My Two Cents

Heathcare reform is really a push-button issue these days. Part of the problem is the Reform Now mentality of Americans driven by the instantaneous gratification system we're used to having in other facets of our lives. To be fair to Obama, if he wants to accomplish things, he needs to start early. His popularity rating sinks if he doesn't appear to be accomplishing something he promised, as does the popularity of whatever party controls Congress. The problem here is that the Congressional machinery is trying to work at lightspeed to push reform through, which usually leads to a great deal of misinformation and an effluvia of loopholes.

Let's be honest here. The healthcare system is broken. Really, it's an issue of how broken it is. There are regional issues as well. The ER is legally required to treat anyone that comes to them, regardless of if there is an emergency or not, and they can't turn away anyone without insurance. In the southern states that border Mexico, this is a big problem with illegal immigrants using a hospital's ER for things that could have been taken care of with a primary care physician or when pregnant mothers cross the border to have their baby and end up in the ER without insurance. Whatever your standpoint is on the political aspects of the matter, there is an economic issue as that the hospital is not reimbursed for services it is required to perform.

In addition, people that do not fall below a certain income or meet other qualifying factors for Medicare or Medicaid but still fall close to the poverty line are going to be seriously limited on their medical options if they don't have insurance through their workplace for whatever reason.

Perhaps the biggest onus for the need for reform lies on health insurance companies, who really make terrible PR decisions on a daily basis when they cut certain coverage or drop consumers due to preexisting conditions. These stories, of course, become anecdotal evidence to fuel speeches on the necessity of reform and how it affects average Americans. Accurate, non-misleading statistics are rarely quoted on the matter. I suspect it's blown out of proportion by self-proclaimed pundits, but what isn't in this matter?

One of the major arguments that I have seen in favor reform is that we shouldn't be rationing health care and that everyone should be able to see the best doctors. This, by definition, is impossible. Everyone can't see the best doctors. It's a fact of life that these doctors have limited time and therefore can only see who they choose, and use money as the limiting factor. Displeasing? It's the ugly truth of the matter. Beyond that, we have a limited capacity to produce medical services. Not everyone is bright enough to go into a medical profession and of those that are, many don't want the hassle. We have limited resources. Not everyone can get a flu shot because we can't produce enough of them. Some drugs are just difficult to make and are going to be expensive.

The idea is to prevent disease before it becomes an issue. That's why we require vaccinations in school children. That's why the flu shot is most helpful when given to the people that travel the most and interact the most with people and are thus not the elderly.

The problem with our current system is hardly the amount of money that is poured into it. The US is the leading developer of medical technologies and new drugs that are proven to be safe and effective. No, the real problem is seeing treatment of disease as the end all be all of medicine. Preventative medicine is the missing key component. The greatest burden on the medical system today is the prevalence of chronic conditions. Medical costs would be significantly less if we didn't need to give type two diabetics insulin if they didn't develop diabetes in the first place. If we actually vaccinated the right people at the right time, illness wouldn't spread so quickly. Perhaps if people exercised more and ate better, there wouldn't be such prevalence of high blood pressure and high cholesterol.

In the end, it's all a matter of cost prevention. If insurance companies rewarded people for meaningful illness prevention tactics with lower premiums and penalized those that have made poor choices, they could still provide quality care while creating monetary incentive to make healthy lifestyle choices. The general American populace tends to have a general complacency about their heath until they fall ill, which is the worst possible attitude. Decreasing medical errors that lead to the need for more treatment would also decrease costs, and we're working on that, though it's too much to hope that mistakes will be completely eliminated.

As far as ERs are concerned, I'm afraid I don't have a great answer. It seems kind of heartless and impossible to ask people for their insurance information at the door if they're in a true emergency situation. However, it's a safe assumption that people using the ER as a clinic could be turned away with no great damage to society. The trick is writing up specifics about this. There is still an increased cost on the hospital for serving those that have no insurance, and the only real solution to that is more tax dollars going to the hospitals in regions that are forced to do this. Still, it's better than hospitals going bankrupt and not being about to treat paying citizens.

Are these things taken into account in health care reform? Doubtful. The government is rushing into this without really considering all the options, only those that lead to immediate "relief," as it were. The public option that there's so much controversy surrounding smacks of socialism, and the reality of the public option is that insurance companies can't compete with it because the government is allowed to run a deficit while businesses are not if they want to survive. The cost it places on the government should be a net of zero, and yet the estimates place it at rather high values.

Do we need reform? Of course, but not necessarily quick reform as that the system won't collapse tomorrow. Do we need the type of reform that's being debated in Congress and pushed by Mr. Obama? That is a matter of personal opinion usually determined by your socioeconomic status and experience with the health care system. I fear the decisions being made now are being driven more by anger with what is currently in place than reason.