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HEALTH CARE REFORM AND YOU



HEALTH CARE REFORM to ME

There is a lot of money flying about at those ethereal heights so it is impressive to me that health care reform is possible in the next year.  I decided to check it out.  Here is what I found.

United States Congress -- The leading governmental soothsayer on health care reform, besides our fearless national leader, seemed to be U.S. Senator Max Baucus (D-Mont). Being green, I hopped on my bicycle and rode to Washington D.C. to talk to him about his view of the subject matter. He told me that he had written a detailed White Paper entitled Health Reform 2009. He shunted me off to his Spartan library with a copy. It is daunting and 90 pages of cogent analysis written by one of his prime campaign sponsors. I commend it to your study if you believe him and are serious about the subject. I flew back home after being sure the pilots knew how to use that special ‘stick' in their cockpit.

The essence of Max's plan is affordable health care without using single payer. What is single payer anyway?

Single Payer -- Single payer is an approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company. The proposed advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs.

Most pundits represent our present Medicare system as an example of a single payer program. Medicare is presently limited to care for senior citizens and a certain class of the disabled. Others refer to the Veterans Administration hospitals and local VA care offices as a single payer medical care provider. Being too young to get Medicare, I decided to join the U.S. Army to see how the VA really works for real people. First, I selected a Vietnam Veteran friend of mine and followed him through his treatment at the Seattle VA hospital where he was being treated for PTSD. His care was superb at all levels. I followed him for two years under this VA program. But, to really see how a single payer would work at the ground level for regular folks, I decided to enroll myself. I nervously fingered the "Enrollment" door at the Portland, Oregon VA hospital armed with my birth certificate and a certified copy of my DD 214. Within an hour I was armed with my brand new VA health card and I was told to make an appointment for a physical exam. Shortly, thereafter I walked into an empty VA waiting room at the appointed time and I was immediately whisked through the most kind and comprehensive physical I have ever had including the executive physical exams I used to get while a senior officer in a large Wall St. insurance company. This single payer deal ain't bad.

Canadian Health Care system -- All the anti-pols say that we wouldn't want anything like the Canadian system, so I went to Toronto which I heard was somewhere near Canada. I talked to the folks on the ground. Here is what they told me.

Canada has a federally sponsored, publicly funded Medicare system, with most services provided by the private sector. Each province may opt out, though none currently do. Canada's system is known as a single payer system, where basic services are provided by private doctors (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. A physician cannot charge a fee for a service that is higher than the negotiated rate — even to patients who are not covered by the publicly funded system — unless the physician opts out of billing the publicly funded system altogether. Pharmaceutical costs are set at a global median by government price controls. Other areas of health care, such as dentistry and optometry, are wholly private.

In talking to citizens on the street in Toronto I found waiting times are a source of complaints. Studies show that 57% of Canadians reported waiting four weeks to see a specialist and a quarter of the population reported waiting four hours or more to get emergency treatment. Others were very happy with the system. There must be another single payer example.

Sweden's Health Care -- Parochial self interest, I am 100% Swede, put me on a trip to my father's land. I hopped in my kayak and paddled to Stockholm. Stockholm is the most beautiful city in the world, bar none. Arriving on flag day I learned why Swedes are so healthy. They drink too much and they drink in the sun in large gulps because they have so little of it. Summer begins in July and is over in August. Because they drink so much, liquor is very expensive, therefore much liquor is home brewed. But, I digress.

The Swedish health care system is a socialized, public health care system. It is informally divided into 7 sections: "Close-to-home care" (primary care clinics, maternity care clinics, out-patient psychiatric clinics, etc.), emergency care, elective care, in-patient care, out-patient care, specialist care, and dental care.

A person seeking care first contacts a clinic for a doctor's appointment, and may then be referred to a specialist by the clinic physician, who may in turn recommend either in-patient or out-patient treatment, or an elective care option. All emergency cases are treated by an emergency department at a hospital.

The health care is governed by the 21 County Councils of Sweden, which act on general recommendations of the parliament and delegate local health care government to the municipalities. Regulations, waiting times and patient fees vary in the different counties.

The state finances the bulk of health care costs, with the patient paying a nominal fee for examinations and some tests. The state pays for approximately 85% of medical costs.

When a physician declares a patient to be ill for whatever reason (by signing a certificate of illness/unfitness), the patient is paid a percentage of their normal daily wage from the second day. For the first 14 days, the employer is required to pay this wage, and after that the state pays the wage until the patient is declared fit.

The state also reimburses patients for travel costs to and from the clinic or hospital.

Being aware that what is important is what the people think, I traveled to my father's boyhood home near Svenstavik and asked my Uncle. He is 71 years old and disabled with a bad back from years of building windows and doors which must be very thick since this town is near the arctic circle. He has the option of home health care daily, a free apartment near the hospital or a group home. He chose his home where delightful ladies look in on him every day and take care of his every need at nominal cost.

The doctors, on the other hand, being paid so little were protesting in the park. You can please all the people some of the time.......................

The President -- Since President Obama started all this, I gave Obama a ring and here is what he told me. He and Joe have put out their own White Paper. They agree it has become the art of the possible. He'd do it different if he was the ruler of the world, but since he is stuck with politics and the greed of the insurance companies, he wants to keep what we have, but tinker. Ah yes, the insurance companies..................

Health Insurance Carrier Concerns -- In order to get a complete view from all quarters, I decided to apply for a job with a good, solid insurance company. After fourteen years toiling on the inside here is what I found. Insurance companies are basically honest. All of them. But, they are lazy and they don't like change as much as a new born baby does with wet diapers. Insurance company management is mediocre (notice you never hear about layoffs at insurance companies -- that should trouble you. Think AIG) and the only reason they do so well is they have lotsa money. Lots. They are so rich they can afford to be lackadaisical. That is why they are not spurred into action until their ox is whored.

They are doomed. Dr. Howard Dean says they are doomed as do California nurses and they are on to something. Profit is going to be taken out of health care. It is only a matter of time. And should be a matter of shame.

C Lauren Paulson 2009

Posted on Friday, May 15, 2009 at 11:20AM by Registered CommenterLAUREN PAULSON | Comments3 Comments | References3 References

References (3)

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  • Response
    I went on to the University of Pittsburgh to work toward my Ph. D. in Biochemistry. I made a point of attending nearly every home game at the stadium next to the medical school where I was working. During those years just before Dorsett and Marino, Pitt was ranked one of ...
  • Response
    BULLETINS FROM ALOHA - WEEKLY BULLETINSl - HEALTH CARE REFORM AND YOU
  • Response
    Response: dental insurance
    BULLETINS FROM ALOHA - WEEKLY BULLETINSl - HEALTH CARE REFORM AND YOU

Reader Comments (3)

Old Russian saying, You can tell say lie 1000 times, but not change truth.

Difference between USSR Communist media and USA "mainstream media"

In Russia government make media say what they want - even if lie.
In USA "mainstream media" try make government what they want - even if lie..

.....eventually they become same thing?!

I Igor produce "Obama birth certificate" at www.igormarxo.org

May 15, 2009 | Unregistered CommenterIgor Marxomarxovich

I applaud your initiative in finding the reality of healthcare for yourself (trip to Toronto).
However, as a Canadian and a health professional, the lived reality is different than your narrow and legalistic description.

For example, you say "most services are provided by private sector".
This is not so. All my medical and hospital and public health services are provided by the government. Full stop. Oh yes, the hospitals are "privately owned" as they are usually owned by a religious organization or a charitable society. But they have no say in anything.

Physicians are legally private (own and pay for their own medical offices), but they may NOT charge anything except government negotiated rates and are controlled in countless ways. For example,the money a doc is paid for an amniocentesis (invasive test into uterus while fetus is present) is less than most women pay for a haircut. Many of our well trained docs leave and go where they are paid and where they have some freedom to practice. Here orthopods and surgeons are allotted operating room time (limits of hospitals and nurses because of poor planning and the gov stranglehold on hospitals and their operating budgets). Generally operating time is only a few hours a week. Insurance companyies exist only for dental services and such -- not for any medically necessary care (not allowed - check with insurance companies who are now doing a gooming business in "critical care insurance" which means that if you are diagnosed with something bad,they give you a huge hunk of money because you will need it to leave CAnada and get care immediately). The dental system and the dentists are private. Check what dentists get paid. Insurance companies are not allowed by law to provide services that are "covered under the Canada Health Act" (everything except dental and non-medically necessary services). Yes, there are a few private clinics popping up. They are technically illegal and risk being shut down if the government chooses at any moment. Because waiting so intense, gov is currently turning a blind eye to these clinics, but those against any private involvement are lobbying hard against these "illegal" services because they are "against the Canada Health Act".
Janet
www.findinghealthcare.ca

Health insurance covers all the medical costs generated by illness or diseases. All the conditions covered by the Health insurance are stated in the health insurance policy. Health policy is a legal agreement. The price of the legal agreement is called the premium. Insurance is a agreement that provides money to cover for the policyholder's medical costs. Thanks for the post.

blue cross blue shield

January 2, 2012 | Unregistered Commenterblue cross blue shield

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