Health Care

“The problem is that our leadership class no longer views Americans as adult constituents capable of making our own decisions: the [sic] view us the way parents view their preschool children.”

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A commenter at the Guardian (!) on the recently passed Senate Health Care bill. The entire thread is worth reading, particularly for her comments:

Maybe I’ll cash in by starting my own insurance company. “Jennifer’s House of Health Insurance and Vintage Clothing.” The premium will be a flat $100 per person per year, with a five-million-dollar deductible. “But Jennifer!” you might protest. “If I have enough money to pay five million dollars a year in health costs, what the hell use is your insurance company to me?”

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On the changing relationship between doctor and patient and that element of distrust

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Jonathan highlights an Instapundit discussion that caught my eye, too. The discussion is about mammograms and the latest proposed guidelines for screening: do the guidelines represent good science, or are they simply meant to save money (these are not mutually exclusive goals)? I don’t know the science, and don’t have any reason to distrust the health care professionals proposing the guidelines, but I understand that an element of distrust is introduced by the current health care debate.

Anyway, the above linked discussion brings up many interesting points. One is the Public-Health fallacy that Jonathan discusses. Another is the changing relationship between doctor and patient in a system where the federal government intrudes so heavily. Guidelines become suspect. Who is the real beneficiary of the guidelines – the individual patient, or the ‘greater good’ of the population as designated by a government official? The government guidelines, or official, become a third party between the patient and the doctor. The relationship is altered. To some extent, this is already the case with third-party payers and the current level of regulation, but the proposed health care bills take it to another level, entirely.

You see the same phenomenon of distrust when a patient talks about ‘greedy’ doctors and drug companies. I think that distrust will be transferred to Washington under the ‘D.C.-centric’ health-care bills that are being considered. And, in the political fight between constituent groups (patients and others), we may end up with a system where large public health bureaucracies will need to be placated first – a bit like California and the public service unions, or the British NHS*. The entire nature of the doctor-patient relationship will be changed. What do you all think? I’m a physician, and like many physicians, have my own levels of distrust. They are currently being directed at the government takeover of health care.

*I recently watched an old “Yes Minister” (Brit sitcom from the 80s) in which a government minister tries to shut down a hospital with no patients (it has a very large staff). A funny joke, yes? Well, the running joke of the show is that the unions resist by making the following claim – who cares if there are no patients? The greater good is served by all those public sector jobs. So, who “owns” the doctor-patient relationship in that sitcom scenario? Soon, alas, to be ours, perhaps?

Update: Think I used the word distrust enough in the above post? It’s like I’m trying to make a point, or something….
Another Update: Hey, a belated thanks for the link, Instapundit!

“When the President chose a partisan path in his speech, he pushed the real debate behind closed doors. This is now a debate among House and Senate Democrats”

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The real action is not taking place at markup.  It is taking place behind closed doors, away from the markup.  When the President chose a partisan path in his speech, he pushed the real debate behind closed doors.  This is now a debate among House and Senate Democrats.  Republicans can influence that debate only to the extent they can change the decision-making process of Democratic members, since everyone assumes that almost every Republican will vote no. 

Keith Hennessey

The comments to the above linked post are utterly depressing. Elections have consequences: I wonder how the ‘Obama’ libertarians and the ‘teach the GOP a lesson’ conservatives are feeling about their respective votes, now? Yes, in a moment of frustration I am being unfair; I barely managed to pull the lever for McCain. In the comments, Keith Hennessey shows up to make the following suggestion:

Call your Representative and Senators (in their DC office). Don’t email them. Call them. Email is largely ignored. Phone calls are not. As an individual citizen, your greatest impacts are (1) speaking up at town meetings, (2) calling, (3) meeting with your representatives and/or their staff, (3) voting, and (4) letters to the editor.

Each individual call has a trivial impact. If enough people call, it can have a big effect.

Yeah, I’m not really feeling it Mr. President

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Our dear President recently delivered an important speech on health care. Sample excerpts are provided below (in italics) with select commentary by yours truly – a busy working physician with no real expertise in health care policy. I do, however, have a keen sense of  ‘so, this is probably gonna hurt, and hurt bad, right?’

There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada’s, where we would severely restrict the private insurance market and have the government provide coverage for everyone. On the right, there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.

That’s a nice summary of the issues, Mr. President. So, what do you think?

While there remain some significant details to be ironed out, I believe a broad consensus exists for the aspects of the plan I just outlined: consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance.

I’m keenly interested in those significant ‘details to be ironed out,’ sir. Is it okay if I remain skeptical about your plan until you, and related House and Senate committees, are done with the ironing? Although, I may not be too pleased with the cuffs-and-collars once that crew is through…..

And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

Hey, it’s nice to call me a friend (although, I’m not really feeling it for the GOP these days, either), but I sense a problem with your logic. If someone is making a wild claim, what legitimate concerns would that person have?

Second, we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system – a system that is currently full of waste and abuse.

Oh, so that’s where we’ll find my legitimate concerns. Most of the plan will be payed for by savings within the existing health care system, you say? I’m sure that will happen. Also, I might be Angelina Jolie. That’s about as likely, sir.

So, to review: the left and the right disagree, the plan ain’t all worked out, quit complaining about it anyway, Republicans, and pixie dust will pay for everything. Got it! Not making wild claims, sir, just kidding around. Because, this is gonna hurt, and hurt bad, isn’t it?