Obama Healthcare - Part I
AUGUST 9th 2009 - Perankhscribe recieves a message from a woman who is for Obamacare. It reads as follows.
"I am very concerned about [your] negative comments about a healthcare plan. I am a woman who use to have health insurance through a husband's job. He lost his job, left me and now, I have no health insurance. I am college educated, can't find a job other than a substitute teaching job and they do not offer insurance. My insurance just went up to $300 per month and I can barely pay the bills as it is. Do you know how many women in their late 40-50's are in the same boat? We already have Medicare, which is governement run and nobody is complaining about that. Plus there are countries who offer government run insurance and again no one complains. I guess I just don't get it? Is it all the people complaining have great insurance? Maybe if teachers made what doctors make I wouldn't complain."
Perankhscribe responds:
The healthcare plan proposed before congress is not the change you seek. You deserve high level health care; not a plan rushed through under the guise of good intention. I am right to be critical of plans like this, I believe this plan will cost some people their lives. Almost everyone believes in the spirit of universal care; we are a compassionate people and we want everyone who is sick to receive care. My concern with the bill before congress is that it does not address our health care needs. Nay, I fear it would be inferior to what we have now and come at a cost we can ill afford.
You have confronted me with an emotional argument, so first I will acknowledge your feelings as having weight. I sympathize with people in your situation, my twenty-four year old girlfriend, a certified nursing assistant makes a little over a thousand dollars a month. She does this managing approximately sixty residents in an assisted living community based residential facility. She works full time on late shifts and needless to say she is living below the poverty line. Her health insurance costs her about eighty dollars per paycheck.(160/month) I am sure those costs will escalate as she gets older, but for now her issue is not so much the availability of cheap health care, but the fear of finding opportunities for her future livelihood. I find this interesting, because my girlfriend is the type of person Obama's plan is supposed to help. For the record, she is managed for a chronic condition which is unlikely to be well provided for under Obama's life management plan. She admits to me that she has "adequate coverage now," will she have adequate coverage in the future? Will she have adequate coverage when she gets to be your age? Hate me for standing in the way of "universal change" if you must, but rushing a plan through congress before people can truly reflect on the impact of such important legislation is far from wise.
-From my perspective, as the plan stands now, it will probably adequately cover far fewer people than the number of people who are getting coverage now. It may sound good to say that you support a plan where everyone will have "coverage" on paper, but what does that really mean?
If you look into the bill you may find that the coverage provided often is barely anything more than preventative medicine. When you actually have an illness, it is questionable to what extent you will receive treatment. Sure, for your run of the mill simple diseases, you might get care. What happens when you age and accrue a list of more complicated illnesses? What happens when you have an unusual disease? In these cases it becomes questionable to what degree you will receive care. People with unique needs are not well provided for. Congressmen don't even read the bills they sign into law, what makes you think they spent hours thinking about the kid with a rare defect nobody ever heard of? How about your father with a strange but treatable variant of cancer? Before I support any bill requiring mandatory enrollment, I have to ask what happens when you have something not explicitly covered in this health care bill? Are you forced to pay the obligatory government fee only to realize that what you paid for is worthless for you? I mean its one thing to choose to pay for a plan that may not cover you, but to be forced to pay for a plan that may not cover you. What is that?
-With socialized medicine you are forced to pay for a system in which the government ultimately gains a monopoly on health insurance. If you do end up with something not on the list then you will need to pay extra to get the care you need. (If it is in fact available.)
So lets say I am forced to pay for
Obama's insurance, then lets say I get something not covered on the
list. What happens next? Surely I have the option of finding
alternative plans that do make accommodations for me? Yeah, I am sure insurance companies will be rushing to provide coverage for the needy and expensive cases right? Wrong. Even
if this plan didn't outlaw supplemental insurance after entering
Obamacare(which it does), insurance companies would still go under
because they no longer collect enough money from the countless healthy
people that would otherwise cover the costs of chronic cases. If by some loophole the insurance companies did find a way to continue business, I am sure it will come at quite the premium.Don't you love how the government takes away the freedom of choice of all to give inferior care to some?
People who really need health insurance pay more with socialized medicine. Don't believe me? In Canada there is a multi-billion dollar industry that makes its fortune by getting Canadians medical treatment here in the United States. Oddly, some Canadians would rather pay extra to get care here than take their chances with their own socialized care. If you are too poor to afford that extra bit because you were forced to spend all your money on Obamacare, then I guess you are out of luck. Hence, the people who really need coverage don't actually get to have care, but at least we can say they are "covered." Is this why "nobody complains" about not having coverage in Europe? Everyone is covered over there right? Does everyone get care over there? Nope.
-If one chooses to request from you that which allows them satisfaction and means to continue their trade, then they should not be considered greedy.
I find it disturbing that you go after doctors as the rich people who can shrug off little things like health care costs. Frankly, you are talking to a student doctor who has about one-hundred and sixty thousand dollars of debt; I can't speak for those "rich" doctors. I willingly took that debt because the prospect of being a doctor promised a livelihood where I could help people, pursue intellectual pursuits and make enough money to hopefully not have to worry about money all the time. If you have to hate somebody for being rich, why don't you hate Obama's wife? Obama's wife made three-hundred thousand a year for her assistance in gaining support for a plan that circumvented laws that required hospitals to give care to poor and uninsured patienst. (Check out as an article here - The Urban Health Initiative or see this Urban Health Initiative Video.) Yes, the wife of our magnanimous leader was involved in screwing over the poor with a patient dumping scheme! The Obama's are exactly the kind of people I want creating universal change in health care!
It disturbs me to see how easily liberals are made to believe contradictions. You profess to want the care that doctors provide, but you also believe that these doctors are standing in the way of health care for all. You have been made to believe that the care offered by doctors is something that you absolutely must have; yet these doctors are being greedy whenever they expect to have anything more than what the government offers. News flash sister, what doctors have they offer you of their own volition. While the doctors I know would save a life even if it meant not getting paid well, why should they be forced to? For my own part as a student doctor, if I freely choose to live a modest means, I will be content. If however this sacred right of man to pursue what is in his own estimate adequate compensation for his effort is violated; if his station in life is decreed not by his free volition, but by the mandates of government. To hell with that government. It is nothing more than a tyranny and its supporters not of my brethren. Beware, for if you proceed in your logic it may one day be used against you. Are not the teachers who protest for more money also greedy?
-Liberal logic confuses me. Doctors who spend their lives in service of their fellow man are callous, but the government is everyone's beneficiary?
What about liberalism has so persuaded you that the government really has your best interest in mind? This plan is nothing more than an effort put forth by powerful people to racket in on the health care industry. You didn't really buy into that hope and change nonsense did you? Somewhere some liberal fat cats stand to gain substantially. Why else do you think they invested large fortunes in Barack Obama? Somewhere a liberal company will be able to drop their expensive employee health care packages, other liberals will have new programs to rape for cash and some scheming liberal politicians will now be able to offer expansions of the health care plan as scraps to entice voters in re-election bids. Simple power theory really, make people dependent on you for a their needs and then ration out their desires in exchange for their loyalty.
-I reject the premise that this plan before congress provides health care. I reject the notion that this plan truly covers all Americans. Therefore, I reject the logic of anybody who believes that this plan is "Universal Healthcare."
Regarding your claim that nobody ever complains about systems like medicare; that nobody ever complains about the health care provided in the countries providing "universal health care." This is provably false. Here is a link to a forum where some Canadians complain about their healthcare. If you want to read some more substantial evidence, read some foreign newspapers, review unbiased health care polling date. Try visiting these countries, visit a variety of their local emergency departments and tell me what they are like. If like Michael Moore you expect me to be gullible enough to believe that countries like Cuba provide better care than the United States, that nobody complains about health care in socialized countries, then don't fault me for being dumb enough to suggest the following: Perhaps "nobody" complains under a socialized system because they are already dead. When the sick people die, the prevalence of people complaining about a disease also decreases. Perfect logic.
My aim though is not really to suggest that you will die in Europe or can't get decent care in Canada. I merely reject the notion that their systems are necessarily superior when they suffer enormous pitfalls in care. One only need review their literature to observe this. To concisely prove why socialized medicine leads to health care delays and poor treatment outcome is outside of the scope of my article. It requires more wisdom than I feel capable of competently imparting. Suffice it to say that delays and serious failings are almost universally common with universal health care and the American people deserve an honest, candid and educated discussion before being mandated to join any program adopted by the government. Obama and his lackeys thus far have tried to silence critics and deflect genuine criticism.
-"I WILL FOLLOW that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous."
As a health care consumer and a student doctor, I have grave concerns about our government rushing to adopt a plan with such controversial proposals. The notion that one day I will be forced to select from a very limited government approved treatment list when I know the best care might be something else frightens me. It goes against the very tradition of our hippocratic oath.
What the government offers you as "approved" treatment may be very different from what my ability and judgment consider to the benefit of my patient. As doctors we are called to use our abilities and evidence based medicine to guide our care. Who will I turn to for unbiased research? When the research on what is good for your health care comes from the same entity deciding what to give you, do you think that there just might be a conflict of interest? Why would you want special interests in government to decide what treatments become the standard of care?
-Personally, I wonder what it is that keeps the government from being just another really bad insurance company? (Aside from the fact that the government will make you join them if you don't have insurance or else.)
As things are now, there are plenty of special interests that limit the acquisition of ideal care. Doctors, like patients, have had their fill with insurance companies who dictate what treatments a doctor will be reimbursed for. An often used argument is that we need the government to step in because insurance companies are out of control. Everyone seems resigned to the notion that government is better than the insurance companies.
Is the government going to cover new expensive and untested treatments that the insurance companies don't? Probably not. They aren't proven to be cost effective. Is the government going to do whatever they can to pay for treatment based on individual needs when you need it? No? How will they decide what conditions get coverage and what don't? What is so great about government care that I should be forced to pay for it or else?
Perhaps what makes the government better than insurance companies is that they "reel in those greedy doctors?" It keeps them from making "bucco-bucks" on the unnecessary procedures that doctors con their ignorant patients into agreeing to. You know how this is done right, reimburse doctors based on outcome? Let me put it to you like this since you are a teacher. If I were to pay teachers based on whether or not their students passed certain tests, how would you feel about that? You want teachers to make the same as doctors right? Then you should be held to the same standards as we are. If your students don't pass that test you should be liable to a lawsuit for educational malpractice. You know in liberal run Detroit half of the population cannot read. As a teacher would you like to be paid on your success at teaching English literature in that environment? Are you aware that there are confounding factors associated with the urban health setting that make expected outcomes less favorable there? Do you think doctors will flock to Urban health centers or will they have to be coerced?
-The government option does not solve the issue that most people have with insurance, namely that they are able to receive the treatment they believe they paid for. The government approach seems to mandate the treatments a doctor will provide even more so than the insurance companies!
Lets consider the treatment of a hypothetical diabetic patient. If a doctor will only get paid for treating diabetes if he brings the Hemoglobin A1c down below 6.0, then that doctor will be unduly influenced to throw every government approved treatment at you just to make ends meet! This kind of influence on care is worse than any subliminal advertising the pharmaceutical companies exert on a doctor. In fact this logic is dangerous for a patient because it assumes that the lab result averagely found in the healthy population is healthy for any particular patient. I cite this particular example because people died with hypoglycemia in Europe when the government mandated getting Hemoglobin A1c below 6.0. Government mandates cannot be tailored to fit every individual patient. Even reputable research is often unclear and debatable. Only naive academics believe that the human body regularly follows the textbook.
Ever wonder how liberals intend to decide who lives and who dies? Have you ever heard of the term "QALY" - It means quality adjusted life year. A form of this variable is often used in formulas that decide what treatments should be paid for under socialized care. (For when there isn't a special interest group calling the shots.) Simply see how many QALYs a treatment adds to your life and divide it by its cost. The cheapest treatments are deemed the most effective. In principle this sounds like a noble attempt to control costs in health care, but I have a problem with it. What the hell is a QALY? Its like the song, how do you measure a year? Who the hell but me can say what my quality of life is and what my time on Earth means to me? Shouldn't this be a decision between my doctor and I? When Obama talks about making responsible health care choices, does he mean I have to always see things the way the government does? Accept that government mandated treatments are my best options? Maybe I want that long shot quadruple bypass operation so I live long enough to see Obama thrown out of office? Imagine what a quality year that would be.
Unfortunately, the proposal Obama supports falls far short of providing
for the expectations we have as health care consumers. He tries to
promise you everything he thinks you want to hear, but the plan itself
does not lay out realistic options to secure these aims. He promises
not to cover the health care costs for illegal immigrants but the plan
he supports makes no provision to prevent it. He plans to expand the
budget by at least another trillion, but he also promised not to raise
our taxes with that. He says that this can be done by remaking our
society into one that will make responsible health care choices instead
of wasteful ones. Well, since Obama can't actually persuade every
patient to take pain pills instead of expensive surgery, I guess he
will just make that choice for you. You know it used to be that the
doctor would explain all of the options to a patient and tried to give
the patient the tools needed to make a responsible decision. I guess
people were just too "wasteful" making their own choices under that
system. The government knows best. They know the best things to do with
your money and they know the best decisions you should make for your
health care.
As I must ultimately bring this article to a close, I don't want to leave one with the belief that our current system is ideal. Our system certainly has its issues; for many the cost of optimal treatment is an onerous burden. Please don't believe that people like myself are against all health care reform. There are many interesting ideas out there with the potential to bring down health care costs and improve quality of care. With that said, the life management plan before congress as supported by President Obama does not provide any of the health care I would seek for myself. I would rather be uninsured than pay one cent for Obamacare. As our forefathers said, give me liberty or give me death! Obama can keep his health care plan.