From: sichermn@beach.csulb.edu (Jeff Sicherman)
Subject: Re: Health Care [long] -- was Re: I will vote for Clinton if ...
Organization: Cal State Long Beach
Distribution: usa
Date: Mon, 12 Oct 1992 02:33:30 GMT

In article <1992Oct11.080107.28487@organpipe.uug.arizona.edu> shackeld@helium.gas.uug.arizona.edu (david m shackelford ) writes:
>Here's some thoughts on health care in the form of attempting
>to convince an apparent Clinton supporter to consider Bush.  
>I give one possible "nightmare" scenario followed by a comparison
>between two philosophies of government with respect to health care.

   Your additudes are earnest but somewhat naive. And if you don't consider
the current wasteful, inadequate system a nightmare scenario, then I don't
know what is ... naive me.


>  
>In article <1992Oct9.232046.12148@u.washington.edu> sieferme@stein.u.washington.edu (Eric Sieferman) writes:
>>
>>Okay.  For you, taxation is the paramount issue.  Vote for
>>Bush.  For me, the three biggest issues are:  national health
>>care, the future of the Supreme Court, and the further intrusion
>>of christian fundamentalism into public life.  I'm voting
>>for Clinton.  Isn't democracy fun? :)
>>
>
>I'd like to take a shot at convincing you that Clinton doesn't
>provide the best solution to your concerns.
>
>Health care is a very important issue, and both parties are
>talking about ways to improve the situation.  I believe, along
>with most Republicans, that our health care problem would be
>solved best through a combination of competition and assistance.
>It appears that most Democrats prefer a solution that depends
>on increased regulation and massive government funding.

  If both the healthcare and insurance industries were commodity
markets and subject to anti-trust regulation, it might be possible
to solve the problems through competition with some subsidies.
However, the nature of the beasts precludes this for the most part.
Through some perhaps ill-advised exceptions, the insurance industry
is not competitive enough and at the same time not controlled enough
visi-a-vis the anti-trust laws. Also, both the intrusion into a
market by both government *and* insurance companies as third-party
payers tends to make the suppliers - hospitals, doctors, clinics,
etc. - not behjave in competitive ways. Furthermore, the consumers
do not have the freedom of choice and the prerequisites for it:
sufficient information for and the opportunity to consider and make
an educated choice in making decisions about most medical services -
particularly for the most costly ones.

>
>Here is the scenario I am afraid of:  Clinton is elected
>President along with Democrat majorities in both the House
>and Senate.  Senator Kennedy sponsors a national health
>care bill totally regulating the health care industry.
>The government would tell us which doctor to see, which
>hospital to go to, which tests could be used, which
>treatments would be allowed.  The system would be similar
>to the VA hospital system or the military hospitals.  

  Seems unlikely. regardless of what you think of Kennedy
either personally or politcally, he just does not have that
kind of influence anymore, if he ever did. And there are too
many antagonistic interest groups to ever successfully push
through, much less implemenet, such a radical plan. Moreover,
the country is still too conservative and cycnical about
massive government intrusions of *all* kinds to ever swallow
a nationalized system of health care services. In any case,
it seems farily clear that Clinton does not propose or support
such a program.

>
>I've seen the results of such a system first-hand.
>There is a lot of benefit in such a system -- as long as
>you don't need any special treatment.  What if we "cut costs"
>by denying AIDS patients access to their expensive drugs?
>What if we decide chemotherapy for elderly cancer patients
>doesn't meet the budgetary requirements?

   That is an issue Oregon is facing right now with their program.
However, the issue is much more an individual case one and not so
clear-cut and - dried as you seem to suggest. The facts are that
a very high percentage of health care dollars are spent by and for
terminal cases in the last year or less of their lives without any
clear benefit to the recipient in terms of quality of life *and*
(this is controversial) benefit to society at large. A consequence
is that much preventive health care is un- or under-funded so that
small problems become bigger, more expensive ones over time. A vicious
cycle.

>
>There is no proof that this scenario could happen.  I'm
>not trying to say that it would, but it scares me enough
>to seek other options.  The Republican party offers an
>in-between step which reduces the chance of a "1984"-ish
>system while offering some chance for improvement.

  Perhaps, but the history of some Republican in-between
programs is that they become a politcal excuse to say
'we did something' without really solving the problems.
That's a risk of the Republican route.
>
>The right way to handle our health care crisis is to
>adopt a combination of regulation and funding.  Rather
>than take complete control of the industry, we should
>single out the biggest problems for regulatory and
>fiscal repair, while observing the indirect results
>of these steps.

  You're creating a straw-man. No one of the major parties
or candidates is proposing 'taking control of the industry'.
But singling out has it's own risks in that less than a
comprehensive approach may let insurance companies wiggle
around through legal and regulatory loopholes and shift
costs, expenses, etc. to the non-big-problem-addressed
side of things. That's what they pay all those lawyers,
lobbiests, and accountants for.

>
>There are many Americans who need the government's help
>in obtaining health insurance.  We should expand the
>window in which medicare/medicaid type insurance is
>available.  To offset some of the cost of expanding the
>rolls, these programs need to have stricter controls and
>streamlining of administrative function.

  Everyone agrees with this diagnosis. Now where is your
cure that doesn't entail some centralization and standardization
of administration and how do you get 'stricter controls' in such
a decentralized system without more administrative overhead ?

>
>The insurance industry needs to be regulated better.
>Our regulatory system should follow the KISS principle --
>"Keep it Small and Simple".  Regulations should be few and
>to the point.  Common sense should dictate most of the
>necessary regulations.

   Unfortunately, this is a country of laws, not of common
sense. It's also necessary to agree with what common sense
is. The health care industry has it's own concept of it, the
insurance industry another one, the government/consumers still
another one. Which one of these is the 'true' common sense.
More likely none of them are and each just interprets it's own
self-interest as common sense - or, more precisely - common cents.
>
>A vast drain on the health care industry is the need
>for doctors to insure themselves against malpractice.  We
>need to impose legislated limits on damage awards.  I have
>some sympathy for the victims of malpractice, and support
>the doctrine that they are entitled to compensation.  I
>do not believe, however, that multimillion-dollar awards
>are reasonable.  Human life is generally regarded as
>priceless [NO Abortion followups please, this is an attempt
>to discuss health care logically!!], thus the amount of
>the award doesn't really matter.  The judgement that the
>individuals and/or organizations involved were responsible
>is the primary importance of malpractice law.

  Actually, the number of successful malpractice cases and
the awards - even the massive ones - are not the real problem
here. Most large awards are paid out over many years in the
form of annuities which reduce the up-front costs to the
insurers. In terms of their size, have you considered what it
costs to support a medically-disabled individual.

  And the punative damages are meant to dissuade the negligent
behavior and to encourage self-regulation by the interested
parties. Unfortunately, the insurance companies seem to lack
the will to do it - it's just easier to raise the rates. And
the doctors seem to lack the guts - it's easier to whine through
lobbiests and just raise their bills - than to attack the problem
of medical incompatance and irresponsibility.

>
>We need to do something that none of the candidates seems
>to mention.  The medical records system, both of patients
>and providers, is woefully inadequate.  A powerful, secure
>interstate database is necessary to prevent the few quacks
>out there from staying one step ahead of the law.  It is
>also necessary to ensure that when a patient needs care
>the proper records are available, whether that care is
>given by the patient's personal physician or an emergency
>technician in another state.  [I'm looking for a job after
>graduation and would be happy to lead the effort provided
>adequate compensation is offered! ;-)]

   


-- 
Jeff Sicherman
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