Who is in charge?
What the responsibility of us, the beneficiary of the Health Care System?
Isn't it interesting that the most critical part of a persons life, the most personal and private part of a person's life, we now so easily turn over the control and destiny to others less informed or caring?
Presently the bureaucratic gate-keepers are the insurance companies. In the future the gate keeper could be the
Neither of which have your personal well being in the fore.
Here is a simplistic overview of the different insured groups and their general behaviors.
These are direct observations from workers in the health care industry.
Present Beneficiary Group Behaviors
No beneficiary, rich or poor pay any attention to the actual costs of health care, unless until they have to pay the bill.
As long as 'insurance' covers the cost we do not care or feel the pain (no pun intended).
I recently had cancer surgery, and the first thought was, what is going to be my 'out of pocket'? My second was how much will my premiums increase?
We are blind to what are the true health care costs and bear no responsibility to those costs.
We pay little to no attention to our individual health because we do not see or feel a direct financial cost relationship to bad lifestyle habits.
Chronic Uninsured
This community usually will not seek health care for a condition until the condition is very bad.
At this point they show up at the ER or call 911 for services.
Will avoid or totally ignore any cost responsibility of services.
Maybe from despair or education, this group takes little to no responsibility for their personal health and lifestyle habits.
Government Insured
Patients are not conscience to costs, and generally act in a non-compliant manner, they show up in a physician's office and say fix me.
Often these members refuse to pay for services not covered in their plan, even though they may be due.
Generally are somewhat more responsible for conditions prior to becoming chronic.
Doctors often opt out providing services for this group or limits quantity due to little or no profit.
Employer Insured
There is a high level of personal responsibility to health needs prior to them becoming chronic.
The participating member will generally have a primary health care provider.
There is a wide assortment of options associated with these plans.
Self Insured
There is a high level of personal responsibility to health needs prior to them becoming chronic.
Member will generally pay closer attention to cost as they generally come with high deductibles and co-pays.
Members will be slightly more aware of their overall health due to the relationship to needing services and associated costs.
Congressional Actions
As an example of government initiatives and bills, lets look at the recent bills to improve 'Quality of Service' in nursing and patient care.
Sure who wants an incompetent doctor, or a nurse station that does not meet the needs of the patients on the ward?
But why is it that every initiative or bill that is enacted has to create:
- 5 or 10 NGO's or Non profits with budgets combined of 100 million dollars or more?
- Increased hospital staff of 45 for an average hospital for oversight of 'quality' within the hospital?
- Hospitals spend tens of thousands of dollars to send staff to conferences and seminars all across the country.
Why can't quality be handled in coordination with institutes of learning for doctors and nurses as opposed to creating additional institutions government or otherwise.
Why can't the offending party lose their job or thrown in jail, if they cannot do it right?
These programs are however put into play by well meaning congressional servants.
They write these tenants so they must have the best solution!
They create some positive results.......so......to hell with the cost! Right?
Health Care Reform 2009
Now we have a new initiative at the doorstep, Health Care for everyone at a reduced cost? What does this really mean? What will be the result?
The present debate will take all health care groups and services, place them in a pot, and extract the lowest common denominator, in the name of cost reduction.
I do not care which side of this debate you fall, I would just ask of you the following:
- Are you willing to accept limitations in prescription medications do to the cost?
- Are you willing to be put out of the hospital in just one day instead of 3 regardless of your condition or the condition or lack of a home care provider?
- Are you willing to wait weeks or months for diagnostic testing and services because the available CT machines are reduced from 1 per 20 thousand potential patients to 1 per 50 thousand patients?
- Do you remember the HMO restrictions on care and service all under the guise of controlling cost? Will you put up with worse?
- Will you accept a restriction that prevents you from going out-of-system to receive additional care or services?
If any of these are a concern, have they been adequately addressed?
Sure you heard all these arguments before, but have you received any substantive explanation or commitment these will not happen?
I hope my reservations are wrong, but I think not.
Your congress is in action writing bills that affect all Americans health care, from EVERY walk in life.
Do you believe that your 'representative' in Congress is truly looking out for all your interests? Do they really represent you?
Here are just a few of conflicting and distracting interest groups with deep pockets affecting your Congress.
The only oversight these 'public servants' have are listed below. They live in the congressional halls and offices.
Insurance Lobby
Lawyer Lobby
Pharmaceutical Lobby
Union Lobby
GE and other Equipment Manufacturers
Campaign Contributions
Pay to Play Programs
Buying Votes Bribes
Fellow Members Vote and Issue Swapping
These pressures in Congress leave the American public in a subservient position to other interests.
The New Health Care Focus
There must be a Beneficiary Chair that represents US at the debate table.
The biggest challenge in this effort is containing costs.
I maintain that until the Beneficiary becomes engaged and becomes an interested party in the Health Care System costs will continue to grow.
Beneficiary Health Care Governance
Hypothetically, if we were to give each citizen 5 thousand dollars a year and told them it was for their health care. (Tax credit or otherwise)
One condition would be that we each must have a yearly check-up and screening.
You would not be able to seek legal rewards beyond reasonable compensation by arbitration.
Malpractice awards would have to meet higher means testing before a suit can be allowed and final judgment arbitrated.
Another condition would be that if you did not use it you must place it in a secure depository at the end of the year for future use.
Any monies above $100,000 in the health savings accounts can be used for retirement after 70 years of age, then pass on to your children.
1) How careful would you be with spending your health care dollars?
2) How careful would you be to adapt a healthy lifestyle, exercise, diet etc?
3) Would you carefully shop for your services, drugs doctor, hospital etc?
4) What would be the role/costs of an insurance company? RIP? Major cost reduction?
5) Would you become educated to any health condition you contract, and be engaged in the best course of care?
6) Would you consult with your health care providers and learn and understand all associated costs?
7) If you had a health issue would you go directly to the ER or would you consider urgent care?
On a cynical level: We have all heard "the golden rule" that he who has the gold makes the rules. Pharmaceutical companies, AMA, health care institutions and insurance companies (to name a few) have the gold, and they dispense it along with their decision on how the system should or will work. Hence, also Congress, as they receive their cut of the gold (campaign contributions, ie. bribes) and make the rules. The Beneficiary is the loser and only a 'necessary evil' to the present system.
Renewal of this health care system may be the greatest challenge ever, even beyond the financial one.
This is because it deals with life and death issues, personal pain, and confidential issues.
Presently we do not control our own destiny and we will be less independent with the Congressional handlers running this show.
I would like to thank my sister Kate for her insight on the issues. She has several decades or more on-hands experience in the health care industry.
