?
*Sigh*, well I've about worn myself out for this Sunday morning. Please leave me some thoughts on this briar-patch. Ya'll know I love to duke it out. :)
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So much for that plan
By Julie (not verified)Yeah, moved home for that health insurance policy...then I got kicked off 3 months later while I was still super sick because company policy changed and it didn't matter if I was living at home and unable to work to support myself...no longer in school meant no longer insured under dad's policy. They gave me a whole weeks notice about the change in policy so I had to scramble to find what I have now...Healthy New York from Oxford...its a pretty good plan, but you have to make under a certain ammount of money a month to qualify for benefits...so now its almost 250 a month to keep myself on health insurance plus whatever copay I need for visits or medication. Yet friends who work for companies with corporate policies are only paying 30 - 40 a month for better coverage. I feel screwed.
Anyways, if all goes well with the new part-time I picked up to suppliment my current part time, company subsidized health insurance shouldn't be too far down the road.
The system sucks
Profit based health care
By John Y (not verified)Right now, the providers who receive the most money(within their own specialty, not comparing fields here) are the ones who:
A) Follow the Health Plan rules. If they follow the guidelines for authorized procedures and appropriate bureaucratic process, the doc gets paid. If, however, they reach back on their long schooling, natural ability, and experience and do something they feel is in the best interest of the patient but doesn't follow what some claims adjuster(who often tends to have started out in a call center somewhere not medical school) doesn't approve, they don't get paid.
B) See the most patients. Due to slim margins, docs have to see as many patients as possible to make it worthwhile. Well, unfortunately there are only so many hours in the day and this forces some(who want to make money) to jam in consultations to small time windows, not exactly ensuring the best care.
So, right now it's kind of built to pay the most to the provider who gives the fastest, highest corporate profit ensuring care, not the best medical care for the patient.
Now, my father is a doctor and my conversations with him about universal healthcare run by the government tend to move towards your argument that quality will suffer, and he cites France and Great Britain as examples. I haven't really argued with him about those examples. However, I think as I get older and I have faced the fear of losing or not having health insurance numerous times, I have a response. As a moral issue, which is how we should look at this, the benefit to the populace of that mental insurance of guaranteed health care far outweighs any possible lapse in health care quality. And in fact, when only a small percentage of society has access to "the best" anyway, what does it matter? That argument, that socialized medicine will reduce care quality, is one focused on tactics not strategy. Maybe it will affect the day to day quality at the top, but doesn't a system that focuses on profit margins and company savings also inherently ensure that the lowest level of care is given? The argument for capitalism in provider compensation may be valid but that's not where our system is. Our system, as it stands, is focused on health plan shareholder compensation. The money isn't really going to the doctors, nurses, and other providers, it's going to brokers, CEO's, and people's stock portfolios. I think a system that's inherent focus is providing quality care for everyone, over profits for the few, may actually have a stronger moral foundation that help it overcome any procedural downfalls that may come because of the volume of patients or government intervention. I'm not sure, but something needs to change. When the people responsible for my care are just as worried about whether their payment will be authorized as they are about what will cure me, we have a problem.
well
By TreslerI like the idea of everyone having a healthcare plan, but have serious reservations about putting it as a government run organization.
You said this an it intrigued me for a number of reasons. Can this be implemented in some fashion so the money -does- go direct to the doctors?
The stronger moral foundation part is bollocks. You lose your moral high ground real quick when you remember that to the doctors its a job. A job the like perhaps, but very few of them are on a personal crusade to save the health care industry, and we have no reason to think that they'll be participatory in a system for 'a good cause'.
Money might do it though.
My real fears crop up when the government is given a wedge to force a door wider - at what point does 'saving the leg' turn to 'amputation' on a congressional budget line item?
I gotta say, the more I look into this, the more I like the voucher system that puts the health insurance companies out of their current business. New business will rise up, and I'm of the opinions that they have sacrificed their right to be in business by infringing on the rights of others. Yeah, their rights end, where mine begin.
Indeed
By Josh Koenig (not verified)You should see the movie. A) because there's a finger-lopping bit that's basically the same, and B) because it starts to address the whole point of "the senate can't do anything right" and "you need to be able to pay more to get the good doctors."
I think those ideas in B are false. I agree that no candidate has a real solution-plan, and really this is because of how malformed and malignant our political system is. We've been putting people in charge of government for a long time who state plainly that they don't believe that government can solve any problems. So we have some shitty corrupt government; go figure. But it's not like this is an inexorable result of having something run through the State rather than a Private Enterprise, and in real terms when Private Enterprise exists on the scale of Kaiser Permanente, as a massive corporation, it's often more bureaucratic and Soviet than even the dreaded DMV (which honestly isn't terrible, and generally suffers from over-crowding and/or poor management at the local level, as do many private enterprise franchises).
And ultimately, the quality of Public Services is accountable to the Public. We're just so far gone from thinking there's anything that "we" can do about "the problem," and our political class is so moribund, inbred, inept and corrupt that we just sort of accept the status quo. I'm guilty as anyone of that.
The other thing about profit-driven care I think is also a bad idea. I think doctors and nurses and medical techs need to be paid very well (say, a salary commensurate with the President, or thereabouts) but in real terms pay-to-play profit motive doesn't generally translate to quality care. It's much better to free doctors and hospitals and clinics from the restrictions of bottom-line thinking and focus on providing care to those who need it. If you want to use financial incentives, then giving out bonuses for doing good on preventative care, having positive health trends with patients, etc, are a much better way of doing that than creating an elite system of "first-class" health care that only some will be able to access.
Anyway, I really do suggest you see the film.
(which honestly isn't
By TreslerFunny, thats exactly what I'm scared of. Generally, no one dies when you have a crappy time at the DMV.
So, what can we do? We're being offered and handful of bad solutions and frankly - while electing different representatives helps, there is no one out their running that is a real brain-trust. Yeah, things need changing. To me, the natural logic from this is to wait on National Healthcare till we get a chance to fix the "moribund, inbred, inept, and corrupt" aspects, as letting -that- faction design National Healthcare just further entrenches them.
And I agree with you regardng the preventative healthcare, and no making it strictly about profit.
People seem to have it in their heads that there are two options - Gov't regulated -or- As a business. Personally, I think a good regulatory institution (umm, like the AMA?) could enforce a level of quality - i.e. both with penalties and rewards) and healthcare can be run on a pay-for-play service, that is in turn funded with a voucher system - in which tax dollars can be used by citizens t get the healthcare they choose.
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