Prez Obama's NYT Op-Ed 08-16-2009

President Obama wrote an Op-Ed for the New York Times about the need for Health Reform. Which, to me, doesn't say a whole lot. There wasn't anything new in it. It was kinda like listening to the old Charlie Brown cartoon adults that sound like waa-waa'd french horns as heard by the Peanuts children. The Op-Ed can be found easily by going to:

http://tr.im/wuRt

We all know we need some kind of health care reform. We all agree on that. The big thing is how much the U.S. Gov't needs to be involved in the health care process. Near the top of the Op-Ed is four paragraphs that is the summary of why health care needs reformed. They read like this:

1. First, if you don’t have health insurance, you will have a choice of high-quality, affordable coverage for yourself and your family — coverage that will stay with you whether you move, change your job or lose your job.

[kinda sounds like the federal law for 'Cobra' to extend benefits beyond employment (for an extra fee).. partly. I've always thought that the Cobra exectution was a little expensive, it's meant to keep the gap of health insurance filled until the next job is found to get covered by the next job's group health.]


2. Second, reform will finally bring skyrocketing health care costs under control, which will mean real savings for families, businesses and our government. We’ll cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies that do nothing to improve care and everything to improve their profits.

[waste an inefficiency ... well, when it comes to waste and inefficiency, the gov't seems to be a real expert at over spending, over wasting, and over inefficiency. I'd center the discovery and repair of waste and inefficiency centered around Medicare/Medicaid fraud. Get those dollars back first before anything else is done.]


3. Third, by making Medicare more efficient, we’ll be able to ensure that more tax dollars go directly to caring for seniors instead of enriching insurance companies. This will not only help provide today’s seniors with the benefits they’ve been promised; it will also ensure the long-term health of Medicare for tomorrow’s seniors. And our reforms will also reduce the amount our seniors pay for their prescription drugs.

[heh, heh, heh.. to me this says... all the money wasted .. we still need to spend! By making money more efficient, it justifies spending more at the level of gov't.]


4. Lastly, reform will provide every American with some basic consumer protections that will finally hold insurance companies accountable. A 2007 national survey actually shows that insurance companies discriminated against more than 12 million Americans in the previous three years because they had a pre-existing illness or condition. The companies either refused to cover the person, refused to cover a specific illness or condition or charged a higher premium.

[yeah.. health care/insurance should be as easy to buy as it is to get car insurance. Heck, I can get car insurance from AAA, AARP, The Hartford, Progressive, Online, Offline, in an office, off the street, etc. I can buy car, home, truck, boat, renters insurance from a lizzard. Why can't is this not available to me for health care/insurance?]

To me, points #2 & #3, should be something that should be re-engineered anyway for existing programs. That should be a no brainer. Companies that are in business are challenged constantly as to how to make more and more profit by making things more efficient by reducing waste. Gov't has no incentive to make things more efficient to reduce waste. There seems to be a notion, in the gov't ranks, that the money they spend is the gov'ts money. No... it's not, it's the people's money. It's the people that fund the gov't. The only gov't product that is sold to the people is US Postage Stamps.

The fine-tuning of Medicare/Medicaid should be an ongoing process. It shouldn't take (at least I don't imagine it should) a move of the US Congress to change the rules/regulations to tighten the efficiencies of these programs. Medicare is a Fed Gov't program... there should be a CEO (or equivalent) of Medicare that can make these kinds of decisions. Medicaid is a different beast. It's a blend of Fed, State, and Local gov't monies to get different things done. I'm not exactly sure where the different sandbox lines are drawn that enumerate where the different sandboxes lie.

As far as #1 and #4 goes, I think that health care insurance/plans should be more accessible by anybody wanting it. The insurance companies, because they are motivated by profit, have to receive enough in premiums in order to make money so that they can keep their employees paid and not have to reduce their work force. I've already written about 'obscene profits' in an earlier blog posting. So I'll not write about it again. The 'real honest thinking' blog had a very good article about 'Health Insurance Company Profits' at: http://tr.im/wuWs that is a must read for anyone wanting to learn more about that and to get a little bit of education about the difference between *profit* and *profit margins*.

I think that ultimately, when we talk about guaranteeing health insurance / health care to anyone, there are really two issues. Is health care a right? Are people guaranteed a fundamental right to health care? If yes, then that'd mean that regardless of condition, because health care is administered by one person serving the next, then to say that health care is a *right* that'd say that the serving health care providers have no choice to sacrifice/use their time to serving others. It'd be a mandate to enslave the health care providers in the health care profession to do what they do. They wouldn't have the privilege to say NO because health care is a right and not a privilege. So, no... Health Care isn't a right. It's a privilege.

Since health care isn't a right (everybody gets it regardless of health), the next thing is cost of health care so that when it's obtained, a premium price isn't paid to obtain it. What are the things that drives up the cost of health care at the doctor's office level? Well, let's list a few: malpractice insurance, malpractice litigation, employee payroll and benefits, rent on building, utilities, laboratory equipment and testing, drugs, medical equipment, medical supplies, office supplies, and maybe a few other things. Of these things, several of these items are fairly constant and can be about the same kind of charges each month to the doctor's office/clinic. The ones that aren't about the same from month to month is malpractice insurance costs, malpractice litigation, medical equipment, medical supplies, and to a certain extent laboratory equipment and testing. All of these amounts are items that potentially get more expensive as time goes (especially for the things related to increases in technology) and we can't change that. People live longer now because of the medical advances brought through technological increases (which is also increases in good pharmaceuticals too). Some of the more elaborate pieces of equipment of technology used in doctors offices is directly related to the needs to keep malpractice costs low. Order extra tests, so the Dr can CHA (cover his/her ass), so that malpractice can't be levied to a Dr/Clinic. The tests cost money to provide CHA services. The suit-happy public, that sees a Dr/Clinic as source of income, then brings a lawsuit to bring their payday to them.

So, it comes back to the lawsuit happy public. For the Dr's that are trying to do the right thing and trying to provide a good and honorable service to the community, they should be able to stay in business and their business not cost an arm and a leg, plus a few more arms and legs, plus more body parts of more people than should cost to be reasonable. For the Dr/Clinic's that are in it soley to see how much $$$ they can rake in, and are only marginal at their health care (like Dr Frank Burns of M*A*S*H) they probably should be raked over the coals. But, instead of persecuting them at the legal level, let their review happen at a medical board level which also has the teeth to take assets of the business away. Keep it out of the courts.

For the lawsuit happy public... well... I say let's get the tort (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 laws) system reformed. Instead of a person/patient being rewarded $1.5 million for *whatever* (which is also the also all the stupid lawsuits that result in all of the warning stickers placed on product... like hot liquids can burn from a coffee cup, cruise control isn't auto-pilot in Winnebago's, etc), they definitely should receive less. Everytime that someone is paid millions of dollars in a malpractice claim of wrong doing, or hot liquid spilled in a lap, or a Winnebago crashed because they set it to cruis-control and then walked to the back to make lunch (in a moving vehicle), the company that pays out .. will eventually have to charge more from existing customers to get the money back. The small person, will always end up paying the costs of the uber wrong they is brought to the legal system. It also doesn't help that the legal fees collected by the lawyers that bring the wrongful/harmful claim is usually around 33% of the amount collected from the wining lawsuit. So, if someone is wrongfully *burned* in their lap from hot coffee, and the court awards the plaintiff $1.5 million, then the winning lawyer/law firm gets a cool $500,000. That's just once a big award is declared in court. Now multiply that times the thousands and thousands of times it's happened, and you have a lot of lawyers are incented to find the different injuries and malpractices happening all around them. Ever hear of the term .. Ambulance Chaser? Well, this is the modern version of ambulance chasing.

Technology.. will march on. As it marches, it'll get more expensive. Wrongful suits, don't need to happen at the rate it happens now. Take the incentive away from these mega dollar lawsuits and health care costs will go down.

Health and Health Care

[NOTE: Probably the main reason why the cost of health care has gone up over the years (faster than inflation) is the fact that the cost for treatment (through technology) has increased. If you go back 40-50 years, if you were diagnosed with cancer or heart disease, about the only thing you were prescribed was a bed to die in. And people did. Now, people have a wide palette of diagnostics, therapies, procedures, medicines that they can take to become less sick. And the price tag to become less sick is higher all the time. The technologies developed to become less sick cost someone to develop them. And the price tag to use them is part of paying back the companies that wield the technology to help others. Cancer or heart disease isn't a death sentence like it used to be decades ago. So-o-o-o-o-o technology can be expensive to diagnose and treat someone's condition. Add to that the fact that insurance premiums that the doctors / hospitals have to pay is outrageously high, doesn't help a bit for the cost of an office visit to be any less either. If the premiums went down... health care costs would go down to. As long as it's more expensive to see a doctor (with the costs a doctor has to pay) it'll always have an increasing price.]

OK... What's the difference between *HEALTH* and *HEALTH CARE?* Anybody?

Health care is what is sought and applied to your life to go from more sick to less sick.

Health is the state of your being. If you're *healthy* .. on the life-death scale, you are closer to the *life* end. If you are *sick*/*sickly* .. then you are closer to *death* (hate to sound morbid or macabre) on the life-death scale. That might be an oversimplification, but that's reality. And I'm not saying that someone with the common cold is on deaths edge and only a few ticks on the life-death scale away from death .. though they have moved closer to *death* than they are *life* when looking at the whole spectrum.

What gets me about this whole health care extravaganza is that people (driven by the gov't officials and national dominant media folks) aren't responsible for their own health .. so the gov't is the one that will make their health care decisions for them.

To me, from a LAW of ATTRACTION perspective, if you emphasize health care .. you get more and more health care. What is health care? Health care is the treatments (diagnostics, procedures, medicines, therapies, etc, etc, etc) needed to go from more sick to less sick. Or from a state of dis-ease to ease. By wanting more health care.. you get more diagnosis, procedure, medicines, therapies .. which will have to be paid for. The law of attraction states that *like* attracts *like*. So.. health care .. attracts more *health care*. A healthy state of being isn't necessarily the end result (though we hope it is) of health care.

I think, we ought to emphasize *HEALTH*. From a law of attraction perspective, health attracts more health (or better/improved health). As health increases .. the disease (or dis-ease) decreases. As health improves, diagnostics decline, medications drop away, therapies occur less, etc.

I'd imagine that if anyone did the studies on obesity and vice-born dis-eases .. that'd probably account for 30-40-50% of all of the health-care costs to get people healthier. People want to spend less on health care, they should look towards increasing their health quotient so that the need for health care diminishes over time.

Ever watch the NBC show 'The Biggest Loser?' No? Well, that's where they (the producers of that show) select about 16-20-24 people (sometimes in pairs, couples, or maybe families) that are *overweight*. And not just regular overweight but obese. What is obesity? Obesity happens when someone is 30% overweight. Super obesity happens at 50% overweight. Basically, everyone on the biggest loser is easily obese and might very well be super obese. It's a 'survivor' type reality show that someone (at least one) every week is voted off the ranch. While everyone is there during the week, they are learning about nutrition, exercise, fitness, and themselves. If someone makes it through the full 16 weeks, they'll likely have lost 80-100 lbs pretty easily... which is quite remarkable. Heck, 25 lbs would be quite remarkable. By the time the final show airs (which is about 6 months from when they started) .. the winner will likely have lost 50% or more of their original body weight. Quite amazing! People sometimes enter the show as diabetics on insulin and leave the show without the need to be dependent on insulin.

Now, I say all that because even if a person doesn't lose the poundage like they do on The Biggest Loser, but steadily lose something, that's a very good thing. Who cares if it's a half-pound or pound a week? It's slow, but it's still very good. Half a pound a week is still 25-26 pounds a year. Do that regularly for 4 years and that's 100 lbs lost! A pound a week will have someone losing 50 lbs-ish a year. Do that for a 2-4 years and someone can lose 100-200 lbs! Still quite remarkable. The thing is.. to start. Start getting more healthy.

With the advent of a lot of studies coming out these days of how obesity has grown in America by 30%, 35%, or 40% since the 1980's or 1990's, it's clear that people are sabotaging themselves causing their own health to decline towards a more stressful state where their organs have to work harder. The heart has to pump harder. The joints are under more stress by the weight on them. The pancreas doesn't generate as much good insulin as it should to digest sugar the way it should putting people into a diabetic state of being, and on, and on, and on.

If people choose NOT to get healthy. Then that's their choice. This might sound like I'm lacking tact and compassion for others. It's their choice. If people choose to abuse their bodies with an over indulgence of food, alcohol, drugs, etc. that is their choice to live with.

Ya know, it's kinda like the way there are laws on many state books for motorcycle riders / operators to have helmets covering their head. I think, that if they choose not to wear a helmet, then they ought to sign some kind of waiver that states they know what they are doing that in the event of a motorcycle accident (while not wearing a helmet) that might compromise their life, they won't be administered any life-saving measures to prolong their life. That way, they are taking full responsibility for the length of their life, and that medical staff (in rescue squads, ambulances, clinics, or hospitals) will not have to invest their time (or resources) to rescue this soul to extend their life by administering any life-saving measures. It's their choice. Let them live (or die) with their choice. At least, if they make this choice, it's their choice and not the gov't making it for them.

Same with health. If people choose not to improve their health. They ought to be able to take themselves out of the *health pool* by signing some document saying they are in full responsibility of what happens in their life according to the decisions they make.

Same with the vices people engage in that might have health consequences.. abusing alcohol, abusing drugs and/or chemicals, tobacco, etc. People have choices. If they choose to abuse their own temple (body) then they ought not to expect everybody else (the gov't) to pick up their health tab.

So-o-o-o-o-o-o-o-o-o what am I getting at? I think, if there's a plan needed to help people and their health, let's minister to their health and do things to make it better. Let's put system's of some kind in place that keep track of a persons vital statistics (age, height, weight, measurements of arms, legs, chest, hips, blood pressure, food consumed activity, calorie exercise activity, etc, etc, etc, whatever) that allow people to see how their ACTIONS (what they do) shows their RESULTS of what they do. Let people see how when they eat a gallon of ice cream or something very fatty, that their weight goes up, and how when they eat things of a high nutrition content (that feeds the body the fuel it needs) how their weight will typically stay level or go down (depending on the physical activity of the day/week).

If the gov't is bent on spending a billion dollars, invest the money into a system that will track all of this information and make it easy to see how ACTIONS has RESULTS. Some kind of health blogging system.

If it came down to multiple billions of dollars, if the gov't wants to do something for everyone, then make a program that gets everyone a bicycle to ride to work, or pays for the widening of roads for bike paths (or both), or pays for the expense of a monthly gym membership (with exercise and nutrition coaching), or does a number of singular things for those that want to increase their quotient of health. If someone doesn't want a bicycle, then maybe they can do the gym membership. Or if they don't want either, have a local neighborhood group exercise meeting kind of thing they can go to on a regular basis.

Now *that* would be a true stimulus package. Stimulate people to increase their health. Stimulate people to ride a bicycle to-/from- work. Stimulate fitness clubs to bring those in that lack high degrees of health.

That's what I call a true HEALTH PLAN.