After casting the Tea Party movement as essentially interested in armed rebellion against a tyrannical US government, he closed with these words:

“….. and you will suddenly get why you are seeing men at political rallies for the first time ever wearing guns.”

The entire segment was geared at fostering fear.

Its indisputable.

Everybody asserts we’re the wealthiest nation on the planet.

Seems to me we are more like the guy living in the big house with two brand new luxury cars, etc., etc., etc., who is doing it with smoke, mirrors, and debt.

But if we are the wealthiest nation on the planet, maybe the only thing that proves is that no nation can afford to use government to guarantee health care to every one of its citizens. This would be especially true when it has no self control in the other aspects of its work.

So I ask: Is the assumption that we can afford this proven? I wonder if anyone is even thinking about it, or is this assumption in and of itself an 800 lb gorilla that no one has the courage to challenge?

(Breath)

I agree the problem is huge and complex. My response to that is why are we making it more huge and complex by writing hundreds of pages of legislation that tries to address a set of variables that can never be completed anticipated because they are by nature fluid, not static?

Why not back up, determine the basics, and start there?

I have suggested that there are really two things that must form the heart of the issue.

One is that everyone should be able to enter the system. The other is that once they are in the system, they should have the ability to stay in it regardless of what happens with their health. (Within that, I am agreeing with your first point, that employment should not be a pre-condition to either of those basics.)

In twenty lines I have suggested a way that might work.

Am I wrong to want Washington to think in simpler terms?

(Breath)

In the end, however, this discussion must go to the other 800 lb gorilla in the room.

Here’s a list of the other points you bring up, with a couple additions of my own.

1)Healthy people choose, because it’s in their best own interest, to not participate in the risk pool.
2)Doctors, in large part because they fear predatory lawyers, waste money in an effort to cover their asses.
3)Lawyers seek and gain ridiculous sums of money when real mistakes, even innocent mistakes, are made. Politicians are unwilling to rein them in, because they are essentially bought by these lawyers via lobbyists.
4)Insurance companies, in order to control costs, should be an advocate of a consumer who can’t possibly be as informed as he needs to be. The insurance companies do a lousy job of this, because it is easier to raise premiums than do this hard work.
5)Doctors, because of the unique position they occupy, also should be advocates for the consumers. They have the ability to control costs as well, while still making a reasonable living that reflects the investment they have made in their careers. Too many of them are too greedy, and that pushes costs higher than they need to be.
6)Government inserts itself in the system in an effort to be helpful, but in the end, it causes as many problems as it solves. It can’t help being arbitrary, and it thus distorts the system, and places providers in the position of having to “work the system” in order to make their end work out. Inequities abound, and every attempt to address them simply cascades into another set of inequities. The people on the side of government can’t recognize this, or refuse in their arrogance to let go off the turf they’ve gained, so the entire situation devolves into a contest to see who can manipulate who the best, and the consumer suffers in the process.
7)Government intrusion results in lobbyists from almost all concerned groups descending on the politicians, doing whatever they can to distort the process so that it favors the group they represent. More inequities abound. The only problem is who lobbies on behalf of the individual consumer?
8)Leadership in all these entities display immense arrogance, robbing the system of funds at $100M a clip in the form of bonuses, golden parachutes, etc., etc.
9)Individuals make very bad choices concerning their own health. Many expect the system will take care of them no matter what, so they feel no need to be pro-active. They create cost by creating needs that better behavior and discipline would forestall. They think the system owes them.
10)Individuals also add cost to the system by getting procedures for convenience instead of for need. They seem to believe they can’t do without some things that aren’t necessary medically.
11)Pharmaceutical companies the same set of traits listed above. Profit is also their mantra.

Do you recognize the underlying theme?

At the end of your second point, you stated this:

“Not sure how that can be fixed, other than to have patient advocates who advise the consumers……”

I’ll ask you, not to pick on you, but because I know you won’t be offended.

Did it occur to you, as you wrote what you wrote, that what we really need is not another layer of participants in the process, but instead participants in the existing layers that actually give a damn about their fellow man?

Read the list again. Do you recognize that every one of these issues is rooted in lousy behavior on the part of every constituent group in the system, including the consumers themselves?

Do we have a cost problem, or do we have a moral problem?

And if it is a moral problem, how will obsessing over cost ever solve it?

Do we really expect the moral issue of greed to go away because the government intervenes?

You also state this:

“Yes, we need more personal responsibility, but you cannot regulate behavior in a free society.”

That is exactly true, and its exactly why the current proposed solution won’t work.

No amount of oversight will take the greed out of the system, and the greed of everyone involved (starting with the greed of the politicians putting forth the answers) will defeat both the process and the solutions that come out of it.

(Breath)

I guess I would ask, what did you expect from a country where half the people do everything they can to marginalize the influence of God in the culture?

What do you expect from a country that kills millions of babies every year before they ever leave the womb? Would you expect an industry that allows that, even encourages it on many fronts, to care about the consumers that managed to survive their gestation period?

Without reference to God, no solid moral structure exists, and profit becomes an acceptable driving force for all behavior.

Who in Washington has the nerve to tell us that our problem is, by and large, that we are fallen, and that so long as the morality of the culture is in a state of decay, the problems of health care can’t be solved, because that industry by its very nature needs people immersed in love, charity, compassion and sympathy to occupy the positions of power that effect it?

(Breath)

I admit freely again that I am fool, and an idealistic one at that.

But I would much rather be an idealistic fool who treasures his God given freedom above anything else than a participant in any proposal that rips freedom so thoroughly from the grasp of my fellow man.

Perhaps it is unrealistic to hope Americans might solve this problem by genuinely loving each other. But that is the only solution I see, because it is the only solution that squares with the plan of God, which insists that the freedom to love is pre-requisite to everything else.

If why I believe this has not come clear in the last couple years, perhaps the last two posts from my prayer blog will help:

http://emboldenme.com/2010/02/freedom-love-evil-desire/

http://emboldenme.com/2010/02/matthew-chapter-17-continued/

“The greatest gift of the human person is not the ability to think, but the freedom to love.”

http://www.definityhealth.com/marketing/index.html

http://www.anthem.com/cdhp/cdhp-groups-ca.html

The concept of making consumers of health care the decision makers and informed consumers is definitely where we need to head as a country and culture.

My favorite paragraph:

“The way business is done in health care (insurance company pays the health care provider), inherently builds the inevitability of waste into the system. The consumer has too little knowledge or control of the product (service) they are buying, and because the insurance company will cover most or all of the tab, they trust the docs and don’t bother to be a consumer and question the number of tests, prescription meds, doc visits, procedures, etc. Add to that the way the insurance companies and Medicare go to battle with the providers over the pass through costs to them, and the whole thing is way too complicated for even a highly educated consumer to understand.”

I still commend Obama for trying to make something happen in year one, as this is (and has been for 30 years) the ginormous elephant in the chambers of congress, and nothing less than a filibuster majority for one party and all 3 houses gives even a faint chance of anything meaningful ever happening.

As great as our health care system can be (I would have never met any of you if I didn’t live near a world class medical center), it has many systemic flaws that are so complex that no one can wrap their arms around them. Yes, those with enough money see no reason to fix it, but the reality of uninhibited escalating costs will hit all of us, including the wealthy Americans who up until now have enjoyed the world’s finest health care.

Just a few of the dynamics that hit me:

(1) I personally wonder why health insurance is employer attached in the first place, especially in a current economy and culture where there is so much job mobility.

I realize there are many drivers on the road who are uninsured, but among the working population, I wonder if there isn’t a higher percentage of car insured drivers than health insured people. Too many “healthy” people chose to roll the dice and go through life uninsured, which ultimately adds a large part of the ultimate expense of the system, whereas they wouldn’t think to do that with their home or car. Take Gator, Guitar Hero, and The Actuary and assume they are healthy and have chosen to go uninsured, and then one of them encounters a $2 million health problem. Now what?

Would we be better off taking that money the employer already contributes and giving it back to the individual to invest in health insurance that is on their own and stays with them for life?

(2) The way business is done in health care (insurance company pays the health care provider), inherently builds the inevitability of waste into the system. The consumer has too little knowledge or control of the product (service) they are buying, and because the insurance company will cover most or all of the tab, they trust the docs and don’t bother to be a consumer and question the number of tests, prescription meds, doc visits, procedures, etc. Add to that the way the insurance companies and Medicare go to battle with the providers over the pass through costs to them, and the whole thing is way too complicated for even a highly educated consumer to understand.

Not sure how that can be fixed, other than to have patient advocates who advise the consumers, and perhaps some form of incentives for efficiency and proficiency for the providers. I also wonder if we wouldn’t all be better off with essentially the same insurance, and from the base level you pay more for the better docs and hospitals out of your own pocket, rather than having the plan determine the docs and hospitals for you (again, more collusion with the managed health care plans between the big hospitals and big insurance).

(3) Insurance – I would like to believe that our current insurance industry represents the best of American capitalism. However, there is just too much evidence from their gigantic profits, highly discriminatory practices, and mammoth lobbying efforts to corrupt the supposed oversight entities, that there has to be a fairer and better way.

I guess I can empathize with the attitude that it is your fault that you have a brain tumor, are fat and have diabetes, have aids because of an active sex life….., but that is just too damn big brother for me. Yes, we need more personal responsibility, but you cannot regulate behavior in a free society (how many of you would appreciate a provision that anyone who drinks would pay out of pocket for any disease that MIGHT have been partially caused by alcohol consumption?). I would rather see every reasonable person insured (no matter how the system is constructed, 10%+ of the population won’t sign-up), no higher price or penalty for “preexisting condition”, but instead bonuses and cost savings for annual checkups, better diet, regular workouts and other preventative efforts by the individual patient. Obesity should be treated as a disease, and we should work hard to find ways to cure people of that condition the same way we have alcoholism, drug addiction, anorexia, smoking, etc.

I am not sure we wouldn’t all be better served having a government run or non-profit insurance industry than what we currently have. The concept of insurance is shared risk. In a perfect world, I want one gigantic pool of patients all paying in equally, equal co-pays and deductibles for all, we then each pay more for the higher the caliber of doc we want to see, less if we follow a regiment of decent diet, exercise and annual thorough checkup, and an insurance entity that would be fair but aggressive in fighting providers on waste. I realize the private insurers are more inclined to give us what we want, but they are also greedy bastards who have rigged the system, and something has to change.

Every penny an American spends on health care, including a nominal amount for basic exercise and nutrition that might prevent disease, should be tax exempt. Abortion, boob jobs and other luxuries should be taxed to high heaven, or at least not be tax exempt.

(4) Pharma – we need some kind of reworking of the system to put the emphasis on R&D partnering private pharma industry with academia research, creating/maintaining healthy profits, quicker but still safe to market, but then not this insane overpriced BS. I currently pay $2000+ a year for one of my meds, AFTER insurance. Comparable medicines that essentially do the same thing (except unfortunately for me) are now generic and cost pennies, but because this Pharma worked a loophole, I will be paying top dollar for another 5+ years. Pay these people enough to keep the R&D that is really beneficial active, but find a way to kill the price gouging that extends far too long (i.e., show us your books, and once you recover your R&D related to this product, plus a nice markup profit, you start charging what it actually costs to produce with a reasonable markup, and you get to keep it from going generic for an extra 10 years).

Another lobby that has rigged the system to make them huge profits. Clearly these people have no ethics, so we need a real oversight from government to make this industry work better.

(5) Malpractice – this needs to be reformed big time. I was massively misdiagnosed, could have sued my doc for a lifetime of money, but it hardly crossed my mind to make that man pay. I have evil thoughts about him from time to time, but in my heart I sense that he did not have malice, and he did something I do at least once a year – he made a big mistake.

If there is malicious intent that causes life altering problems, the doc, hospital, pharma, device manufacturer or government need to pay to give that person a lifetime of health care, assisted living support as needed, sustainable income if he can’t work, and some reasonable amount of penalty benefit. However, we need to enable docs, hospitals and pharmas, with strong oversight, to do their work without constant fear of legal action, or the excessive cost of insurance fees.

I really don’t know whether this can be a local or state issue when the problem seems a lot bigger than any state can manage, and certainly when the oversight that is so desperately lacking should come logically from the federal level. Our state has great health care, and at least according to the opponents of our Republic Governor, better insurance, such that they are debating whether to allow Minnesotans to buy insurance from companies outside the state of MN.