Tuesday, June 19, 2012

Caution! This soap box is only able to support one overweight, aspiring physician.

Even though the Supreme Court ruling on the PPACA (erroneously referred to as ObamaCare, even though it is a re-hash of what the Republican Party offered as an alternative to what Hillary Clinton put together and proposed for health care reform in the 1990's, and furthermore the "individual mandate" was an idea trumpeted by Gingrich and the Heritage Foundation as a way to kill medicaid) wasn't released yesterday, I wanted to share my latest feelings on the subject. 

My personal (albeit a pipe-dream) hope is that the PPACA is struck down, and in the aftermath, congress would rally and pass an intelligent, well thought out modified single payer system -- one that would be in place by the time I am practicing medicine.*

Here is my reasoning behind that hope. 

Right now, those of us with private health insurance are already at the mercy of "death panels." That's right! I spent years in the emergency department watching this scenario play out. If a life threatening trauma or illness would befall anyone with private insurance, the company responsible for paying for your care is run by a CEO and board of directors that is bound by law to do everything in his power to generate the largest margin of profit, ever larger, every single successive quarter. 

Hmmm. That doesn't sound like a good situation. 

The alternative is to rely on the government, or at least a quasi-governmental institution to provide payment for services rendered. 

But wait, I don't like bureaucratic red tape! I don't even like going to the DMV!

There will be problems! 

It will be inefficient!

The employees will probably be lazy and take advantage of working for the government!

Absolutely, all of the above will occur. How could it not?

Hmmm. That doesn't sound like a good situation either. 

Well, I agree. But it is better than having a share holder return dictating access to health care.

We will always have to deal with cost to benefit ratios in health care -- increasingly so as technology and expensive research continues to bring better, but more costly care. 

Allstate Insurance, in the last decade showed the way, as you can read in this damning report, for all other insurance companies. Granted, this is not specifically discussing health insurance, but don't be fooled in thinking that the healthcare industry is run by benevolent masters isolated from the insurance business as a whole. 

For those of you who dislike the current health care bill, I behoove you to examine what the lies at the root of your disdain. This is not to say there are not valid criticisms concerning the bill, but I don't think the issue lies where the fuss is the loudest. When the hot air from the talking heads is eliminated from the discussion, and personal political bias takes a back seat, let us at least agree that things as they currently stand are at best unsustainable, and at worst, amounts to your impending, unforseen bankruptcy. In defense of what could seem like hyperbole: this from the article -- "medical bills contributed to nearly two thirds, or 62 percent, of all bankruptcies in 2007 and just over three-quarters of people who suffered a bankruptcy due to illness were insured at the onset of their health issue."

I feel compelled to address, at least in general, my opinion on what the role of the federal government should be.

First, the things that I want from my government.

  • Infrastructure. Including, in part, utilities and transportation (safety and physical structures)
  • Military protection from foreign hostile actions (not private profiteering in the name of nation building, as we've seen for more than a decade now)
  • Police protection & law enforcement (including, as silly as it sounds, justice for all, regardless of the bank account size)
  • Appropriate business climate (what this exactly means is up for legitimate debate. I would argue this does not mean tax holidays for companies that have built their business with the infrastructure that taxpayers of today, and yesteryear have paid for)
  • A tax code that does not require professional assistance to interpret or plumb the depths of (or for that matter, even software)
  • Reasonable access to health care
Now, the things I do not want from my government.
  • Laws concerning what I can say, think or express
  • Laws concerning what I can put in my body
  • Laws concerning who can marry who (for those who fear for the institution of marriage, especially in the name of religion, I respond by saying I want no part of legislating morality, and denying the benefits that come with state sanctioned marriage due to a "sin" only further highlights my reluctance with having government involved; afterall, "a sin is a sin," and if we maintain this logic with honest consistency, gluttons should also come under lawful punishment -- also, I make a stark distinction between state sanctioned unions and those wed under whatever religious auspice any given person adheres to)
  • Laws or regulations that in any way infringe on personal liberty in the name of safety (I'm looking at you TSA!)
These are just the short list, and what I've listed is heavily influenced by the "hot" issues of the moment.  

As this post stands, I had to struggle to achieve this level of brevity. 

*I also wanted to make the distinction between a single payer system and the nationalization of health care, as some (especially in the media) have not been able, or perhaps, more appropriately, unwilling, to make that distinction. I am not advocating for the nationalization of healthcare -- I don't want to have to be a government employee just to practice medicine in the United States. In fact, I think marrying the private sector efficiency and innovation of health care facilities and clinicians with a single payer, government backed or operated system is as American as apple pie -- or, perhaps as American as diabetes would be more appropriate. 

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