Healthcare
I've been trying to listen to people on both sides of this debate, and I thought it was time I posted some of my own thoughts and questions.
1.) Government Healthcare already exists. How's it doing?
We should start by looking at how well that's working out for the people who use it and what we need to do to revise that to make it work better before expanding the system. Despite crys from the past, I know a few people under VA care right now who are actually pretty happy with their care. I also know people on Medical and Medicare who can not say the same thing. The military and the prison system both are government health care. Who is comparing these systems and seeing where they differ, and what the effects on the patients and care givers are?
2.) Physical Infrastructure is lacking.
Our hospitals, at least locally (to LA) are horribly overcrowded. Paying for it is only part of the issue. If we were serious about saving peoples lives etc, we'd be looking at building out a stronger infrastructure in real physical terms. Get more Emergency Rooms, more doctors and nurses, and, to borrow a phrase, more boots on the ground. Hospitals, like Stadiums and other large undertakings are almost always government subsidized to some degree or another, and hence, fall under the realm of already (to some degree) government care, and currently lacking. Until we have the facilities to care for people, whether or not we can pay for caring for people is moot.
3.) Appropriate care
If I have a question for my doc, I need to schedule an appointment to go in. I can call ask-a-nurse for things like basic colds, but If I want an answer about how altering my meds will affect me, or what I should do to compensate for endocrine issues, I have to stop working to go in and waste everyone's time, presumably because this is easier to meter and monetize, but I think something as simple as an email or web based forum where I could have a running communication with my doc should be pretty simple to do. This is a basic reform that doesn't really tie into who's paying for anything at all, it's just good sense.
One example of this being done right was my sisters childbirth. She had a midwife she'd been working with for some time prior to the birth. They had a facility in a hospital and doctors were on hand if needed, but not needing one, they were able to work with someone who was more appropriate for them, and free up a doctors time, while still getting the time and care they wanted.
4.) What works?
Has anyone done a comprehensive study of what existing commercial providers charge and what they provide? Have we looked at customer satisfaction and doctor satisfaction, and what trade-offs each plan chooses to make? Initially, when I spoke with my little sister about this, I asked her where she had seen socialized medicine work, and work well, and we talked about some other countries, but in the end, had to concede that, much like firearms regulation, the makeup of our country means that much of what does and doesn't work for other countries may be moot. However, right now there are a number of companies providing health insurance, and a number of hospitals, urgent care clinics, and the like, all of which we should be reviewing and rating, and seeing what works for various parts of the country and what doesn't.
5.) Will it make a difference?
Where are the small scale pilot programs? Can we set up free healthcare for residents and look at what it does and what it doesn't do? NPR had a story a short while back on the number of people who "didn't have" healthcare who were eligible for it. They did a piece on a city which decided to offer free healthcare to anyone, and in a town of some tens of thousands of people, had only gotten about a thousand people to sign up. Shouldn't we be looking at these items on a small scale to see what happens, and what should be corrected, before launching anything on a national level?
6.) What about research and development?
Honestly, I don't see this as a problem. The US military is state run, and it hasn't seemed to hurt commercial development of warfare technology at all. Even were it demonetized, all of the cardinal sins are motivating factors, and universities and professors would continue to do research on the government dime.
7.) How will this affect personal freedom?
I've been told this is a trite question, but I've not heard a good explanation of why it is yet. Feel free to tell me why this comparison is bad. Governments require seatbelts, helmets on motorcycles and the like. As they take responsibility for more and more of our lives, we give up control and freedoms to gain security. Am I being stupid for calling riding in a car without a seatbelt "freedom"? How about riding a motorcycle without a helmet? How about the freedom to spend what I earn as I will, and the effect taxes have as a robber of freedom, making us as much slaves as the sharecroppers left after slavery was abolished in name only in the south?
Perhaps. But we have seen in the past an increase in government intervention into peoples personal and family lives, and we must ask, with every interaction with our government, what powers we hand off. I will not be so foolish to say that any plan we have will necessarily give away any specific rights, but as specific plans come together, we should look at what is implied in each of them, and see what they require us to give up.
8.) Should we?
This question needs to be weighed against a number of factors, including the questions above, but also many more. The first question is, "What do we aim to achieve?", followed quickly by "What will it cost if everything goes perfectly?", and by this, I don't mean just monetarily. Then we have "How realistic is this?" We can look at and learn from other governments. We can look at and learn from the private sector. We can look at and learn from existing government programs.
We have a leader right now who has made great claims about government transparency, but who has come to the table seeking to make changes so fast that not even the legislators know what they are going to do. We have no concrete plan but are on such a short timetable that we are trying to throw something together before doing any of the due diligence. I would love to see our leadership start by examining some of these systems which are already in place, and start debate on some of these foundational issues, and then, from there, with the public behind them, move to reform healthcare in a manner that is consistent with what we have learned from examining the world as it is, be that single payer health care, mandatory health care, informing people better of their options, just building more hospitals, or perhaps, hopefully, something we have not yet considered which becomes apparent when we begin by really examining things as they are.
-- James
1.) Government Healthcare already exists. How's it doing?
We should start by looking at how well that's working out for the people who use it and what we need to do to revise that to make it work better before expanding the system. Despite crys from the past, I know a few people under VA care right now who are actually pretty happy with their care. I also know people on Medical and Medicare who can not say the same thing. The military and the prison system both are government health care. Who is comparing these systems and seeing where they differ, and what the effects on the patients and care givers are?
2.) Physical Infrastructure is lacking.
Our hospitals, at least locally (to LA) are horribly overcrowded. Paying for it is only part of the issue. If we were serious about saving peoples lives etc, we'd be looking at building out a stronger infrastructure in real physical terms. Get more Emergency Rooms, more doctors and nurses, and, to borrow a phrase, more boots on the ground. Hospitals, like Stadiums and other large undertakings are almost always government subsidized to some degree or another, and hence, fall under the realm of already (to some degree) government care, and currently lacking. Until we have the facilities to care for people, whether or not we can pay for caring for people is moot.
3.) Appropriate care
If I have a question for my doc, I need to schedule an appointment to go in. I can call ask-a-nurse for things like basic colds, but If I want an answer about how altering my meds will affect me, or what I should do to compensate for endocrine issues, I have to stop working to go in and waste everyone's time, presumably because this is easier to meter and monetize, but I think something as simple as an email or web based forum where I could have a running communication with my doc should be pretty simple to do. This is a basic reform that doesn't really tie into who's paying for anything at all, it's just good sense.
One example of this being done right was my sisters childbirth. She had a midwife she'd been working with for some time prior to the birth. They had a facility in a hospital and doctors were on hand if needed, but not needing one, they were able to work with someone who was more appropriate for them, and free up a doctors time, while still getting the time and care they wanted.
4.) What works?
Has anyone done a comprehensive study of what existing commercial providers charge and what they provide? Have we looked at customer satisfaction and doctor satisfaction, and what trade-offs each plan chooses to make? Initially, when I spoke with my little sister about this, I asked her where she had seen socialized medicine work, and work well, and we talked about some other countries, but in the end, had to concede that, much like firearms regulation, the makeup of our country means that much of what does and doesn't work for other countries may be moot. However, right now there are a number of companies providing health insurance, and a number of hospitals, urgent care clinics, and the like, all of which we should be reviewing and rating, and seeing what works for various parts of the country and what doesn't.
5.) Will it make a difference?
Where are the small scale pilot programs? Can we set up free healthcare for residents and look at what it does and what it doesn't do? NPR had a story a short while back on the number of people who "didn't have" healthcare who were eligible for it. They did a piece on a city which decided to offer free healthcare to anyone, and in a town of some tens of thousands of people, had only gotten about a thousand people to sign up. Shouldn't we be looking at these items on a small scale to see what happens, and what should be corrected, before launching anything on a national level?
6.) What about research and development?
Honestly, I don't see this as a problem. The US military is state run, and it hasn't seemed to hurt commercial development of warfare technology at all. Even were it demonetized, all of the cardinal sins are motivating factors, and universities and professors would continue to do research on the government dime.
7.) How will this affect personal freedom?
I've been told this is a trite question, but I've not heard a good explanation of why it is yet. Feel free to tell me why this comparison is bad. Governments require seatbelts, helmets on motorcycles and the like. As they take responsibility for more and more of our lives, we give up control and freedoms to gain security. Am I being stupid for calling riding in a car without a seatbelt "freedom"? How about riding a motorcycle without a helmet? How about the freedom to spend what I earn as I will, and the effect taxes have as a robber of freedom, making us as much slaves as the sharecroppers left after slavery was abolished in name only in the south?
Perhaps. But we have seen in the past an increase in government intervention into peoples personal and family lives, and we must ask, with every interaction with our government, what powers we hand off. I will not be so foolish to say that any plan we have will necessarily give away any specific rights, but as specific plans come together, we should look at what is implied in each of them, and see what they require us to give up.
8.) Should we?
This question needs to be weighed against a number of factors, including the questions above, but also many more. The first question is, "What do we aim to achieve?", followed quickly by "What will it cost if everything goes perfectly?", and by this, I don't mean just monetarily. Then we have "How realistic is this?" We can look at and learn from other governments. We can look at and learn from the private sector. We can look at and learn from existing government programs.
We have a leader right now who has made great claims about government transparency, but who has come to the table seeking to make changes so fast that not even the legislators know what they are going to do. We have no concrete plan but are on such a short timetable that we are trying to throw something together before doing any of the due diligence. I would love to see our leadership start by examining some of these systems which are already in place, and start debate on some of these foundational issues, and then, from there, with the public behind them, move to reform healthcare in a manner that is consistent with what we have learned from examining the world as it is, be that single payer health care, mandatory health care, informing people better of their options, just building more hospitals, or perhaps, hopefully, something we have not yet considered which becomes apparent when we begin by really examining things as they are.
-- James