For John, BLUF: Obama Care experiencing heavy seas. Nothing to see here; just move along.
Over at Hot Air Blogger Ed MOrrissey says "Great news: White House knew all along ObamaCare implementation impossible". It is not just the recent employer mandate that has had to be delayed. There are other parts of the Patient Protection and Affordable Care Act that are being put aside.
Captain Ed has this comment to show the problem, but before and now:
Remember the impossibly-complicated flow charts produced by ObamaCare opponents to demonstrate the folly of the ACA? At the time, proponents of the bill insisted that those were just scare tactics designed to irrationally frighten voters from the benefits of change. Now, though, it’s the ACA’s supporters producing similar flow charts to demonstrate why they can’t meet their deadline:Read the last paragraph.
On the other hand, the goal of the exercise may be to make execution of the Patient Protection and Affordable Care Act so hard to implement that we will agree to going to some single payer system, sort of like the UK NHS. Regards — Cliff
12 comments:
The NHS is socialized medicine, like the VA. Single payer doesn't have to include socialized medicine.
Here are some comparisons. The article is old, but thing's haven't changed that much outside of the US. (His descriptions of medicare and the VA aren't really out of date either.)
http://prospect.org/article/health-nations
When the debate was in full swing, I figured we'd end up transitioning to a system like Germany's.
How can anyone with an ounce of integrity ever believe that government administered healthcare was going to be an improvement?
A young woman or man can volunteer to join the armed forces, knowingly go into harm’s way to serve their country, get terribly wounded in that pursuit, and have to spend months slaying the Washington bureaucracy simply to get their claim filed and approved.
Now if their sacrifice isn’t impetus enough for the government to find a way to reduce the red tape, if our heroes can’t get a higher level of service than available at any car wash in New Jersey, than what hope does Agnes in Duluth with her diabetes and gout have that her medical care will be delivered with anything resembling efficiency?
"... ounce of integrity ever believe that government administered healthcare was going to be an improvement?"
Because it's been demonstrated elsewhere.
Given the evidence that it can be done, now it's just up to us to stop doubting that we could do it too.
WHAT????? Britain's NHS has announced in only the past week that it is officially bankrupt. Medical care in the UK is among the worst in the world. You need to talk to the very people who have the greatest impact.....the providers...and most of them speak only of horrific doom. Universal free healthcare is a populist myth that only gets people killed by their government. It amounts to a form of genocide.
In the US..the military have always been second class citizens in our well cultivated and protected caste system..But then, those of who did more than merely serve an obligatory tour of duty did so out of a sense of honor and integrity alien to the liberal, collectivist element in our society today.
I devoted 33 years of my life to the defense of my country....and I would do it again in a heartbeat......but don't patronize me with liberal platitudes and other patronizing BS. You didn't do the time....so you have no real understanding of its meaning or importance. There are sheep....and there are sheep dogs.
Assume the NHS is bankrupt - that it costs more than it gets at present. That'd only mean that they'd have to pay some more in taxes to keep it afloat and their total costs would only go from 'a lot cheaper than ours' to slightly less than 'a lot cheaper than ours'.
"Universal free healthcare is a populist myth that only gets people killed by their government."
Free healthcare is a myth. Nobody has ever said otherwise. All healthcare has costs. The mystery for Americans is how is it that other places seem to get better outcomes with less in costs. Now we could declare defeat and admit that Americans simply can't do healthcare better, but I have a higher opinion of our abilities than that.
"....but don't patronize me with liberal platitudes and other patronizing BS."
I am a liberal, but what I've put forth here are not platitudes and I din't patronize you or anyone else. You seem to have a straw-man liberal in your head.
"You didn't do the time....so you have no real understanding of its meaning or importance. "
"It" being what exactly? I'm talking about health care systems. Was straw-man liberal talking about something else?
Currently 250,000 veterans with claims pending have waited over a year to have their claims adjudicated. Candidate Obama in 2008 decried the backlog then of 30,000, Under President Obama that number has soared to its current shameful level.
I’m not debating whether we can – I’m debating whether we will and based on that, the answer is resounding no!
For me it’s not a left or right, Democrat or Republican thing. It’s a government thing. Neither side can be trusted to do this correctly and it shouldn’t be entrusted to them until they have demonstrated that they can get their act together.
So when I see veterans applauding the speed and efficiency of the VA, then maybe I will feel okay about some government involvement in healthcare. Mr. Lynne, I noticed you avoided addressing the government’s current performance as it pertains to our veterans.
By the way, I just went on to the Canada Health web site and looked up wait times for an ultra-sound in Halifax Nova Scotia. The provincial average across health centers is this: 5 out of 10 patients had their ultrasound done within 28 days – 9 out of 10 patients had it done within 143 days. So, the best case scenario is within a month – if you’re the tenth patient, you’re looking at possibly a little over 4 months. If you’re the tenth guy awaiting a pancreatic scan, if you have a lesion you’ll be well on your way to the bone yard before you get the test. Bear in mind Halifax is an urban area where wait times are usually less than the national average.
As a comparison, I needed to have an ultra-sound done prior to a surgical procedure and during my surgical consult the nurse wheeled in an ultra-sound machine, the MD squirted the cold goop and he did it right there. It wasn’t a life-threatening situation – he just needed to know where to cut. My wait time was 10 minutes.
The liberal mantra has been, and always will be on the order of, "for the good of the many, sacrifices of the few are necessary." This applies particularly to medical care. The fact is, government administered health care is a system based on rationing in the name of financial efficiency.....spreading the money around a little. As older folks generally incur a greater number of illnesses or issues, their medical costs are larger than someone in their 20's. The same applies to veterans, folks we send into battle and bring back severely altered for their experience. So.....rationing is a means to an end....and that end often is a government proudly trumpeting across the landscape that it costs less to provide medical care with Big Brother than with those nasty, dirty insurance companies. Age based medical care has long been a fact of life in GB, if you are 65 and you have cancer, you go home to die. Even IF you are "eligible" for care, your "reservation" may well not come up for over a year. BUT....medical care there costs less. Burial costs however go up.
"Single payer doesn't have to include socialized medicine." Huh?? Do you think that the government who is the single payer are just going to dole out payments to whoever submits a bill. That only happens in a different galaxy. The government is going to insist on controlling what it pays for...and how much.....and THAT IS socialized medicine.....even though that fact will not penetrate the liberal fantasy that if they say it, it is so just because they say it. "We're not in Kansas anymore Toto" said three times.
Eric J is right on the money. The military and its clingon VA system is a window into what US socialized medicine will look like. I WORKED in the military medical system for 15 years of my military career......and I can tell you more stories than you have time to listen to. One particularly irksome one is the "tiered military pharmacy formulary." Not well advertised outside of military medical facilities, but some years ago, the DoD mandated that military pharmacies maintain three tiers of drugs...one for active duty, one for military dependents of active duty, and one for retired members and their dependents. The latter tier was replete with the lowest cost generic drugs available and higher cost name brand drugs were simply not authorized....under any circumstance. The same with Tier Two except that the cost factor wasn't as restrictive. Only active duty personnel were afforded the best medicine money can buy. And THAT is the face military medicine puts out to the world. But..behind the scenes...
As for the VA.....they are little more than a horribly overfunded and massively incompetent sham organization existing on the backs of the battered servicepeople they purportedly serve. They are an obscenity but nobody cares because it is only military folks. How many General/Flag officers get their care in a VA facility???? I can give you the answer easily.....NONE!!! In patient VA care is little more than medical warehousing under minimally acceptable conditions...the facilities are filthy and staffed by bureaucrats at the minimum wage and ability scale. There are lots of internships and residencies in VA medical facilities because new doctors can go there and make mistakes while learning without those mistakes becoming a public issue.
AND THAT is the face of ACA medical care.
I think you need to do some research. It seems clear that you're not entirely sure of what the terms mean and that you didn't read the link. Socialized medicine is when the doctors themselves are a government agency. That is, the government cut's their salary checks. In the US this is the VA. NHS in the UK is socialized medicine. Single payer is socialized insurance (although in theory it could be private). That's when all the doctors and hospitals run as private entities (or public) and deal with a large single insurance system (usually run by a government entity). In essence this is what medicare is - it's a single payer system.
So yeah - single payer doesn't have to include socialized medicine. That is, you can socialize the insurance system without having to socialized the care system. This is essentially what goes on in France.
I have done the research and I am perfectly aware that YOU are applying a very narrow definition of the term socialized as it applies to medicine. And that is the rub.....liberals like this term because it serves as a smokescreen for the truth. Conservatives however view the term in broader terms. If you are paying for the service...you are controlling the service provider. The only difference is who cuts the paychecks, and that is simply a sham. The government tells the provider what they can provide and how much they will get for providing it. There is almost imperceptible difference between that system and employing them...in terms of medical care delivery.
You will of course disagree, if only because liberals choose their own reality and insist that become the standard by which the rest of the society must abide. But try as you might, you cannot alter reality and the reality is that socialized medicine is a question of who pays the bills...not who pays the paycheck. The corollary to this is the military contractor relationship. The contractor pays its own people, but pays its people with money it gets from the Department of Defense. It is a thin if not non-existent argument that the DoD doesn't therefore control the contractor because payment is contingent on compliance.
Lots of interesting issues here, but could we focus for a second on the ratios. Before the PP and ACA we had X number of providers and Y number of insured (self insured or other insured), for a ratio of Y/X. Under PP and ACA we add, I would assume folks to the pool of insured (Y+), but not to the pool of providers. So, now the ratio is Y+/X, where the number is bigger, not smaller. Doesn't that have an impact on the medical service provided, or has there been a lot of slack in the system? What about stories of medical providers voluntarily removing themselves from the market place? Would that give us a new X- number to work with?
I have felt, all along, that the first step to better health care would be to add 80,000 new physicians, physicians assistants and nurse practitioners to the pool of providers. I would have done this through the Public Health Service, one of the Uniformed Services of the Federal Government. (Like the Coast Guard, Navy and NOAA.) This would (1) improve the patient to provider ratio and (2) allow the Public Health Service to direct providers to under-served areas, like Maine, Montana and some Inner Cities.
Would this not work?
Thanks
Regards — Cliff
PS: I think I originally was thinking 60,000, but I have inflated.
Adding providers is a nice objective, but I would ask this, "Why haven't the requested 80,000 providers already shown up on the work roles?" The answer is twofold. The most important factor is the necessary MINIMUM education required to provide threshold quality of care. It isn't JUST about paying for that education and training.....it is about qualifying to be admitted to that education and training....and I submit....we are already at the breakpoint on that factor. If we lower the bar any further, you might as well do medical training by mail or hire graduates of third world schools with only the barest of RUDIMENTARY standards of performance.
The next issue will be that of pay. You may be able to front load the system with primary care people but they will need to refer patients to.......who?? Specialists are rethinking their role and calling as with each passing month, their earnings are further diminished. I recently saw a hand surgeon. He is thinking of doing something else and quite soon. He has over $200k in student loans and other indebtedness resulting from nearly 10 years of sub-par resident earnings....and the government (Medicare, et al) continue to slash his payment for procedures until he can barely pay his ancillary staff and make a modest profit.
USPHS in its heyday was largely on the same level as "county hospitals," existing to service government workers and the indigent. Brighton Marine in Boston is a PHS relic still administered by the remnants of the USPHS via some government contracts. Their support equipment is old,decrepit and unreliable. Their xray machines still operate using wet film cassettes. There is no CT or MRI capability. Most of the primary care docs are Russian with a minimal capability to speak or understand English. The USPHS is, from my experience and that of others, a close cousin to the VA system.....a living breathing chamber of horrors.
The problem with this discussion is the choice of metrics. Choosing the right metrics enables one to make his case easily and more or less convincingly. Provider/patient ratio is one of those metrics. In reality, it could be an excellent ratio that delivers less than minimally acceptable levels of heath care. In the UK...they have and maintain an excellent ratio, but they have gone to lengths to define what duties those providers must perform. If you are hospitalized in GB, you will be on a WARD...not a room....and your meals must be paid for in advance..by someone. Nursing care is extraordinarily sparse because some bureaucrat at the NHS figured out that you could use less nurses and have an excellent nurse to patient ratio if you severely limit what those nurses are expected to provide.
But....back to the core issue....why would anyone want to spend thousands of dollars and well past 10 - 12 years of their productive life in school just to work for what is essentially a government directed wage?
Finally, wages and such aside, as an Emergency Medicine specialist told me a few weeks ago, he loves to work for Foundation Medical Partners (the parent corporation for Southern New Hampshire Medical Center). They pay him well enough but more important, he is free to practice medicine as he sees fit and determines necessary to his patient's need. On the other hand, if he is treating a Medicare patient, it is a crap shoot whether or not what he does is going to be covered, and to what extent. He says he'll quit when some faceless nurse or technician sitting in a windowless cubicle in DC decides well after the fact that the treatment decisions he makes in the ER were wrong.
And THAT is the real reason for hating ACA. There ARE bodies of second guessers who will be employed to decide what treatments are acceptable, for whom, when, and how much....NOT the treating physician.
I appreciate the desire to have an in depth policy discussion about this. I’m not a health care policy wonk so I will not go down that road. In my defense I will say that I likely have about as much comprehension of the ACA as do many of the congress critters who voted to pass it without having read it.
I know it is an unwieldy bureaucratic monstrosity with carve-outs and waivers for special interests.
I know the people who passed it think so much of it that they don’t want it for themselves.
I know you need a hand-truck to transport one copy of this bill.
I know the government can’t process claims efficiently for those most deserving. I’ve noticed on this point, Mr. Lynne remains silent as a tomb. Whereas anybody evaluating the potential success or failure of a given venture bases that determination on past performance, Mr. Lynne prefers to argue semantics about the term “socialized” rather than the track record of government administered healthcare.
Post a Comment