Friday, August 21, 2009

Still in Summer

The Health Care Debate continues apace, fury and ignorance abounding.

It's been very easy to convince a horde of Americans, not all of them right wing reactionaries, that the changes in health care insurance in the works will result in bureaucratic interference, rationing, euthanasia, deteriorating quality of care, treatment of illegal aliens, higher costs, and so on.

In other words, things that are already happening thanks to the kindly ministrations of the for-profit health-care insurance industry, things that the "reform" is supposed to address.

Whether the "reform" will do it very well, I can't say. We still have only the outlines of a Reform Plan, and all we can take from the outline is that everyone will be required to have coverage, and some of the more egregious practices of the Insurance Cartel will be curbed. Apart from that, nothing is certain. Even those things are not all that certain, but they seem to be consistent through all the permutations of the bills working their way through congress

Bureaucratic interference, of course, is a constant of the for-profit health insurance industry. Second only to the collection of premiums, this industry exists to scrutinize and too often deny payment for treatment for injuries and illnesses, to interfere with preventative treatment and to stand on the alert between doctors and their patients to ensure that nothing is ordered or treated that conflicts with ever-changing, arcane, and indecipherable insurance company rules. Everybody knows that is how the Insurance Cartel operates, and yet for some reason, the howlers insist that the only "bureaucratic interference" that matters is the interference of a government drone approving this or that payment for services rendered. Hunh? And when it is pointed out that in government programs under way, the government drones have a very light hand indeed, hardly even noticeable, whereas the insurance company bean counters are always on the tail of physicians and patients looking for ways and means to deny payment and treatment, the rejoinder is that one can always choose another insurance company, but you can't choose another government!!! That's not the point, you patiently offer. The point is that it is the insurance companies that throw up all these bureaucratic roadblocks you fear and deplore, not the government. Nazi/Socalist!!!! Stalin!!!


As for rationing, goddamned right there's rationing by the insurance companies, and by the fact that so many millions of Americans go without health care insurance and so must -- how you say -- "self ration" health care until there is an emergency. And in the ER there's ongoing rationing starting with the triage of your case. You may be left to die in the ER if the triage nurse doesn't believe your condition is serious enough for immediate or urgent treatment, as we have seen happen over and over again. If the ER is the only place you can get treatment for whatever serious matter ails you -- the Bush Regime was famous for insisting that everyone in America had access to Health Care at the ER, it was the law!!! -- then you're in deep trouble. The ER is the least efficient and the most expensive form of medical treatment possible. Insurance companies put strict limits on the amount and kinds of treatment they will pay for, regardless of the patient's condition, and that's about as strict a rationing plan as you could ask for. Government programs in existence have their own rationing standards, but for the most part, they take into consideration the condition of the patient such that there is no cut off of treatment for individuals in need of care. Strange, that. But the foamers insist that the only rationing that matters is the rationing that government does. OK, sure. Whatever.

Euthanasia does go on. Insurance company denial of treatment, or insurance company cut off in mid-treatment, is often a death sentence, and surprisingly enough, that is a form of euthanasia. But you can always get a different company!!!! No, you can't. If you have a "previous condition" in most cases you can't get insurance. Ahem. And so... if you don't have insurance, you can't get insurance, or you're cut off from treatment, be prepared to get your affairs in order because you're on the Euthanasia Train. Between 18,000 and 22,000 die every year for just this reason. That doesn't even get into what medical "procedures" can be utilized when nobody's watching. The government programs that exist, however, seem to organize their approach to care and treatment so as to prevent any attempt at euthanizing patients -- or to prolong their suffering. It's really a remarkable difference. One that people would do well to appreciate. But no. The howlers and foamers have to go crazy over (sometimes justifiable) fears that someone wants to kill them or their granny, and that someone is in the government!@!!!!1. Well, no. No it's not. It's probably someone in the private sector, though.

Deteriorating care under "government" programs? Or under private sector programs? You decide. In fact, "government health care" has a solid reputation, though not perfect. The actual "government" programs that exist: Military and its offshoots, VA, Indian Health Service, etc. provide generally excellent care at reasonable costs for the government, and as a rule, inadequate or inefficient care issues are addressed with speed. IHS has had a lot of problems, to be sure, and those problems are being rectified. Meanwhile, access to private sector care is becoming less and less available to more and more people, as they lose -- or can't get -- private insurance, and so their care is self-evidently deteriorating. But the government!!!! It's just idiotic.

Treatment of illegal aliens is a bête noire for many of the howlers, regardless of the "debate" under way. The existence of "illegals" drives them nuts. They're all criminals!!!!! Yes, well. Like everyone else, illegals have to be seen (but not necessarily treated) in the ER, but beyond that, they have no special rights or privileges with regard to health care coverage, and almost all can get into dire straits if they become sick or injured. Their situation is very much like that of the typical uninsured American. Except for the fact that there are no programs at all to assist them -- no Medicaid, no Medicare, no "charity care." Nothing. Nothing that has been proposed so far will alleviate that situation in the slightest. But the howlers need something to howl about, so why not "illegals!!!!!?"

Cost control is a real issue. I don't know why medical costs are so prone to gross inflation, though I suspect the current rattle-trap "system" is a big part of it. But many costs seem to be wildly out of proporation to the services provided (the famous $12 Tylenol comes to mind as an example), so bringing some rationality to the fee and payment structure of the medical industry would be a relief for everyone. Of course, that's socialism!!!!!! Hitler!!!!!! Stalin!!!!!!!!!!!!! which makes no sense, but there you are.

The lies keep coming. "Mandatory Death Panels" is one that was spread with lightning speed. There are so many more. But then, there are so few real details about what will be in the health care reform legislation, so much political posturing, so little effort toward a comprehensive system overhaul.

There isn't even any clarity about what the supposed "public option" we're expected to be enthusiastic about is supposed to be. Are we talking "Medicare-like" as Gov. Dean keeps saying, in that a public entity of some sort would be responsible for paying medical bills submitted by private sector providers (a la Medicare), or are we talking about a new-model health care provider system (a la VA, etc?) At times, it is impossible to tell. It's also very difficult to suss out what the "vision" for the future of health care in America is. Maybe there isn't one.

At any rate, this endless summer drags on...

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