Thursday, January 28

Health Care Reform — Why Are People So Worked up?

Why are Americans so worked up about health care reform? Statements such as “don’t touch my Medicare” or “everyone should have access to state of the art health care irrespective of cost” are in my opinion ignorant and visceral reactions that indicate an undesirable understanding of our จัดฟัน health care bodies history, its current and future resources and the funding challenges that America faces going forward. While we all wonder how the health care system has reached what some refer to as a crisis stage. Let’s try to take some of the feeling out of the debate by quickly examining how health care in this country emerged and how that has formed our thinking and culture about health care. With that as a foundation let’s look at the pros and cons of the Federal government health care reform recommendations and let’s look at the concepts you try to by the Republicans?

Access to state of the art health care services is something we can all agree would be a positive thing for this country. Experiencing a serious illness is one of life’s major challenges and to face it without the means to pay for it is positively frightening. But even as will see, even as know information, we will find that achieving this goal will not be easy without our individual contribution.

These are the themes I will touch on in order to make some sense out of what is happening to American health care and the steps we can personally take to make things better.

A current history of American health care — what has driven the costs so high?
Important components of the Obama health care plan
The Republican view of health care — free market competition
General access to state of the art health care — a worthy goal but not easy to achieve
so what can we do?
First, let’s get a little historical perspective on American health care. This is not designed to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What had costs higher and higher?

To begin, let’s turn to the American municipal war. In that war, outdated tactics and the carnage ınduced by modern tools of the era combined to cause dreadful results. Not generally known is that most of the fatalities on both sides of these war just weren’t the result of actual combat but as to the happened following a battlefield twisted was ınduced. To begin with, evacuation of the hurt moved at a snail’s pace and this caused severe delays in treating the hurt. Secondly, many wounds were subjected to twisted care, related operations and/or amputations of the affected arms or legs and this often resulted in the starting point of massive infection. To survive a battle twisted just to die at the hands of health care bills providers who although well-intentioned, their interventions were often quite fatal. High death tolls can also be related to everyday ailments and diseases in a time when no antibiotics existed. In total similar to 600, 000 fatalities occurred from all causes, over 2% of the You. S. population at the time!

Let’s skip to the first half of the the twentieth century for some additional perspective and to bring us up to more sophisticated times. After the municipal war there were steady improvements in American medicine in the understanding and treatment of certain diseases, new precise techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a “wait and see” approach. Medicine could handle bone cracks and increasingly attempt risky operations (now largely performed in sterile and clean precise environments) but medicines just weren’t yet available to handle serious illnesses. The majority of fatalities always been the result of untreatable conditions such as tuberculosis, pneumonia, scarlet nausea and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.

This very basic review of American history helps us to understand that until quite recently (around the 1950’s) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; “nothing to treat you with means that visits to the doctor if were relegated to emergencies so ordinary scenario costs are curtailed. The easy simple truth is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that procedures that were provided were paid for out-of-pocket, meaning by way of a persons personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Apart from the very destitute who have been lucky to find their way into a charity hospital, health care costs were the duty of the individual.

What does medical care insurance are related with health care costs? Its affect health care costs has been, and remains to this day, absolutely enormous. When health insurance for folks and families emerged as an approach for firms to escape salary freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the accessibility to billions of dollars from health insurance costly, encouraged a forward thinking America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare health insurance and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding an end to most situations has consequently become very lucrative. This is also the primary reason for the vast range of treatments we have available today.

I really do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives which have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor’s offer and most of us demand and access the latest available health care technology in the form of pharmaceutical drugs, medical devices, diagnostic tools and surgeries. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the “perfect storm” for higher and higher health care costs. And by and large the storm is only modern.

At this point, let’s turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform recommendations in the news today. Is the current flight of You. S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% in our gross national product is being spent on health care? What are the other industrialized countries paying for health care and is it even close to these numbers? When we add nation-wide politics and an selection year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and selecting out how you think about it. Properly television we can more smartly determine whether certain health care recommendations might solve or aggravate some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions?

The Obama health care plan is complex for sure — I have never seen a health care plan this is not. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs ordinary manner that quality and our access to health care is not in a harmful way affected. Republicans seek to achieve these same basic and broad goals, but their approach is planned as being more market driven than government driven. Let’s look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking even as attempt to reform health care.

Through insurance transactions and an expansion of Medicaid, the Obama plan dramatically stretches the number of Americans which will be covered by health insurance.

To cover the cost of this expansion the plan requires everyone to have health insurance with a charges to be paid if we don’t abide by. It will supposedly send money to the states to cover those individuals added to state-based Medicaid programs.

To cover the added costs there were a number of new taxes introduced, one being a 2. 5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthy Americans.

The Obama plan also uses concepts such as evidence-based medicine, liable care organizations, comparative effectiveness research and reduced refund to health care providers (doctors and hospitals) to regulate costs.
The insurance require covered by points 1 and 2 above is a worthy goal and most industrialized countries outside the You. S. provide “free” (paid for by rather high individual and corporate taxes) health care to the majority of if not their citizens. It is important to note, however, that there are a number of constraints which is many Americans would be culturally unprepared. Here is the primary suspect area of the Obama plan, the insurance require. The You. S. Better Court recently decided to hear arguments for the constitutionality of the health insurance require as a result of a request by 26 states attorney’s general that congress maxed its authority under the commerce term of the You. S. metabolic rate by passing this element of the plan. The problem is that if the Better Court should rule contrary to the require, it is generally believed that the Obama plan even as know it is doomed. This is because its major goal of providing health insurance to everyone would be severely limited if not terminated altogether by such a decision.

As you would guess, the taxes covered by point 3 above are rather unpopular with those entities and individuals who have to pay them. Medical device companies, drug companies, private hospitals, doctors and insurance companies all had to “give up” something that would either create new revenue or would keep costs down in their spheres of control. As an example, Stryker Corporation, a large medical device company, recently announced at least a 1, 000 employee lowering of part to cover these new fees. This is being experienced by other medical device companies and drug companies as well. The lowering of good paying jobs in these sectors and in the hospital sector may rise as former cost structures must be dealt with in order to accommodate the reduced rate of refund to private hospitals. Over the next a decade some estimates put the cost discounts to private hospitals and medical professionals at half a trillion dollars and this will flow right to and affect the companies who supply private hospitals and doctors with the latest medical technologies. None of this is to say that efficiencies will not be realized by these changes or that other jobs will in turn be created but this will represent painful change for a while. It helps us to understand that health care reform does have an impact both positive and negative.

Finally, the Obama plan tries to change the way medical decisions are made. While clinical and basic research underpins almost everything done in medicine today, doctors are creatures of habit like average folks and their training and day-to-day experiences determine to a great extent how they go about the diagnosis of and treating our conditions. Enter the concept of evidence-based medicine and comparative effectiveness research. Both of these seek to develop and utilize data bases from electronic health records and other sources to give better and more timely information and feedback to medical professionals for the outcomes and costs of the treatments they are providing. There is great waste in health care today, estimated at perhaps one third of an over 2 trillion dollar health care spend annually. Imagine the savings that are possible from a reduction in unnecessary make sure procedures that do not compare confidently with health care interventions that are better documented as effective. Now the Republicans yet others don’t generally like these ideas as they tend to characterize them as “big government control” of your and my health care. But to be fair, regardless of their political persuasions, most people who understand health care at all, know that better data for the purposes described above will be crucial to getting health care efficiencies, patient safety and costs headed in the right direction.

A brief review of how Republicans and more conservative individuals think about health care reform. I believe they would agree that costs must come under control and that more, not fewer Americans should have access to health care regardless of their capacity to pay. But the main difference is that these folks see market forces and competition as the way to creating the cost discounts and efficiencies we start to use. There are a number of ideas with regard to driving more competition among health insurance companies and health care providers (doctors and hospitals) so your consumer would set out to drive cost down by the choices we make. This works in many sectors in our economy but this formula has shown that improvements are illusive when applied to health care. Primarily the problem is that health care choices are difficult even for those who understand it and are connected. The population, however, is not so informed and besides discomfort been brought up to “go to the doctor” when we feel it is necessary and we also have a cultural heritage that has engendered within most of us the that health care is something that is just there and there really isn’t reason not to access it for needs to be reason and worse we all feel that there is nothing we can do to affect its costs to insure its availability to people that have serious problems.

OK, this article was not designed to be an inclusive study as i needed to keep it short so that they can hold my audience’s attention and to leave some room for discussing what we can do contribute mightily to resolving some of the problems. First we must understand that the dollars available for health care are not limitless. Any changes that are executed to provide better insurance coverage and access to care cost more. And somehow we must find the revenues to pay for these changes. At the same time we must pay less for procedures and procedures and do something to restrict the accessibility to unproven or badly documented treatments even as are the highest cost health care system in the world , nor necessarily have the best results in terms of longevity or avoiding chronic diseases much prior to when necessary.

I believe that we require a revolutionary change in how we think about health care, its availability, its costs and who pays for it. And if you think I am about to say we should randomly and drastically reduce paying for health care you would be wrong. Here it is fellow citizens — health care spending needs to be preserved and protected for those who want it. And to free up these dollars those of us who don’t want it or can delay it or avoid it need to act. First, we need to encourage our political figures that this country needs sustained public education with regard to the value of preventive health strategies. This should be a the goal and possesses worked to reduce the number of You. S. smokers for example. If prevention were to take hold, it is reasonable to assume that those needing health care for the numerous life style engendered chronic diseases would decrease dramatically. Millions of Americans are experiencing these diseases far prior to when in decades past and much of this is due to poor life style choices. This change alone would free up plenty of money to handle the health care costs of those in dire need of treatment, whether due to an serious emergency or chronic condition.

Let’s go deeper on the first issue. Most of us not allow do something about implementing basic wellness strategies into our daily lives. We don’t exercise but we offer a lot of excuses. We don’t eat right but we offer a lot of excuses. We smoke and/or we are drinking alcoholic beverages to excess and we offer a lot of excuses as to why we can’t do anything about managing these known to be dangerous personal health habits. We don’t take advantage of preventive health check-ups that look at blood pressure, cholesterol tellings and body volume but we offer a lot of excuses. In short we neglect these things and the result is that we succumb much prior to when necessary to chronic diseases like cardiovascular disease, diabetes and high blood pressure. We wind up accessing doctors for these and more routine matters because “health care is there” and somehow we think we have no responsibility for reducing our demand on it.

It is difficult for us to be handled by these facts but easy to responsibility the sick. Maybe they should take better care of themselves! Well, that might be true or maybe they have a ancestral condition and they have become among the unfortunate through absolutely no fault of their own. But the point is that you and I can implement personalized preventive disease measures as an easy way of dramatically improving health care access for others while reducing its costs. It is far better to be productive by doing something we can control then shifting the responsibility.

A large huge number of free web sites available that can drive us to a more healthful life style. A soon as you can, “Google” “preventive health care strategies”, look up your local hospital’s web site and you will find more than enough help to get you started. Finally, there is a lot to think about here and I have tried to outline the challenges but also the very powerful effect we could have on protecting the best of America’s health care system now and into the future. I am anxious to know from you and until then — take charge and increase your chances for good health while making sure that health care is there when we want it.

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